Effect of Omega-3 on Dry Eyes
Results of a new study show extended use of omga-3s decreases inflammation and improves tear osmolarity in patients with dry eye.
omega-3 and dry eyes
Supplementation with omega-3 fatty acids can improve significantly the signs and symptoms associated with dry eye, according to Eric D. Donnenfeld, MD.
In patients with dry eye, re-esterified omega-3s (EPA / DHA) supplementation significantly improves tear osmolarity, matrix metallopeptidase 9 (MMP-9), tear break-up time (TBUT), ocular surface disease index (OSDI), and increases the omega-3 index
Donnenfeld said as he presented his study findings during the 2014 ASCRS Annual Meeting.
Prescribing a daily regimen of re-esterified Omega-3s has become a regular part of Donnenfeld’s practice and in his daily life. He and his family all take omega-3 supplements regularly because according to Donnenfeld, this study adds to the growing evidence that confirms what many dry eye experts have suspected for a long while.
Omega 3 supplementation on Dry Eyes Study Details
Donnenfeld participated in a recent double-masked, randomized, placebo-controlled, multicenter study of re-estirified omega-3s (EPA /DHA). A total of 105 individuals completed this study (with 54 in the treatment group and 51 in the placebo group). The average age of the subjects was 57 years and 70% were women.
The primary endpoint of this study was to determine the efficacy of 2,668 mg of EPA and DHA re-esterified omega-3s on tear osmolarity. The secondary endpoint was to review the changes in ocular surface disease index (OSDI), TBUT, staining of the cornea, lipid layer thikness, Schirmer’s test, and MMP-9. In addition, Donnenfield and colleagues analyzed the omega-3 index score, a blood test that measures the omega-3 fatty acids EPA + DHA on the red blood cell membrane.
We wanted to learn if all these factors can be influenced by the intake of re-esterified omega-3s
said Donnenfeld, professor of ophthalmology at NYU and trustee of Dartmouth Medical School in Hanover, NH.
Omega 3 supplementation on Dry Eyes Study Results
Tear osmolarity
Mean tear osmolarity for the individuals taking the re-esterified omega-3s and those in the placebo group were about the same (326 mOsm/L) at the initial screening, and at baseline up to week 6. The difference was significant from week 6 to week 12. Compared with baseline, there was a drop in the omega-3 group from 309 mOsm/L to 307 mOsm/L, which represents a difference of 19 mOsm/L. Tear osmolarity stayed the same in patients taking placebo (p=.0004)
It is evident that omega-3s, in this form and concentration, have an influence on tear osmolarity
Donnenfeld said: “In my opinion, it is safe to extrapolate that this change will continue to occur with continuous use”
Matrix Metallopeptidase 9 (MMP-9)
The MMP-9, an inflammation marker test, showed a significant decrease from baseline to week 12 in the omega-3 group: 43 ng/ml to 20 ng/ml. In contrast, the placebo group results were minimal and changed only from 32 ng/ml to 30 ng/ml. Donnenfeld said that this signifies a very positive effect in decreasing inflammation with the use of omega-3s.
Ocular surface disease index (OSDI)
To evaluate the OSDI, patients were given a subjective panel of questions asking them about dry eye symptoms, including fluctuation of vision, feeling of dryness, or gritty feeling in their eyes. There was a significant difference from baseline to week 12 in the omega-3 group compared with the placebo group. The mean OSDI in the omega-3 group decreased from 32 at baseline to 16 after 12 weeks of omega-3 supplementation versus a change from 27 at baseline to 22 at week 12 in the placebo group (p=.002).
Tear Breakup Time (TBUT)
TBUT is very characteristic of meibomian gland dysfunction (MGD) and the investigators discovered when they looked at the baseline between omega-3s and placebo that they were virtually the same. In the time between week 6 to week 12, the TBUT improved in the omega-3 group, but not in the placebo group, and there was a statistically 3.5 second improvement in the omega-3 group, compared with the placebo group.
Omega Index
Among the individuals in the treatment group, the omega index, a blood test that measures the omega-3 fatty acids, EPA + DHA on the red blood cell membrane also showed a statistically significant increase from baseline to 12 weeks, according to the study findings. Donnenfeld highlighted a study from Frank A. Bucci Jr., MD, in 2011 that compared the re-estirified form omega-3s to an ethyl ester form.
“The amount of saturation and the amount of omega-3s, on the red cell membrane is similar to the systemic numbers. It increases significantly from baseline with continual use”, he said.
Conclusion
Omega-3s supplemented in the re-estirified form and in the concentration of 2,240 mg EPA/DHA improves tear osmolarity, MMP-9, TBUT, OSDI and increases the omega-3 index. Although the study results indicate a significant improvement in dry eye after 12 weeks in patients taking omega-3s in the properly regulated dose and form, Donnenfeld concluded that this treatment should be considered as ongoing and should not cease at 12 weeks,
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