The DEWS and Don’ts of Dry Eye Science
To see more comfortably, look to the sea. That’s one part of a treatment plan we prescribe for patients who suffer from dry eye syndrome, a.k.a. dry eye disease.
Look to the sea, or any other body of water where fish thrive. Because what we’re really talking about is fish. Fish oil, to be exact.
For years, optometrists and ophthalmologists have been prescribing fish oil to fight the symptoms of dry eye disease, for good reason.
What is Dry Eye?
So what is dry eye, and how does it develop?
“…a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
Wow. How’s that for mud in your eye?
A good layperson’s definition from the American Optometric Association is more accessible – Dry eye is “…a condition in which a person doesn’t have enough quality tears to lubricate and nourish the eye.”
As for Lifetime Vision, we find it easiest to describe dry eye disease by how it makes people feel. It’s the painful, gritty sensation and the constantly fluctuating vision that can be an all-day-every-day way of life. And it can be a miserable life, at that.
DEWS II established that dry eye is caused by a number of factors. It revolves around inflammation from a bunch of different sources that affect the balance of the three layers that make up a person’s tear layer: the lipid (oil) layer, the aqueous (water) layer, and the muchin (mucus) layer. In most peoples’ eyes, these three layers exist in a delicate balance. But when there’s inflammation, they are thrown out of balance and your eyes feel parched.
DEWS II also recognized fish oil as an effective treatment for dry eye symptoms because it contains significant amounts of omega-3 fatty acids. According to WebMD, “Omega-3 fatty acids reduce pain and swelling. This may explain why fish oil is likely effective for psoriasis and dry eyes.”
Benefits of Fish Oil
The omega-3 fatty acids in fish oil have been shown to help with a wide range of medical conditions or in their prevention. According to various sources, they can:
- Lower blood pressure.
- Reduce triglycerides.
- Increase “good” cholesterol.
- Slow plaque development in the arteries.
- Reduce the chance of abnormal heart rhythms.
- Reduce the likelihood of heart attacks and strokes.
- Lessen the chance of sudden cardiac death in people with heart disease.
- Improve symptoms of depression and anxiety.
- Provide structural strength for your neurons and increase blood flow to your brain, which could help with Alzheimer’s later in life.
These are all great reasons for eating more fish and taking fish oil supplements, regardless of whether your eyes feel dry.
I personally take fish oil because I have arthritis in my thumbs. Arthritis is inflammation of the joints. Since I started taking fish oil, the pain in my thumbs have disappeared. I shake hands with every single person I meet, and there’s no pain anymore.
Not All Fish Swim the Same Way
If you go looking for a fish oil supplement, it’s important to keep in mind that not all fish oils are the same. It depends on how they’re made, the cheap way or the right way.
The cheap way to produce fish oil supplements is to squish up the fish parts, bubble the oil to the surface using alcohol, gather up the fish oil and manufacture it into pills. These are the supplements you’ll find in big-box stores.
The problem with the alcohol-based method is the omega-3 doesn’t absorb through your stomach very well. When you burp you get that awful taste, but worse, you’re not getting full circulation of fish oil through your bloodstream.
The other method uses triglycerides, which are sugars, to extract the oil. It’s more expensive because of the extra step, but it’s also more effective. It results in better absorption of the omega-3 fatty acids, so you have more of the anti-inflammatory properties in your bloodstream.
The takeaway is if you’re looking for fish oil, find a triglyceride-based, not alcohol-based, supplement. Better yet, visit the Lifetime Vision Dry Eye Clinic and we’ll recommend the better brands of fish oil on the market.
I’m talking and writing about all of this now because of a recent study that claims to refute the benefits of fish oil for treating dry eye symptoms. The New England Journal of Medicine published the study a couple of weeks ago.
Called the Dry Eye Assessment and Management (DREAM) study, it was conducted by a team that included researchers from the National Eye Institute and National Institutes of Health. The study concluded that, “Fish oil is no better than the placebo for decreasing a person’s symptoms for dry eye.”
The only problem with the DREAM study is it used olive oil, which also contains omega-3 fatty acids, as the placebo in its control group, when it should have been a sugar pill or something similar. By using a different omega-3, even though the fatty acids in olive oil are less effective than those in fish oil, the control patients still received an anti-inflammatory benefit.
The DREAM study was flawed from the start.
What We See
The keys to dry-eye treatment are determining what the problems are and being able to measure and reproduce what’s going on.
The Lifetime Vision Dry Eye Clinic uses state-of-the-art equipment and processes to take seven different dry-eye measurements; we’re able to follow, track and monitor improvement in patients who suffer from dry eyes as precisely as possible.
The results we’re seeing are an eye-opener – the symptoms of around 95 percent of our patients are improving.
Bottom line –
Fish oil is an effective treatment for dry eye disease, as the DEWS II study established and as we’re seeing in our practice.
Whether you live near the sea, in the desert or among the potholes of the Upper Midwest, Lifetime Vision will continue to prescribe fish oil to make your eyes feel better.