Nutrition for comanagement of ocular surgery

Performing surgical procedures always involves altering the patient’s physiology in some way. This is especially true when performing an ocular procedure. Normal physiological processes are put “on hold” while the procedure is performed, but the recovery phase requires an even more robust physiological status. This is where nutritional support in the pre- and post-surgical period can make a difference.

The two areas of ocular surgery that seem to be affected most by a patient’s nutritional state are anterior (dry eye) and posterior (macular degeneration). We will review both of these areas to discuss the effects of nutrition on some of the more common surgical procedures and what recommendations you can make to your patients. A healthy patient coming into the procedure will heal quicker and, likely, more effectively.

We are becoming more aware of the incidence of dry eye syndrome (DES) and how it not only affects the comfort of the patient but also the visual status. It is estimated that DES is experienced by up to 59 million Americans, with about 75% of those being older than 65 years. It is a condition that increases as we age, partially due to the fact that a 65-year-old has about 60% less oil in their body than does an 18-year-old.

In considering cataract surgery, for example, a dry eye can result in inaccurate topography and keratometry readings. This can potentially throw off IOL power selection. Several studies have confirmed that a large percentage of cataract surgery patients have DES.

A typical regimen for treating dry eye preoperatively usually consists of topical artificial tears. However, this type of treatment doesn’t get to the source of the condition but rather is palliative to the patient’s symptoms. Postoperative treatment often consists of steroids, nonsteroidal anti-inflammatory agents and/or antibiotics, as well as artificial tears. If they are treated only postoperatively, they may think that the surgery “gave them” dry eye. Quite often the source of this condition is blepharitis.

Oral nutritional formulations consisting of essential fatty acids (EFAs) are being used to treat DES – some with more success than others. EFAs as an effective treatment for DES depends on the proper balance of both omega-6 and omega-3 EFA from chemically stable plant oil to consistently produce series one tear-specific anti-inflammatory prostaglandin (PGE1). Properly designed EFAs nutritional formulations will also block arachidonic acid (AA) fatty acid cleavage to the series two cyclooxygenase enzyme (COX2), which can convert to a pro-inflammatory series two prostaglandin (PGE2) without the nutrient cofactors that inhibit the formation of COX2.

EFA treatment of dry eye syndrome depends on specific nutrient cofactors that aid the downstream metabolic conversion to anti-inflammatory prostaglandins. These nutrient cofactors also stimulate the production of healthy goblet cells, as well as enhance production of clearer and thinner meibomian gland oil production. Properly designed formulations will also stimulate lacrimal gland secretion, as well as stimulate the production of tear lactoferrin, the antiviral, antibacterial iron-binding protein that is particularly vital to the LASIK patient. Dry eye nutritional formulations that are based on the most recent science now include iron-free lactoferrin in the product. Serum lactoferrin is released from the eyelid in a manner similar to serum IgG, and possibly from tear neutrophils during infection and inflammation and, by binding iron, prevents the pathogen from obtaining sufficient iron for growth.

In the next blog, we’ll look at the nutritional aspects of support for the macular degeneration patient.