There is now growing evidence that the
anti-inflammatory properties of omega-3 fatty acids, such as those found
in flaxseed oil and fish oil, can relieve dry eye.
According to Jeffrey P. Gilbard, MD, founder
and chief executive officer of Advanced Vision Research, and the inventor
of the very popular and effective TheraTears (drops and gel) flaxseed
oil enriched with fish oil (containing eicosapentaenoic acid [DHA and
EPA]) decreases inflammation, stimulates aqueous tear production, and
augments the tear film oil layer by enhancing the flow of oil out of
the meibomian glands.Flaxseed
oil and fish oil are important sources of omega-3 essential fatty acids,
one of two types that the body needs but can't produce. The other is
omega-6, which is over-abundant in the typical Western diet. Much of
that omega-6 is converted to arachidonic acid, which promotes inflammation.
"Americans are eating way too much
omega-6 fatty acid while being omega-3 starved," Dr. Gilbard said. By
adding an omega-3 supplement into the diet, this balance is reversed.
Adding vitamin E to the formulation, or taking it separately, prevents
oxidation of the fish and flax oils.
"Studies show that about 90% of Americans
are deficient in omega-3 fatty acid intake," said Lawrence Minardi,
MD, an ophthalmologist in solo practice in Charleston, WV. "The omega-3
oils are really important for the meibomian glands to work properly.
Since many of us are deficient in omega-3 oils, those meibomian glands
develop a very thick secretion. Consequently, the oily layer of the
tear film is deficient, and people who are deficient in omega-3 oils
end up with an evaporative tear loss and dry eye syndrome."
Omega-3 fatty acids, found in salmon,
tuna, herring, mackerel, and other cold-water fish, also affect dry
eye through another mechanism, Dr. Minardi said. "These oils tend to
be anti-inflammatory in the diet, and many cases of dry eye syndrome
are related to inflammation of the lacrimal gland and the conjunctiva,"
he noted.
"If we reduce the inflammation via
the competitive inhibitory effect of omega-3 fatty acids on the arachidonic
acid cascade, then there's less inflammation in the conjunctiva and
in the lacrimal glands so there will be better tear production," Dr.
Minardi added.
Dr. Minardi also strongly recommends
the reduction of simple carbohydrates in one's diet, such as bread (except
for whole-grain breads), pasta, rice, and potatoes, which can adversely
affect dry eye.
The health benefits of flaxseed and
fish oils have been known for years and have been the subject of renewed
interest from physicians who believe it might help patients with dry
eye and a host of other medical conditions.
Most recently, a study of 32,470 women
participating in the Women's Health Study has found that women with
a higher dietary intake of omega-3 fatty acids are at decreased risk
of developing dry eye. The study, performed by a team of investigators
from Harvard Medical School, was to be presented at the Association
for Research in Vision and Ophthalmology annual meeting May 4-9 in Fort
Lauderdale, FL.
Dr. Minardi said that he has treated
more than 300 patients with omega-3 fatty acid supplements in the last
several years. "The overwhelming majority have seen significant improvement
in their ocular symptoms and dry eyes," he said. "I have dry eye syndrome
myself, and I've been taking it for 2 years. My dry eyes are immensely
better."
Dr. Minardi also suggests that patients
take omega-3 fatty acid supplements before he performs LASIK, since
most are omega-3 deficient. He recommends that they continue to use
supplements afterward to avoid complications with dry eye that could
negatively affect the results of the surgery. He also recommends the
supplements to patients who wear contact lenses.
Some opthalmologists now use omega-3 nutrition
routinely for patients following LASIK and on patients who have signs
of meibomian gland clogging. They have markedly increased tear stability,
and in addition they achieve significant increases in visual acuity.
Patients who have ocular surface disease following LASIK will complain
of visual fluctuation because their cornea breaks down. With the omega-3
supplements they notice that their tear film is a lot more stable and
they are able to see better, feel better, have less dryness, and have
better visual acuity.The nutritional
supplement should be used with artificial tears, preferably
TheraTears,
at least during the early phase of treatment, Dr. Gilbard said, since
the supplement takes effect gradually over about 2 months.
"The way to get rid of dry eye as soon
as possible is to treat it from the inside as well as the outside,"
Dr. Gilbard said. "With the combination, patients get better faster,
and some patients are able to stop their eyedrops."
With all the evidence now pointing
to the widespread contamination of fish, and the advice now being given
that fish be consumed no more than once or twice a week, it is considered
advisable to obtain omega-3 from a combination of fish and flax oils.
