Ask dry eye patients about their diet, supplements
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ATLANTA – A discussion with patients about their current dietary habits and nutritional supplementation can help the optometrist customize a dry eye treatment plan, according to a speaker here at SECO.
Melissa Barnett, OD, FAAO, FSLS, FBCLA, who practices at UC Davis Eye Center, said, “Getting a feel for what your patients like is important, too. Some patients don’t want to use a prescription drop. They may already be taking a supplement. Many patients are concerned about being on therapies forever.”
Omega-3 supplements are available in different types, dosages and ratios, she said.
“I recommend you have one or two that are your favorite that you prescribe,” Barnett said.
Triglyceride molecules contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), she said. Alpha-linolenic acid (ALA) and linoleic acid (LA) are the most abundant omegas in the diet, but they must convert to other omegas to affect inflammation.
“EPA and GLA [gamma-linolenic acid] are the superstars of the omegas because they really help with inflammation,” Barnett said. “Flaxseed oil provides mostly ALA and a small amount of LA, but it’s not efficiently used. It’s good to know what and how much patients are taking and also if they’re eating fish.”
GLA, found in black currant seed oil, efficiently reduces inflammation with dry eye-specific effects, Barnett said; however, it is not obtainable through diet, fish or flax.
GLA specifically helps reduce inflammation and increases lacrimal function and also reduces inflammation from other diseases such as rheumatoid arthritis, irritable bowel disease, dermatitis and diabetic retinopathy.
“Typically, 2,000 mg to 3,000 mg of omega-3 is required to have a significant effect, but you only need 235 mg of GLA,” Barnett said.
She said she fits a lot of scleral contact lenses, and GLA helps with contact lens discomfort.
“In this group, it’s really important to treat meibomian gland dysfunction to the maximum level,” she said. “I’m quick to recommend an omega in these patients. Lens fogging can be helped by cleaning up eyes and lashes and improving the tear film.”
Reduce inflammation with the right balance of omegas, Barnett said, but be careful not to overdose.
“Fish oil is a blood thinner. Ingesting excessive amounts could lead to easy bruising and other blood thinning effects,” she said. “It’s better to reduce the amount of omega-6 while moderately increasing omega-3 in the diet.”
She urged clinicians to talk to patients about adopting a healthy diet, increasing water consumption, reducing caffeine intake, using moisture goggles at night and a humidifier at night and near their desk at work, eliminating overhead fans in the bedroom and redirecting vents in the car.
Consider autoimmune conditions, such as Sjogren’s syndrome, in these patients, and order testing if appropriate, Barnett said.
Other vitamins are critical for corneal and conjunctival health, including vitamin A, vitamin C, vitamin D and vitamins B6 and B12.
“I don’t specifically recommend one diet over another; every patient is specific,” Barnett said.
She recommends that patients reduce protein, fat and cholesterol; increase complex carbohydrates; get enough vitamin A, zinc, folate, B6 and C; eliminate alcohol and caffeine; reduce sugar and salt intake; and drink water.
“This is easy to talk to our patients about,” she said.
Turmeric, an antioxidant, also reduces inflammation.
“It helps with wound healing and cancer,” Barnett said. “It can help with dry eye, too. I add this when other things aren’t working.” – by Nancy Hemphill, ELS, FAAO
Reference:
Barnett M. Off the menu: A nutritional approach to dry eye. Presented at: SECO; March 4-8, 2020; Atlanta, Ga.
Disclosures: Barnett reports she is a consultant for ABB, Acculens, Alcon, Alden Optical, Allergan, Anthem, Bausch + Lomb, Bruder, Contamac, CooperVision, Gas Permeable Lens Institute, Johnson & Johnson Vision Care, Novabay, Novartis, Ocusoft, Paragon Biotek, Percept, ScienceBased Health, Scleral Lens Education Society, Sjogren’s Syndrome Foundation, STAPLE program, SynergEyes, Visioneering Technologies.