OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/87458

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Page 91 of 168

October 2012 EW CORNEA 89 Certain types of dry eye patients seem to benefit more than others from omega-3 supplementation. "I recommend fish oil mostly for evaporative dry eye," said Esen K. Akpek, M.D., associate professor of ophthalmology, and director, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University, Baltimore. "I have the clinical impression that it might work." At Dr. Latkany's practice, which specializes in dry eye, he routinely recommends omega-3 use. Of those who take it, he estimates that 70% become asymptomatic. However, this occurs along with the use of other treatments, such as Restasis (cyclosporine ophthalmic emulsion, Allergan, Irvine, Calif.), punctal plugs, or environmental changes. "Very few patients notice a big dif- ference from omega-3 use alone. It would be in the single digit percent- age," he said. Dr. Latkany recommends omega-3 use the most to Sjogren's syndrome patients—who typically might have dry eyes, hair, mouth, and skin. He often finds his patients have already heard about omega-3 bene- fits, perhaps not specifically for dry eye but for general health. Because of the general health benefits, Dr. Sheppard recommends omega-3 fatty acids for virtually all patients. "The American diet is noto- riously deficient in the high-value foods. Rather than becoming a dietitian, I just recommend it to everyone. It can't hurt, with the ex- ceptions of seafood allergy and coag- ulation deficiency conditions," he said. Additionally, patients can use omega-3 both to help treat dry eye and help prevent other eye condi- tions such as age-related macular degeneration—a condition where there is even more solid research regarding omega-3 use and preven- tion of disease, he said. Dr. Sheppard typically recom- mends 1,000 mg of omega-3 twice daily in addition to GLA supple- ments, although he will encourage patients to take more if they are will- ing and able. That dosage amount provides both eicosapentaenoic acid and docosahexaenoic acid— better known as EPA and DHA, Dr. Sheppard said. However, Dr. Sheppard also noted that patients with evaporative dry eye seem to yield the most consistent benefits. The study he presented at ARVO intentionally fo- cused on postmenopausal females as they represent a fairly homogeneous subpopulation that could benefit significantly from supplementation, he said. What product works best? Practitioners seem to have personal preferences regarding specific omega-3 products. "No single study shows yet that one product works better than the other," Dr. Latkany said. "Any well-known company that purifies its product, you'll be fairly safe with it." However, Dr. Sheppard steers patients toward pharmaceutical- grade, mercury-free supplementa- tion. "With a cheaper version, there's more risk for contaminants. We're recommending this at a high dose, so it's essential to be safe," he said. Dr. Bucci prefers a higher qual- ity omega-3 product that absorbs more quickly in the body, comes from fish sources versus flaxseed, and does not contain alcohol. There has been recent talk in the popular press about krill oil as an omega-3 source that can be better absorbed by the body, Dr. Latkany said. He has seen some of his patients successfully use krill oil. In the rare instances where a pa- tient does not like fish oil, is allergic to it, or has another physician con- cerned about its use because the patient takes anticoagulant therapy, Dr. Sheppard recommends the use of flaxseed oil, which the patient can obtain as a gel cap or even sprinkle in powder form on food. EW Editors' note: Dr. Akpek has no finan- cial interests related to this article. Dr. Bucci has financial interests with PRN. Dr. Latkany has financial interests with Alcon. Dr. Sheppard has financial inter- ests with Alcon (Fort Worth, Texas), Allergan, Bausch + Lomb (Rochester, N.Y.), Lux Biosciences (Jersey City, N.J.), Merck (Whitehouse Station, N.J.), ScienceBased Health, and Vistakon (Jacksonville, Fla.). Dr. Asbell has no financial interests related to this article. Contact information Akpek: 410-955-5214, esakpek@jhmi.edu Asbell: 212-241-7977, penny.asbell@mssm.edu Bucci: 570-825-5949, buccivision@aol.com Latkany: 212-689-2020, relief@dryeyedoctor.com Sheppard: 757-622-2200, jsheppard@vec2020.com

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