Dry Eye Syndrome – An Insight into the Importance of Omega 3

As mentioned on the NHS website, dry eye syndrome is a “common condition that occurs when the eyes do not make enough tears or the tears evaporate too quickly”. In turn this leads to the eyes drying out and with it the onset of inflammation (swollen, irritant and red eyes). It is estimated that around 1 in 3 people over the age of 65 suffer from dry eyes, and it is more common in women than men.

Dry eye syndrome, in the vast majority of circumstances, would not be considered a serious condition. However, the symptoms have the ability to cause profound discomfort on a day-to-day basis, and tasks that would normally be mundane and simple become more difficult due to the pain and inflammation.

Our article this week is provided by Iain Johnson, a qualified personal trainer, nutritionist and optician. He looks at dry eye syndrome in more depth and discusses the importance of the ratio between omega 3 and omega 6 in your body to reduce the symptoms of the condition.


One of the biggest complaints that we get in optometric practice is dry eye syndrome (DES). It is far more common in the elderly, especially those who wear contact lenses.[1] Although the term ‘dry eye’ doesn’t sound too debilitating it can cause profound discomfort and as the tears film is the first refractive surface of the eye, it can reduce visual acuity.[2] Working on a computer frequently increases the incidence, and so do chronic conditions such as diabetes.

In 2007 a questionnaire was sent to 690 people to assess the incidence of DES and the impact that it had on peoples day-to-day lives. The results showed that there was an adverse impact on professional work, VDU use, driving (day and night), and even mundane tasks such as watching television.[3] It is certainly not something to be ignored.

The most common treatment for dry eye syndrome is the use of lubricating eye drops. Whilst they can be effective at relieving the symptoms, they fail to fully address the underlying cause. Not only that, but having to use drops frequently is inconvenient and potentially expensive. Fortunately we have other options that can relieve the DES and improve other aspects of health at the same time.

What Causes Dry Eye Syndrome

EYE

It was initially thought that DES was caused simply by a lack of aqueous tear production. It is now understood to be a multifactorial condition that involves all of the layers of the tears film and also inflammation of the ocular surface.[4] This is important because it shows that it’s not a simple case of fixing the tear production by slowing the drainage down or using drops to artificially lubricate the eyes. Instead we need to look at options to improve the quality of the tears produced and alleviate the ocular inflammation. Perhaps drops should be seen as a temporary fix whilst the root cause is addressed.

Addressing Inflammation – Omega 3 and Omega 6

Omega 3 and Omega 6 produce signalling molecules known as eicosanoids which control many bodily systems such as the inflammatory response. Generally speaking the omega 3 fatty acid derived eicosanoids are anti-inflammatory and the omega 6 eicosanoids are pro-inflammatory – although it must be stressed that it is an extremely complex pathway that isn’t fully understood. As an example, one study conducted using the omega 6 rich evening primrose oil showed a marked decrease in dry eye symptoms over a six month period compared to a placebo.[5] Evening primrose oil is thought to be one of the only omega 6’s that have an anti-inflammatory effect.

One consideration that is being researched heavily is the ratio between omega 3 and omega 6 in the diet. It is thought that humans evolved on a ratio of around 1/1, and the current ratio is around 16/1 (omega 3/omega 6) in the west.[6] Researchers have already acknowledged that it isn’t simply a case of increasing the amount of omega 3 and omega 6 polyunsaturated fats in the diet, but instead addressing the balance between the two for an overall anti-inflammatory effect that can reduce the chances of DES and other chronic illness.[7]

800px-EFA_to_Eicosanoids.svg

Addressing the Balance

Some of the best sources of Omega 6 – Vegetable Oil, Margarine, Processed foods, Mayonnaise

Some of the best sources of Omega 3 – Fatty fish, Walnuts, Flaxseeds

As you can see, it’s easy to get plenty of omega 6 with the modern western diet and much harder to obtain sufficient quantities of omega 3. If we look at the fatty acid distribution of common cooking oils the picture becomes even more clear:

NUTRITION TABLE

Due to the instability of omega 3 polyunsaturated oils they are not often used for high temperature cooking. Increasing the amount of omega 3 in the diet and through supplementation, whilst reducing the amount of omega 6 by using cooking oils that are highest in mono-unsaturated fats like olive oil should be the goal.

DES Omega 3 Studies

There have been numerous studies looking at the relationship between  polyunsaturated fats and DES with almost universally positive outcomes. A randomized, double-masked, placebo-controlled trial conducted with 36 patients was conducted in 2011, examining the use of an omega 3 supplement for treating dry eye syndrome.[8] The supplement contained 450mg EPA, 300mg DHA and 1000mg of flaxseed oil. Patients were examined on day 1 and then on day 90.  A massive 70% of the patients in the treatment group became asymptomatic at the end of the trial compared to just 7% of the placebo group – a huge success.

It’s hard to argue with the results of this trial. Perhaps the best way is to quote the conclusion of a meta analysis of 7 studies from 2007 to 2013 looking at the efficacy of omega 3 supplementation for DES:

“Our findings suggest that omega 3 fatty acid offers an effective therapy for dry eye syndrome.”[9]

Antioxidants

Many supplement companies are making blends that contain essential fatty acids along with antioxidants. Whilst the article has shown that omega 3 fatty acids are an effective treatment for DES, antioxidants are also thought to have some positive effect.

Conclusion

With DES being much more prevalent in the older population, and with people living longer, it is more important than ever to address DES. The condition has negative effects on many areas of day-to-day life and is becoming more common with increased computer use. Taking simple steps to address the issue by increasing the amount of omega 3 in the diet from food and supplementation whilst also decreasing the amount of pro-inflammatory omega 6 can go a long way. Dietary antioxidants can complement this, with many supplements already available that combine the two. Not only will you be reducing dry eye syndrome but also decreasing the chances of some chronic diseases that have an inflammatory component at the same time –  a win-win.


Iain Johnson

Iain Johnson is a dispensing optician with qualifications in nutrition and personal training. He has written for major publications, featured in training DVD’s and regularly lectures on the subject of nutrition and eye health. He is available for consultations, writing and lecturing at www.iainjohnson.com

 


With many thanks to Iain for this informative article. If you have any questions regarding the health topics raised, please do email me at amanda@cytoplan.co.uk, alternatively please call 01684 310099.

Amanda Williams

Cytoplan Ltd.


Relevant Blogs

Omega 3 Supplements – Fish, Krill or Algae?


Omega 3 Supplements

Krill Oil – Krill are the most bioeffective natural sources of beneficial Omega 3 fatty acids EPA/ DHA; Astaxanthin, a powerful antioxidant and Choline, an essential neurotransmitter. Krill Oil nutrients can help manage cholesterol and provide powerful antioxidant and anti-inflammatory properties.

Fish OilCytoplan high potency fish oil capsules give you 550mg of the essential fatty acids EPA/DHA per 1000mg capsule; this supplement comprises 60 capsules. We also have a 120 capsules size.

Omega 3 Vegan – Vegan Omega 3 from Marine Algae – An ideal vegan source of the important Omega 3 essential fatty acids EPA and DHA. Two gluten-free capsules will provide 334.0mg DHA and 166mg EPA (on average).


References

  1. The Vision Care Institute (2008) New Ways to Get to Grips with Dry Eye, [online] Available at: http://www.thevisioncareinstitute.co.uk/dry-eye-course [Accessed 1st Oct 2014].
  2. Montés-Micó, Robert. “Role of the tear film in the optical quality of the human eye.”Journal of Cataract & Refractive Surgery 33.9 (2007): 1631-1635.
  3. Miljanović, B., Dana, R., Sullivan, D. A., & Schaumberg, D. A. (2007). Impact of dry eye syndrome on vision-related quality of life. American journal of ophthalmology, 143(3), 409-415.
  4. Javadi, M. A., & Feizi, S. (2011). Dry eye syndrome. Journal of ophthalmic & vision research, 6(3), 192.
  5. Kokke, K. H., Morris, J. A., & Lawrenson, J. G. (2008). Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Contact Lens and Anterior Eye, 31(3), 141-146.
  6. Simopoulos, A. P. (2006). Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomedicine & Pharmacotherapy, 60(9), 502-507.
  7. Roncone, M., Bartlett, H., & Eperjesi, F. (2010). Essential fatty acids for dry eye: A review. Contact Lens and Anterior Eye, 33(2), 49-54.
  8. Wojtowicz, J. C., Butovich, I., Uchiyama, E., Aronowicz, J., Agee, S., & McCulley, J. P. (2011). Pilot, prospective, randomized, double-masked, placebo-controlled clinical trial of an omega-3 supplement for dry eye. Cornea, 30(3), 308-314.
  9. Liu, A., & Ji, J. (2014). Omega-3 Essential Fatty Acids Therapy for Dry Eye Syndrome: A Meta-Analysis of Randomized Controlled Studies. Medical science monitor: international medical journal of experimental and clinical research, 20, 1583.

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4 thoughts on “Dry Eye Syndrome – An Insight into the Importance of Omega 3

  1. Hello
    Overall the article was useful but I was surprised to see a couple of things in it.

    I would expect most people to understand the phrase “best source of Omega 6” as meaning that this was a good source to use – and hey presto – margarine was mentioned !!!!!!

    A table showing relative FA profiles of vegetable oils could also be a bit misleading. Someone with inflammation already (or even not) doesn’t want to be heating vegetable oils AT ALL. Udo Erasmus is quite emphatic that heating any oils – even Olive Oil, which was suggested in the article – causes inflammation.

    “Due to the instability of omega 3 polyunsaturated oils they are not often used for high temperature cooking” would have been better as “should NOT be used for cooking at all”. !!!!

    It was useful, however, to learn the underlying cause of dry eye syndrome. Thanks

    Best Wishes
    Judith

    1. Thanks Judith,
      Glad you liked the article. I can see where you are coming from in terms of the wording, when I use best source I by no means aim to point people in the direction of margarine! Again, with the wording, omega-3 oils are not suitable for high temperature cooking – full stop.

      As far as the use of olive oil in cooking, I have a slight difference of opinion. It’s not to say that Udo is wrong, I admire the guy and think he has done some amazing work in the field. However I can’t go with his opinion without some studies to back it up. From my research I found that using olive oil had anti-inflammatory effects, and although heating did cause some degradation it was only around the 20% mark – making it less good but not terrible. We could get onto other health concerns from high temperature cooking but I think this would be another article all together! The point being that if you are going to cook at high temperatures olive oil is a better option than vegetable oils that are high in omega-6.

      Again, this is just one aspect of dry eye syndrome because it has many causes. Whilst PUFA intake and underlying inflammation play a huge role and correcting this will help most, it won’t help all.

      Thanks for the feedback.
      Iain

  2. Iain
    Thanks very much for your reply.
    I’d be really interested to hear more about your research showing heating OO as anti-inflammatory. Thank you.
    I agree that OO would seem a safer option than some of the other vegetable oils on offer, but then why not go the whole hog and recommend the even safer option of Coconut oil !!
    For me 20% degradation is 20% too much, and whilst we wait for scientific “proof” that it is detrimental to health to cook with OO (and I shall – when I have time – look into this), then we could be playing Russian roulette with our health and our clients’ health by suggesting that it is a safe option.
    I always recommend first and foremost limited frying / roasting anyway, but when people do wish to fry, then to use Coconut oil.
    Personally, I turned my health around by adopting a healthy diet, including taking out heating OO, though I realise that this is far from scientific proof 🙂 !!!
    I appreciate that this is only one aspect of the complaint and in fact only one aspect of the nutritional picture concerning inflammation.
    Many Thanks
    Judith

    1. Hi Judith,
      Ive given a reference at the bottom of this reply. The paper looked at heating extra virgin olive oil and how this affected the compounds and nutritional propertied. Overall they conclude that despite the heating conditions the oil held up against oxidation and maintained most of the nutritonal compounds.

      I do not disagree that a fat like coconut oil is better for cooking, I often use it myself. But i have not seen anything compelling to suggest olive oil is bad. Again, I suggest slow cooking methods over frying to clients – but sometimes its unrealistic.

      I’m glad that you turned your health around with a great diet – I too had problems and that’s what got me interested in the first place. I think its great to see people being passionate about nutrition and its much easier when you’ve seen the results first hand!

      Thanks,
      Iain.

      “How heating affects extra virgin olive oil quality indexes and chemical composition,” Y. Allouche, A. Jiménez, J. J. Gaforio, M. Uceda, G. Beltrán, J Agric Food Chem, 2007 Nov 14;55(23):9646-54. Epub 2007 Oct 13, PMID: 17935291

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