Eyeworld

63 EW CORNEA July 2018 with Santen Pharmaceutical (Osaka, Japan), Shire, Novartis (Basel, Switzer- land), MC2 Therapeutics (Copenhagen, Denmark), Valeant Pharmaceuticals (Laval, Canada), Allergan, Oculus (Wetzlar, Germany), CLAO (St. Paul, Minnesota), and Vindico (Thorofare, New Jersey). Contact information Asbell: penny.asbell@mssm.edu Galor: agalor@med.miami.edu Matossian: cmatossian@matossianeye.com Sheppard: docshep@hotmail.com "Both groups got better but were not significantly different," Dr. Asbell continued. "It's hard to recommend anything from this trial because they both got better with no significant difference in many measures of signs and symptoms." Clinical impacts Despite the significance of the re- sults, it is not clear how much they will affect ophthalmologists' clinical practice. Dr. Matossian said the "less-than-ideally controlled arms of the DREAM study" meant it would not impact her clinical approach, which includes a "starter triad" of preservative-free artificial tears, re-esterified oral omega-3s, 5 and a microwaveable heated mask. After that, Dr. Matossian moves to prescription medication eye drops and an in-office vectored thermal pulsation procedure. Similarly, Dr. Sheppard did not see the DREAM study impacting his dry eye approach, which includes the use of a black currant seed oil supplement, a source of gamma-lin- olenic acid (GLA). His research on GLA with other polyunsaturated fat- ty acid (PUFA) supplements found significantly improved dry eye signs and symptoms among post-meno- pausal female patients. 2 "Many of us in the field have a concern that the placebo effect will cause some practitioners to refrain from using all forms of PUFAs, including the GLA, that do benefit patients with dry eye," Dr. Sheppard said. Even Dr. Galor doubted much clinical impact from the research because she views omega-3s as part of a holistic approach to dry eye. "I talk to patients about dietary factors and the importance of a healthy diet, not just with omega-3s but with vegetables, fish, and foods with high antioxidant qualities," Dr. Galor said. "I mention that supple- ments have been shown to improve dry eye symptoms and signs in smaller studies, and I don't think we should discard the results of those studies." EW References 1. Asbell PA, et al. n-3 fatty acid supplemen- tation for the treatment of dry eye disease. N Engl J Med. 2018;378:1681–1690. 2. Sheppard JD Jr, et al. Long-term supple- mentation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: A randomized double-blind clinical trial. Cornea. 2013;32:1297–304. 3. Kimura Y, et al. Restoration of tear secretion in a murine dry eye model by oral administra- tion of palmitoleic acid. Nutrients. 2017;9. 4. Basu A, et al. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26:995–1001. 5. Epitropoulos AT, et al. Effect of oral re-es- terified omega-3 nutritional supplementation on dry eyes. Cornea. 2016;35:1185–91. Editors' note: Dr. Matossian has finan- cial interests with Allergan (Dublin, Ireland), Bruder Healthcare Compa- ny (Alpharetta, Georgia), Johnson & Johnson Vision (Santa Ana, Califor- nia), Physician Recommended Nutri- ceuticals (Blue Bell, Pennsylvania), Shire (Lexington, Massachusetts), Sun Pharmaceuticals (Mumbai, India), and TearLab (San Diego). Dr. Galor has financial interests with Shire and Aller- gan. Dr. Sheppard has financial inter- ests with TearLab, Quidel (San Diego), Allergan, Bausch + Lomb (Bridgewater, New Jersey), Topcon (Oakland, New Jersey), and Novartis (Basel, Switzer- land). Dr. Asbell has financial interests LipiView (Johnson & Johnson Vision) image of 31-year-old male with emergency presentation for pain and blurring of vision in both eyes. The tear osmolarity was OD 339 and OS 347, the InflammaDry test (Quidel) was positive OU, and he was diagnosed with MGD with OSD and DED. LipiView image of MGD and DED patient, who was started on preservative-free artificial tears, re-esterified oral omega-3 liquid 1 teaspoon per day with food, a Bruder microwaveable heated mask, lifitegrast OU BID, and a short course of loteprednol etabonate OU BID with no refills. He was scheduled to return for a LipiFlow treatment. Source (all): Cynthia Matossian, MD

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