Both signs and symptoms of dry eye disease significantly improved after patients took oral re-esterified omega-3 supplements for 12 weeks, according to a study.
Compared with patients who took a placebo, patients who took the oral re-esterified omega-3 fatty acids had significantly improved tear osmolarity, tear breakup time, omega-3 index levels, matrix metalloproteinase-9 and Ocular Surface Disease Index scores, study co-author Eric D. Donnenfeld, MD, told Ocular Surgery News.
“Dry eye is the most common problem that brings patients to an eye doctor’s office. It is the most important rate-limiting step of patient satisfaction following surgery, whether it is cataract or LASIK,” Donnenfeld said. “We have adopted the use of re-esterified omega-3s, and we use this in all patients who are having surgery in order to improve the ocular surface, reduce postoperative dry eye and provide better quality of vision. It is an important step for all patients who are having surgery to make sure the ocular surface has been improved as much as possible.”
In the multicenter, prospective, double-masked, controlled trial, 105 participants were randomized to receive either 3,125 mg of linoleic acid or four soft gels containing 1,680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid daily for 12 weeks.
The omega-3 supplements were re-esterified, making them different from common nutritional supplements that have been converted from their natural triglyceride form into “something not found in nature,” Donnenfeld said.
“All fish is at risk to have mercury and contaminants in them. Basically every company converts them into a safer form by adding alcohol. The process of adding alcohol makes the omega-3 safe. In doing so, it converts the omega-3 from a natural triglyceride found in nature to a new form, an ethyl ester, not found in nature. By adding alcohol, it changes the composition of the omega-3. It is still an omega-3, but now the body cannot process it,” he said.
Re-esterification, however, “removes the artificially induced alcohol in chemically modified ethyl ester fish oil to create a more natural form of omega-3 fatty acids that is not only better tolerated with less gastrointestinal side effects but also better absorbed than omega-3 fatty acids in the ethyl ester form,” Alice T. Epitropoulos, MD, and colleagues wrote in the study.
For the study’s primary outcome, the omega-3 group showed a significant mean reduction in tear film osmolarity from baseline to 12 weeks of 19.4 mOsm/L vs. a mean reduction in the control group of 8.3 mOsm/L (P = .004). Both the omega-3 group and the control group had similar baseline measurements for tear film osmolarity.
At the final 12-week follow-up, the omega-3 group’s mean OSDI symptom scores decreased from 32.4 to 15.5 compared with the control group’s mean OSDI scores of 27.1 to 22 (P = .002).
The researchers also found that the number of MMP-9 positive patients decreased from 28 to nine in the omega-3 group at final follow-up compared with a decrease of 20 subjects to 13 subjects in the control group.
Tear breakup time showed a significant improvement in the omega-3 group, and the difference was statistically significant compared with the control group at the 12-week follow-up.
“For me, omega-3 therapy has become the lynchpin of treatment for dry eye disease. It is a holistic approach to a chronic problem,” Donnenfeld said. – by Robert Linnehan
- Epitropoulos AT, et al. Cornea. 2016;doi:10.1097/ICO.0000000000000940.
- For more information:
- Eric D. Donnenfeld, MD, can be reached at Ophthalmic Consultants of Long Island, 711 Stewart Ave., Suite 160, Garden City, NY 11530; email: firstname.lastname@example.org.
Disclosure: Donnenfeld reports he is a consultant for PRN Omega Health, Allergan, Alcon and Shire.