Stature, diet, dry eye severity dictate omega-3 dosage

Paul M. Karpecki

LAS VEGAS – Dosing of omega-3 in patients with dry eye depends on disease severity, body mass index and diet, according to Paul M. Karpecki, OD, FAAO, here at Vision Expo West.

Karpecki spoke at the Ocular Surface Disease and Wellness Symposium, which was co-sponsored by Primary Care Optometry News.

As a frequent lecturer, Karpecki said he is often asked which omega fatty acid to prescribe to dry eye patients and at what dosage, so he tasked his residents to find as many studies as they could on the topic.

“We came up with about 26 articles and narrowed it down to 17,” he said at the symposium, “and there wasn’t a single study that did not show an effect on dry eye.”

Omega fatty acids are available in both triglyceride and ethyl ester forms, Karpecki continued. “The triglyceride proponents said the ethyl ester forms don’t work. They both work. But triglyceride works faster and has fewer side effects.”

He said that flax has some absorption in women and very little in men.

“If men have a family history of prostate issues, I'd not recommend they take flaxseed,” Karpecki said.

Dosing is based on three things, he continued.

“How severe is the dry eye? If you have severe dry eye you need a lot more,” he said. “How big is the patient? Anyone with a BMI above 30 will not absorb as much. How good is the patient’s nutrition? If you never eat fish you need a lot more.”

Karpecki said that a woman who watches what she eats probably should take 1 G of pure EPA and DHA.

“A big guy with a terrible diet, severe rosacea and dry eye will need 2,500 mg to 3,000 mg,” he said.

Karpecki said his group also found seven studies on gamma linolenic acid (GLA), which comes from black currant seeds and is found in wine.

“It’s a direct route to PGE-1,” he said. “In the presence of fish oil .... it is anti-inflammatory. Without fish oil it’s pro inflammatory; 170 mg of EPA/DHA with 1,570 mg of GLA seems to be extremely effective.”

He said the combination of the two reduces the amount of fish oil you need to take.
An audience member asked if the fish oil can be applied topically.

“No, you can’t,” Karpecki answered. “The oil may help the tear layer, but, systemically, you won’t get enough concentration.”

Krill oil is a good source, but patients would need a larger amount, he added. – by Nancy Hemphill, ELS, FAAO

Reference:

Karpecki PM, et al. The dry eye institute: The “why” and the integrated health care model. Presented at: Vision Expo West; Las Vegas; Sept. 13-16.

Disclosures: Karpecki receives consulting fees from AcuFocus, Aerie Pharmaceuticals, Anthem, AMO, Alcon Labs, Allergan, Akorn, Bausch + Lomb/Valeant, BioTissue, Bruder Healthcare, Cambium Pharmaceuticals, Eyemaginations, Essilor, Eyes4Lives, Eye Solutions, Focus Laboratories, Glaukos, iCare USA, Johnson & Johnson Vision Care, Oculus, OcuSoft, Konan Medical, MacuLogix, Beaver-Visitech, Ocular Therapeutix, Reichert, Shire Pharmaceuticals, Regeneron, RySurg, Science Based Health, SightRisk, TearLab, TearScience and Vmax. He has conducted research for Akorn, Allergan, Bausch + Lomb, Eleven Biotherapeutics, Fera Pharmaceuticals, Rigel Pharma and Shire; and has an ownership interest in Bruder HealthCare.