Pilot, Prospective, Randomized, Double-masked, Placebo-controlled Clinical Trial of an Omega-3 Supplement for Dry Eye

Department of Ophthalmology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9057, USA.
Cornea (Impact Factor: 2.04). 10/2010; 30(3):308-14. DOI: 10.1097/ICO.0b013e3181f22e03
Source: PubMed


To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum, aqueous tear evaporation, and tear volume in patients with dry eye.
In a pilot, prospective, randomized, double-masked study, patients with dry eye received a daily dose of fish oil, containing 450 mg of eicosapentaenoic acid, 300 mg of docosahexaenoic acid, and 1000 mg of flaxseed oil (TheraTears Nutrition; Advanced Vision Research, Woburn, MA) for 90 days. There were 2 patient visits: baseline and final. At these visits, patients completed the ocular surface disease index to score subjective symptoms, and slit-lamp examinations, breakup time, corneal staining, Schirmer type I, fluorophotometry, evaporometry, and collection of meibomian gland secretion samples for lipid composition analysis were performed.
A total of 36 patients with dry eye completed the study. At the end of the study, 70% of the patients became asymptomatic, whereas for the placebo group, 37% [corrected] of the symptomatic patients became asymptomatic. Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion. The lipid composition of the samples collected from the omega-3 group was found to be very similar to that from the placebo group. No trends between groups were seen for other objective parameters.
Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate. On the other hand, the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry.

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    • "The ratios of omega-3s reported in salmon fillets (1.5/1 EPA/ DHA) are relatively consistent and are often reflected in the ratio of EPA/DHA in many commercially-available omega-3 dietary supplements . A ratio of 1.5/1 EPA/DHA is often used in clinical trials investigating the effects of omega-3 dietary supplementation (Viral Brahmbhatta et al., 2013; Jackson et al., 2012; Wojtowicz et al., 2011), and this ratio was also used in our experiments. EPA, DHA, and SFN were dissolved in DMSO, and frozen stocks were held at À20 °C. "
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    ABSTRACT: High levels of the flame retardant 2,2',4,4'-tetrabromodiphenyl ether (BDE 47) have been detected in Pacific salmon sampled near urban areas, raising concern over the safety of salmon consumption. However, salmon fillets also contain the antioxidants eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), whose oxidation products induce cellular antioxidant responses. Because oxidative stress is a mechanism of BDE 47 toxicity, we hypothesized that oxidized EPA and DHA can ameliorate the cellular and mitochondrial toxicity of BDE 47. HepG2 cells were treated with a mixture of oxidized EPA and DHA (oxEPA/oxDHA) at a ratio relevant to salmon consumption (1.5/1 oxEPA/oxDHA) followed by exposure to 100μM BDE 47. Pretreatment with oxEPA/oxDHA for 12h prior to BDE 47 exposure prevented BDE 47-mediated depletion of glutathione, and increased expression of antioxidant response genes. oxEPA/oxDHA also reduced the level of reactive oxygen species production by BDE 47. The oxEPA/oxDHA antioxidant responses were associated with partial protection against BDE 47-induced loss of viability and also mitochondrial membrane potential. Mitochondrial electron transport system functional analysis revealed extensive inhibition of State 3 respiration and maximum respiratory capacity by BDE 47 were partially reversed by oxEPA/oxDHA. Our findings indicate that the antioxidant effects of oxEPA/oxDHA protect against short exposures to BDE 47, including a protective role of these compounds on maintaining cellular and mitochondrial function. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Feb 2015 · Toxicology in Vitro
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    • "The studies were excluded in the full-text assessment and in which 3 articles combined omega-3 fatty acid with other interventions and 5 articles without available data. Finally, a total of 8 relevant randomized controlled studies were included in this study [14–21]. "
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    ABSTRACT: Background Dry eye is a common, complex condition that can reduce ocular comfort and visual performance. The impact on quality of life has been rated as similar to the effect of moderate angina and, in more severe cases, dialysis and severe angina. This study aimed to use meta-analysis to compare omega-3 fatty acid and placebo fatty acid in the management of dry eye syndrome. Material/Methods Comparative studies published until 1 June 2014 were searched through a comprehensive search of the Medline, Embase, Web of Science, and the Cochrane Library electronic databases. A systematic review and cumulative analysis of comparative studies reporting the effect of omega-3 fatty acid on dry eye syndrome was conducted. All analyses were performed using the Review Manager (RevMan) v.5 software (Nordic Cochrane Centre, Copenhagen, Denmark). Results The trials involved a total of 790 participants in 7 independent studies. All the studies are published between 2007 and 2013. Meta-analysis of the 5 studies that reported data in mean SD values revealed that the tear break-up time (TBUT) was significantly greater by 1.58 s (WMD=1.58, 95% CI=0.60 to 2.55; P=0.007). Combination of all the Schirmer’s test data showed that omega-3 fatty acid supplementation could significantly improve the Schirmer’s test (WMD=0.74, 95% CI=0.29 to 1.19; P=0.001). However, the combination of all the OSDI test data showed that omega-3 fatty acid supplementation did not significantly improve the OSDI test results (WMD=−4.54, 95% CI=−9.85 to 0.78; P=0.09). Conclusions Based on the data included in our meta-analysis, omega-3 fatty acid was associated with better TBUT and Schirmer’s. No significant differences were detected in OSDI test results. Consequently, our findings suggest that omega-3 fatty acid offers is an effective therapy for dry eye syndrome.
    Preview · Article · Sep 2014 · Medical science monitor: international medical journal of experimental and clinical research
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    • "Results from dry eye animal models showed that a deficiency of n-3 PUFA in the diet does not correlate with the severity of dry eye (Viau et al., 2011), whereas n-3 PUFA dietary supplementation contributes to n-3 PUFA incorporation in the lacrimal gland, altering lipid homeostasis and partially interfering with the course of dry eye, without altering lacrimal production of prostaglandins (Viau et al., 2009). Wojtowicz et al. (2010) showed an increase in average tear production, as measured by the Schirmer test, and improvement in dry eye symptoms in patients receiving oral supplementation of fish oil containing EPA and DHA. Alpha-lipoic acid (ALP) is an endogenously synthesized cofactor for mitochondrial enzyme complexes. "
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