Laser surgery has become increasingly popular as an alternative method of treating pressure.
New revolutionary device for the treatment of dry eyes due to Blepharitis/Meibomian gland dysfunction (MGD), the E-Eye IPL machine.
Omega Eye for DED and MGD
By Sheraz Daya MD, FACP, FACS, FRCS(Ed), FRCOphth
Dry Eye Disease & Anti-Inflammatory Omega-3, A Corneal Specialist Perspective
As my colleague, Arthur Cummings wrote in last months edition; taking care of dry eye prior to surgical interventions to ensure better outcomes for our patients is a critical element of our practice now. My focus in this article is on the treatment options that we use in our practice in improve the ocular surface prior to surgery or for our regular evaporative dry eye patients. Also, I would like to mention how we communicate with our patients to ensure they understand the importance of using there therapies and remaining compliant with them.
It is well established that Dry Eye Disease (DED) is multifactorial in etiology, but a growing body of evidence points towards inflammation as a leading cause. 1
The recently published DEWS II report highlights that long chain poly-unsaturated fatty acids, in particular Omega-3, are recognised to have a broad range of systemic anti-inflammatory effects. 2
I use Omega-3 supplements for the majority of my evaporative dry eye and surgical patients and have been doing so for the last few years. I use a brand of Omega-3, called Omega Eye. When I started using this product 4 years ago I was very sceptical and thought that the upcoming approval of Cyclosporine in the UK at that time would the answer I needed. However, some of our findings with patients were surprising; we saw Schirmer’s improvements after 3 months as well as an improvement of both Demodex Blepharitis and Seborrheic Blepharitis. Interestingly we are noticing that Telangiectasia is less pronounced and the turbid secretions we tend to see become thinner and clearer. My own feeling is that poor meibum quality may cause inflammation so having a supplement that can change the quality of the meibum is helpful, which Omega Eye has been proven to do. I must have hundreds of patients on this therapy now and we are consistently getting good results with the product. After 6 to 12 weeks, not only does the quality of meibum improve, the lids become less inflamed and patients report a symptomatic improvement. I am confident and convinced that this therapy is working, along with the other products patients use – PF artificial tears and moist heat masks, as I track their progress with our TearLab Osmolarity testing which provides a quantifiable value in terms of their improvement.
Communication to Patients
Communication is a critical step for us, to ensure that the patient gets the right product and uses it effectively. At our clinic, we make sure that the staff educate the patients on the products and that when I, or another specialist, have recommended a certain product for them that we have stock available of it in the practice. I have noticed that the conversion rate and the compliance rate for patients who take products away from the clinic is much higher than for patients that go to the pharmacy or online. Again, advanced diagnostics can make a big difference here as we can objectively and quantifiably show the patients that the treatment works with advanced diagnostics like TearLab. In our experience, the patients really like to have a number that they can track to see their condition improving. With Omega Eye I have the knowledge that it is proven to reduce osmolarity and other disease markers in 8-12 weeks. This allows me to recommend a product confidently that is backed in science.
Possible Reasons Why Omega Eye works so well
Experts in inflammatory conditions, such as cardiovascular disease, highlight the necessity of higher essential fatty acid intake, particularly Omega-3 from oily fish. 3
The Women’s Health Study, a large retrospective observational trial involving over 32,000 women, described an association between a low dietary intake of Omega-3 EFAs and DED. This study reported a 30% reduction in the risk of DED with each additional gram of Omega-3 EFAs consumed per day. 4
The ideal dietary intake ratio of Omega-6 to Omega-3 is 1:1, but a typical Western diet can shift this ratio to 25 to 1.5 Furthermore, it has been recently shown that this ratio in tear lipids is elevated in people with DED and that this occurs in proportion to the degree of tear film dysfunction and corneal staining. 6
Omega-3 Evidence in Dry Eye
Several studies have previously shown the effectiveness of Omega-3 fatty acid supplementation on DED with different sources and doses, and placebo contents; eleven of those trials are elegantly complied in the recently published DEWS II study. Overall, Omega-3 supplements were found efficacious in reducing inflammatory markers and improving symptoms as well as clinical markers of DED. In a study of patients with Meibomian Gland Dysfunction (MGD), Omega-3 improved OSDI, TBUT, lid margin inflammation, MG expression and Schirmer score. 7
More recently, a double-masked, randomised placebo-controlled trial, showed that the oral consumption of re-esterified omega-3 fatty acids is an effective treatment for DED. Results showed a statistically significant improvement in Tear Osmolarity, TBUT, OSDI and MMP-9 positivity, over a 12-week period. Improvement of Dry Eye signs were seen as early as 6 weeks, indicating a “rapid response”. The improvement in signs and symptoms for dry eyes support the recommendation that dietary supplementation of re-esterified Omega-3 fatty acids should be included as a primary therapy for patients with MGD. 8
What impact the form of Omega-3 has
Omega-3s from fish oil are available commercially in one of two forms: triglycerides or ethyl esters. The majority of these Omega-3 fatty acids are sold in the ethyl ester form which contains alcohol. Studies have shown that ethyl esters are the least bioavailable forms of Omega-3’s, compared to the triglyceride forms. Re-esterification is a process that removes the alcohol from chemically modified ethyl ester fish oil to create a more natural (triglyceride) form of Omega-3 fatty acids which is not only better tolerated with less gastrointestinal side effects but also better absorbed.
In a large double-masked RCT, both forms were tested for bioavailability using the Omega-3 Index as measurement and showed statistically significant increases however, the re-esterified form increased it to a greater extent, which from a clinical point of view, may lead to faster results. 9
Omega Eye has been specifically developed to relieve the symptoms of Dry Eye and Blepharitis from within and is both recommended and used by leading Eye Care Professionals in the UK in conjunction with other therapies, such as eye drops, lid wipes and heat masks. Every batch of Omega Eye is third party tested to ensure it adheres to the same standards of quality and purity as prescription products.
A daily dose of Omega Eye has exceptionally high levels of Omega-3 (1680mg EPA and 560mg DHA) from pelagic fish (anchovy, sardine, mackerel) in a highly bioavailable re-esterified triglyceride form. It is ideal to help reach the desired >8% omega ratio in cell membranes and clinically proven to reduce the majority of Dry Eye Disease within 3 months. 8
1) Yagci A, Gurdal C. (2014) The role and treatment of inflammation in dry eye disease. Int Ophthalmol. 2014 Dec;34(6):1291-301.
2) Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS< Craig JP, (2017) TFOS DEWS II Management and Therapy Report, Ocul Surf. 2017 Jul;15(3):575-628.
3) Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R et al. (2007). European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 14 (Suppl 2), S1-S113.
4) Miljanovic B, Trivedi KA, Dana MR, et al. (2005) Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr. 2005; 82:887-893.
5) Russo GL. (2008) Dietary n-6 and n-3 polyunsatured fatty acids: from biochemistry to clinical implications in cardiovascular prevention. Biochem Pharmacol. 2009 Mar 15;77(6):937-46.
6) Walter SD, Gronert K, McClellan AL, Levitt RC, Sarantopoulos KD, Galor A. (2016) U-3 Tear Film Lipids Correlate with Clinical Measures of Dry Eye. Invest Ophthalmol Vis Sci 2016; 57(6):2472e8
7) Olenik A, Jim_enez-Alfaro I, Alejandre-Alba N, Mahillo-Fern_andez I. (2011) A randomised, double-masked study to evaluate the effect of meage-3 fatty acids supplementation in Meibomian gland dysfuction. Clin Interv Aging 2013;8: 1133e8.
8) Epitrpoulos, A.T., Donnenfeld, E.D., Shah, Z.A., Holland, E.J., Gross, M., Faulknet, W.J., … Perry, H.D. (2016). Effect of Oral Re-Esterified Omage-3 Nutritional Supplementation on Dry Eyes. Cornea, 35(9), 1185-1191.
9) Neubronner, J., Schuchardt, J.P., Kressel, G., Merkel, M., von Schacky, C. and Hahn, A. (2011) Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacyl glycerides versus ethyl esters. European Journal of Clinical Nutrition (2011) 65, 247-254.
Like looking through a misty pane, Everything seems drab and grey, Then Mr. Golchin's skillful hands, Opened the door to a clearer land. Dust and cobwebs, now I see, Passing spiders wink at me! Wrinkles on my face and neck - Heavens above - I look a wreck! But I can see bright colours, Little birds upon the trees And hills and distant valleys, That for long evaded me. How wonderful the advances made in medical R and D, And Mr. Golchin's gifted hand, That restored good spirit to me.