Is This the New Norm?

Is Ocular Nutrition the New Norm for Dry Eyes?

BY MILE BRUJIC, OD, & DAVID L. KADING, OD, FAAO

Traditional treatment and management strategies for dry eye patients typically involve environmental modifications. If meibomian gland dysfunction seems to be causing the dry eye symptoms, we consider eyelid hygiene, warm compresses, and even in-office expression, and then some type of artificial tear. If there aren’t any significant improvements, we may introduce immunomodulatory therapy, such as topical cyclosporine 0.05%, or anti-inflammatory therapy, such as a topical corticosteroid.

New Thoughts

In recent years, a significant amount of research has become available on the effects of nutrition and the ocular surface.

Specifically, essential fatty acids (EFAs) have been increasingly studied because of their anti-inflammatory activity (Roncone et al, 2010; Rosenberg and Asbell, 2010). When consumed on a regular basis, they may decrease the frequency of dry eye disease (Miljanović et al, 2005). Consumption of EFAs in placebo-controlled studies has been shown to decrease expression of inflammatory markers in the tears and conjunctiva (Pinazo-Durán et al, 2013; Brignole-Baudouin et al, 2011).

Additionally, EFAs may decrease both clinical signs and symptoms associated with dry eye (Kangari et al, 2013; Kawakita et al, 2013).

Although we traditionally consider omega-6 EFAs to be pro-inflammatory, a certain subtype, specifically linoleic acid (LA), has remarkable anti-inflammatory activity (Erdinest et al, 2012). Most commercially available forms of ocular nutrition utilized and marketed for dry eye usually contain a combination of both omega-3 and lower quantities of omega-6 EFAs, which in combination can decrease signs and symptoms of dry eye disease (Larmo et al, 2010). EFAs have also been shown to improve signs and symptoms of dry eye in patients who have meibomian gland dysfunction (Oleñik et al, 2013).

This information may be useful in helping patients who have contact lens discomfort as well. Patients utilizing EFAs were shown to have better tolerance of lens wear (Oleñik et al, 2014).

Check the Formulations

Be aware that not all nutrients containing omega-3s are considered equal. There are significant differences in the amount of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to the total amount of fish oils in the formula being used, with the high-quality formulations having a higher ratio of EPA and DHA to total fish oils.

Because of the variability in formulations, we suggest utilizing one to determine clinical outcomes on your patients and to remove the variability of various formulations.

The Verdict

With the increasing body of scientific information that is currently available on the topic, and the quality of the ocular nutrition products available, we should rethink dry eye management and take a more holistic approach to preserving ocular surface wellness. This is why we feel that ocular nutrition is the new norm for managing dry eye. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #221.

Dr. Brujic is a partner of Premier Vision Group, a four-location optometric practice in northwest Ohio. He has received honoraria in the past two years for speaking, writing, participating in an advisory capacity, or research from Alcon Laboratories, Allergan, B+L, Optovue, Nicox, Paragon, SpecialEyes, TelScreen, Transitions, Valeant Pharmaceuticals, Valley Contax, VMax Vision, VSP, and ZeaVision. Dr. Kading owns the Specialty Dry Eye and Contact Lens Center in Seattle, Wash. He is the co-owner of Optometric Insights with Dr. Brujic. He has received honoraria for consulting, performing research, speaking, and/or writing from: Alcon Laboratories, Allergan, Bausch & Lomb, Biotissue, Contamac, Essilor, Nicox, Oculus, RPS Detectors, TearScience, Valley Contax, and ZeaVision. Follow him on Twitter @davekading