BLOG: Omega-3 part 2 — You’re probably not doing it right

ByDarrell E. White, MD

At the end of part 1 of my blog on omega-3 fatty acid in dry eye care, I made a (typically) bold statement: Treatment with fish oil should be a core part of your treatment plan for pretty much every dry eye patient. I’m pretty sure that there are a large percentage of you who have been treating DED for a long time who are nodding your head right now in agreement. You’re also smiling and patting yourself on the back for being so far ahead of the curve. Heck, that was sure my response after a quick reading of Alice Epitropoulos’ study. There’s only one little problem, though.

You’re probably not doing it right.

I really hate to burst your bubble like that, but if it’s any consolation, neither am I. In my defense, I plead “science” and respectfully rest my case. Very careful reading of not only the Epitropoulos article but others that look at the details of omega-3 fatty acid and meibomian gland function offers us some very specific guidelines when it comes to a “best practices” approach to the treatment of DED with fish oil.

I mentioned the “Omega-3 Index” (http://www.omegaquant.com/omega-3-index/) as one of the variables that was evaluated in the study and found to be significantly increased in study subjects taking fish oil. A higher Omega-3 Index is a good thing. The Omega-3 Index is a measurement of the amount of omega-3 fatty acid found in the cell membranes of red blood cells and is an actionable proxy for omega-3 fatty acid in the body. The magic number is 8; an Omega-3 Index over 8 is associated with healthier tear function. Under 2 is considered pathologically low, while 2 to 6 is suboptimal.

When was the last time you ordered an Omega-3 Index for one of your DED patients? Me either. That’s the first thing we are doing wrong. We should all be testing baseline and post-Rx levels for our DED patients. Sadly, the Omega-3 Index (OmegaQuant) is typically not covered by any insurance plans. Hopefully this will change, but even if it doesn’t, the use of the Omega-3 Index in the Epitropoulos study tells most of us that we are doing something else wrong.

We are allowing our patients to take a fraction of the amount of fish oil it takes to have an effect on their dry eye.

Part 3 of my update on omega-3 fatty acid treatment for DED will examine the particular formulation of fish oil used in the study, as well as the dose. I’m hopeful that I will be able to provide food for thought on both.

Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations; is on the speakers board for Bausch + Lomb, Allergan and Shire; and has a financial interest in TearScience.