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Vitamin A palmitate, carbomer gel may reduce dry eye symptoms from prostaglandin use
Vitamin A affects cell regulation and differentiation in the conjunctival epithelium.
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Vitamin A palmitate and carbomer eye gel can reduce dry eye symptoms resulting from long-term use of prostaglandin analogues for glaucoma, according to a study.
Both agents increased goblet cell density and reduced toxicity to the conjunctiva.
“As we have shown in the paper, we noticed that the two eye drops, vitamin A palmitate and carbomer gel, would be beneficial to the ocular surface of glaucoma patients. After 6 months’ use, they were proved to have the effect of improving Ocular Surface Disease Index questionnaires score and preventing the gradual decline in tear break-up time. Since dry eye syndrome caused by long-term usage of anti-glaucoma drugs has been of major concern, our research makes these two eye drops as an economical, effective way to solve the problem,” Xiaodong Zhou, MD, the corresponding author, told Ocular Surgery News.
Zhou described the beneficial effects of vitamin A on ocular surface health.
“Vitamin A is an important vitamin which would be vital to the health of the ocular surface, especially the conjunctival epithelium. It has an effect on cell regulation and differentiation. The lack of vitamin A would cause severe dry eye. Some animal experiments proved that additional vitamin A has the ability to increase the conjunctival goblet cell density, which results in more secretion of mucins in tears, thus helping the stability of tear film. Carbomer gel works as a supplement of the aqueous layer, which was supposed to have the ability to increase the amount of tears in human eyes,” Zhou said.
Patients and methods
The prospective cohort study, published in the Journal of Glaucoma, included 30 patients, 23 with primary open-angle glaucoma and seven with normal-tension glaucoma, who received prostaglandin analogues for at least 1 year. Patients were enrolled in three identical clinical trials and randomized to three groups. Ten patients were treated twice daily with vitamin A palmitate eye gel 0.1%, 10 with carbomer eye gel 0.2% and 10 without any medicine application as placebo.
Investigators analyzed OSDI questionnaires, Schirmer 1 testing without anesthesia, tear break-up time and goblet cell density at baseline and at 1 month, 3 months and 6 months.
“It is a prospective, randomized, controlled study. We chose tear break-up time, Schirmer 1 test without anesthesia and Ocular Surface Disease Index questionnaires to evaluate both quality and quantity of patients’ tear film. Confocal microscope and conjunctival impression cytology were both applied as the way to evaluate the density of [goblet cells],” Zhou said.
Results
Average baseline IOP was 15.8 mm Hg in the vitamin A palmitate group, 16 mm Hg in the carbomer gel group and 14.9 mm Hg in the placebo group.
At 6 months, average IOP was 15.6 mm Hg in the vitamin A palmitate group, 15.7 mm Hg in the carbomer gel group and 14.7 mm Hg in the placebo group. Changes in IOP between the first and final visits were not statistically significant.
OSDI scores decreased significantly in the vitamin A palmitate group (P = .023) and carbomer gel group (P = .002) but not in the placebo group. The decreases in OSDI scores took place in the third month of the study. There were no significant differences in OSDI scores among the three groups for the first 3 months.
At the final visit, the average OSDI score of 14.1 in the placebo group was significantly higher than the 7.2 score in the vitamin A palmitate group (P = .011) and the 3.3 score in the carbomer gel group (P < .001).
Tear break-up time decreased from 6.6 seconds at baseline to 3.6 seconds at 6 months in the placebo group (P = .001). Tear break-up time remained stable in the vitamin A palmitate and carbomer gel groups. Tear break-up time was similar in all three groups throughout the entire study period.
In addition, all three groups had similar Schirmer values throughout the study period.
Goblet cell density decreased in the placebo group (P = .001) and increased in the vitamin A palmitate group (P = .006) but was stable in the carbomer gel group.
Goblet cell density increased from 40.4 cells/mm2 at baseline to 69.1 cells/mm2 in the vitamin A palmitate group (P = .017); the increase was seen at 6 months. Goblet cell density decreased from 59.9 cells/mm2 at baseline to 35.4 cells/mm2 in the placebo group (P = .002); the decrease was seen at 3 months. – by Matt Hasson
- Reference:
- Cui X, et al. J Glaucoma. 2015;doi:10.1097/IJG.0000000000000316.
- For more information:
- Xiaodong Zhou, MD, can be reached at Department of Ophthalmology, Jinshan Hospital of Fudan University, 1508 Longhang Road, Jinshan District, Shanghai 201508, China; email: xdzhou2013@126.com.
Disclosure: Zhou reports no relevant financial disclosures.
Perspective
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William B. Trattler, MD
This study focused on glaucoma patients who are on prostaglandin analogues for more than a year. Not surprisingly, it is common for this group of patients to have dry eye. A study was conducted to see if vitamin A or carbomer gel can help improve the health of the conjunctiva in these glaucoma patients and whether it might help improve the typical signs and symptoms of dry eye, including tear break-up time and the Ocular Surface Disease Index. Overall, the study found that patients who received vitamin A drops or carbomer gel had improvement in conjunctival goblet cell density, improvement in tear break-up time and improvement in their OSDI score. The implication is that a high percentage of patients on chronic glaucoma medications have ocular surface disease, and it is important to address this condition with either currently available medications or medications such as vitamin A or a carbomer lubricating gel.
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