Treating dry eye is difficult. The evidence often seems contradictory with itself, signs do not match symptoms, and we are dealing with a condition requiring maintenance rather than a cure. These are all quite foreign concepts when it comes to eye care. As an ophthalmologist treating mainly cataract and laser vision correction patients, I am used to providing a permanent, precise and consistent solution where patients can have their surgery and not even think about it again. If only dry eye disease could be treated this way. So many of my patients are great at getting things under control with their dry eye treatments but struggle to maintain things long term. This is understandable as most of us find it difficult to complete a week long course of antibiotics when we have to. It is especially difficult to maintain something where you do not continue to perceive any benefit. Dry eye is one of these conditions where when it is well controlled, ongoing treatment feels unnecessary and it is only when things again deteriorate that you realise how much help that maintenance work was doing for your symptoms.
On the ladder of dry eye treatments, the addition of Omega-3 fatty acid supplements have some biological plausability. They should change the consistency of the meibum within meibomian glands, the source of trouble for evaporative dry eye sufferers, and biochemically, omega-3 supplements should also give some anti-inflammatory effect. This is even more important as we now understand better, the dry eye cycle of inflammation leading to dryness. Historically, there has been some good evidence to show that omega-3 supplements were helpful for dry eye symptoms and signs. This was all shaken up however, by a relatively recent study indicating that the addition of Omega-3 supplements gave little to no additional benefit over those simply taking Olive oil as a placebo. Such opposite outcomes from studies looking at similar ideas was very confusing for optometrists and ophthalmologists as we are caught between not wanting to burden our patients with something that may not be helpful, yet also knowing that most of us have seen patients where supplementation has been beneficial.
In this latest episode of Ophthalmology Against The Rule (OATR) podcast, your hosts, me, Dr Ben LaHood and Dr Nick Andrew take a closer look at the key studies to see where the differences lie and how this should all be interpreted. Our motto for the podcast is "looking at the common things often overlooked" and this is certainly one such topic. Have a listen and learn about which supplements should be the most beneficial, which patients should have supplementation, and most importantly, is there evidence to say that omega-3 supplements have evidence supporting their role in the treatment of dry eye. All of this, along with your usual dose of OATR content and entertainment. The latest episode is available now via Apple podcasts, Spotify, Google and our website, www.oatrpodcast.com so let us know what you think and whether you are left with any questions we can answer in our next episode.