• In this study of the effects of omega 3 fatty acids (O3FAs) on dry eye symptoms and clinical signs in a population of symptomatic video terminal display users (average computer time of 8 hours/day), the authors show that 2400 mg/day of O3FAs for a minimum of 30 days will not only significantly improve dry eye symptoms but also tear break-up time and conjunctival impression cytology (both noted at 45 days). Although Schirmer test values did not improve significantly, the authors suggest that a longer treatment time may be necessary for measurable improvement in tear production.
• Use of O3FAs improved dry eye symptoms, tear break-up time, and conjunctival impression cytology in symptomatic individuals who averaged 8 hours/day on the computer.

Written by Rahul Bhargava MS

The incidence of dry eye has significantly increased in youngsters and the office-going population working on computers and other visual display terminals (VDTs). Although omega 3 fatty acids (O3FAs) have shown promising results, there are no clear-cut guidelines for the recommended dose and duration of therapy. Previously published studies at our center suggest that a dose of 1200 mg per day (720 mg EPA and 480 mg DHA) for 3 months and 6 months, significantly improves conjunctival goblet cell density in computer users and contact lens wearers, respectively.^1,2 However, compliance was poor, and participants were not satisfied in taking supplements for long durations.

Therefore, the present study was undertaken to evaluate whether increasing the dose and reducing duration of therapy could produce measurable improvement in symptoms and clinical markers of dry eye in VDT users. However, O3FAs in a dose of 2400 mg per day for 45 days did improve dry eye symptoms, TBUT, and conjunctival cytology but not Schirmer’s, suggesting that, apart from an optimal dose, duration of treatment is also a crucial determinant for achieving clinical benefit. Thus, treatment needs to be continued for a reasonable duration, which may range from 45 days to 3 months.

Secondly, benefit may be more marked in populations whose natural diet is either devoid of O3FAs (eg, vegetarian diet of Indians) or is rich in O6FAs (eg, typical American diet). The results may have practical applicability worldwide as only Mediterranean and Norwegian diets are rich in O3FAs, and the role of personal computers and VDTs has increased exponentially worldwide. Based on the outcomes of the present and previous studies, we would recommend a dose of 1200 to 1500 mg of combined EPA and DHA daily for 2 to 3 months to treat dry eye in VDT users. In contrast to tear supplements, the benefit usually persists for another 2 to 3 months after cessation of therapy.

References

1. Bhargava R, Kumar P, Phogat H, et al. Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye. Cont Lens Anterior Eye. 2015;38(3):206-210.http://www.contactlensjournal.com/article/S1367-0484%2815%2900009-0/abstract
2. Bhargava R, Kumar P. Oral omega-3 fatty acid treatment for dry eye in contact lens wearers. Cornea. 2015;34(4):413-420. http://journals.lww.com/corneajrnl/pages/articleviewer.aspx?year=2015&issue=04000&article=00010&type=abstract

Abstract

OBJECTIVE

To evaluate the effect of an omega 3 fatty acid (O3FA) oral supplement (2,400 mg/day) for 45 days on dry eye symptoms, tear production, stability, and conjunctival cytology in young and middle-aged visual display terminal (VDT) users.

METHODS

Institutional review board approval was obtained, and a randomized, double-blind, interventional study was done; eyes of 256 VDT users were randomized to receive 4 capsules twice daily for 45 days (O3FA group), each containing 180 mg of eicosapentaenoic acid and 120 mg docosahexaenoic acid. The O3FA group was compared with another group (n=266) who received 8 capsules of a placebo (olive oil). Patients were evaluated at baseline, 30 days, and 45 days. The primary outcome measure was an improvement in dry eye symptoms. Secondary outcome measures were improvement in the Nelson grade on conjunctival impression cytology, Schirmer test values, and tear film breakup time (TBUT). Means of groups (pretreatment, day 30, and day 45) were compared with repeated-measure analysis of variance. The relation between the outcome variables and VDT time was evaluated using linear regression.

RESULTS

In the O3FA group, the mean symptom score differed significantly (P<0.005) (pretreatment, 30 days, and 45 days); the TBUT and Nelson grade also improved significantly but only after 45 days of intervention. Schirmer test values did not differ significantly after adjustment for multiple comparisons (P=0.010). The change was not significant in the placebo group.

CONCLUSION

Consumption of 2,400 mg/day of O3FA supplement improves symptoms, tear stability, and conjunctival cytology but not tear production in symptomatic VDT users.

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