Does a Vitamin a Day Keep Dry Eye Away?

A recent study of a vitamin containing omega-3 fatty acids seems to point in that direction.

All physicians would like to find a way to ease their patients' dry eye symptoms, including those prone to dry eye after cataract surgery. Wouldn't it be nice to find that a supplement taken once a day might fit the bill?

With that outcome in mind, a prospective, randomized trial of an omega-3 supplement for dry eye, was conducted. The double-masked, placebo-controlled study found that the average tear production and tear volume increased in the group taking the omega-3 supplement.

James McCulley, MD, conducted the study with the goal of proving or disproving that omega-3 fatty acids provided any benefit in helping dry eye patients. Jeffrey Gilbard, MD, one of Dr. McCulley's colleagues from training days, had a company with a product named TheraTears Nutrition (Akorn, Inc.), which contained omega-3 fatty acids. The company hoped to design a product that could be taken by mouth to help improve dry eye symptoms. Dr. McCulley agreed to run a study to test TheraTears against a control, which included everything in TheraTears except omega-3 fatty acids.

About the Trial

Patients were randomly assigned to receive a daily soft capsule, containing either the active drug or placebo for 90 days. Each dose of the active softgels included fish oil containing 450 mg of eicosapentaenoic acid (EPA), 300 mg of DHA and 1000 mg of flaxseed oil (TheraTears Nutrition). The placebo capsules contained wheat germ oil. Patients were seen at baseline and again after 90 days of treatment.¹

During their office visits, patients completed the ocular surface disease index to score subjective symptoms. A slit-lamp examination was performed and patients were also evaluated for tear breakup time and corneal staining. Other testing included Schirmer type I, fluorophotometry and rate of evaporation. A collection of meibomian gland secretion samples were also collected and evaluated.¹

At the end of the study, 70% of patients taking the omega-3 supplement became asymptomatic, while in the placebo group only 7% of the symptomatic patients became asymptomatic. Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretions. The lipid composition of the samples collected from the omega-3 group was found to be very similar to that of the placebo group.¹

“The product we used with its omega-3 makeup was a very positive study in that it showed that patients' symptoms improved and that tear volume and flow increased,” says Dr. McCulley. “We were surprised there was no change in the meibomian secretions. So, assuming there was no change in the biochemical makeup in the meibomian secretions, my best guess is that the mechanism of action was anti-inflammatory. The omega-3s had no negative side effects. Therefore, I think they can be used very effectively and appropriately in all patients with dry eyes and should be a part of the initial therapy, whether for mild dry eye or severe.”

REFERENCE

1. Wojtowicz JC, Butovich I, Uchiyama E, Aronowicz J, Agee S, McCulley JP. Pilot, prospective, randomized, double-masked, placebo-controlled clinical trial of an omega-3 supplement for dry eye. Cornea. 2011;30:308-314.