|TheraTears Eye Nutrition from Akorn Consumer Health is available at major retailers and direct to physicians that have an Akron account.|
A healthy serving of omega-3 fatty acids may help patients manage dry eye disease. Here’s what to know and what to tell (and sell) your patients.
Prescribing nutraceuticals for eyecare in general is a must for all primary care optometric practices. Optometry has historically been a leader in the prescription of nutraceuticals for macular degeneration. This naturally extended to diabetic retinopathy and now, dry eye treatment.
The keystone nutraceutical for treating dry eye is omega-3 fatty acids, or fish oil. Many different formulations have been introduced. Rather than recommend that patients shop on their own to find fish oil, it is more beneficial to the patient if the eyecare practitioner selects and prescribes a particular brand of omega-3 fish oil.
TRIGLYCERIDE OR ETHYL ESTER?
While triglyceride forms of fish oils are more expensive to manufacture, research has shown they allow up to 70% more absorption compared to the less expensive “ethyl ester” form. The process also includes a rigorous distillation process to purify the oil and expunge pollutants such as dioxins, mercury, lead and others.
The “Styrofoam Cup Test” is a great way to discuss the difference with patients. You can easily demonstrate in the office. Cut an ethyl ester fish oil gel cap in half and express it into a Styrofoam cup. The ethyl ester oil will proceed to melt the Styrofoam itself. This is a strong demonstration to convince patients that just going to a big box store for their fish oil may not be such a good idea.
HOW OMEGA-3 HELPS
Two components in omega-3 fatty acids help dry eye. EPA (eicosapentoenoic acid) promotes cell nucleosis, membrane fluidity, and fluidity of secretions, while DHA (docosahexaenoic acid) enhances the structural integrity of cells. Omega-3 fatty acids generate anti-inflammatory prostaglandins E3 and luekotrine B5. EPA directly blocks the pro-inflammatory cytokines, tumor necrosis factor-alpha, interleukin-1-alpha, and interleukin-1-beta. Many studies have shown that omega-3 treatment can reduce ocular inflammation associated with chronic dry eye and increase tear break up time, tear production and meibomian gland function.
PRESCRIBING FOR DRY EYE
Prescribing dry eye nutraceuticals in a primary eyecare practice is essential to make sure that patients are obtaining the correct formulation of omega-3 fatty acids and to allow us to be more involved in the ongoing preventative care of other conditions for which omega-3’s are beneficial, such as macular degeneration and diabetic retinopathy.
In our practice, we routinely prescribe omega-3 fatty acids as an integral part of our dry eye treatments. We begin with meibomian gland imaging, tear and meibomian oil layer analysis, lid hygiene with modern blepharitis pharmaceuticals, warm compresses, prescription of omega-3 fatty acids (1,000mg to 2,000mg per day) and meibomian gland expression procedures as needed.
|Four Fish Oil Supplements
Not sure what brand to prescribe or sell directly to patients?
Here are a few brands to consider:
•Dry Eye Omega from PRN (Physicians Recommended Nutriceuticals)
•HydroEye from Science Based Health
•ProOmega and ProOmega 2000 from Nordic Naturals
•TheraTears Eye Nutrition from Akorn Consumer Health
By Randall Sakamoto, OD, PhD, FAAO, is in private practice in Honolulu, HI
Science Based Health
888.433.4726 | ScienceBasedHealth.com