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From the Townsend Letter
May 2015

Omega-3s' Therapeutic Impact on Eye Care
by John W. Lahr, OD, FAAO
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There are some protective measures that can be employed to lessen the risk of macular degeneration or stabilize the condition should it begin:

  • Limit the exposure to HEV-blue light wavelengths between 410 nm and 450 nm – these are dangerous and lead to macular changes implicated in degeneration.
  • Eat a healthful diet with foods or supplements rich in carotenoids and antioxidants, and with anti-inflammatory properties.
  • Quit smoking – smokers are 33% more likely to develop AMD.
  • Maintain good health, which includes well-controlled blood pressure and cholesterol levels.
  • Exercise regularly.

While many of these protective measures are the same as those to maintain general good health and well-being, the diet and nutritional intake, as well as protection from blue light, are of major importance. Let's first look at protection from blue light and sources of this danger. HEV is all around us in everyday life, with the sources being:

  • sunlight – highest danger from 10 a.m. to 2 p.m. daily
  • artificial light sources

    o    incandescent bulbs (low danger)
    o    fluorescent bulbs, including compact fluorescent (CFL; moderate to high danger)
    o    light emitting diodes (LED; moderate to high danger)
    o    high and low pressure sodium bulbs (no danger)

  • cellular phone displays
  • tablets
  • laptop displays
  • monitors, including both desktop computers and television screens

Protection from HEV involves reducing the intensity, which means simply moving the emitting device farther from the eyes or reducing the brightness of the device. A filter placed over the eyes in the form of a lens that is tinted or coated can also block the 410–450 nm wavelengths. Unfortunately, a lens that will block the targeted wavelengths is yellow-orange in color, which affects the hue and perception of images and is cosmetically unappealing to most individuals.
Another protective option is to increase the ability of the retinal tissues to provide a natural filter or barrier to lessen or eliminate the damaging effects of HEV. While almost all of the AMD studies to date have focused on individuals with moderate AMD and evaluated diet and supplements that have reduced the progression of degeneration, there are several occurring now that may allow a better understanding of prevention through diet and nutritional supplements.
The two landmark studies completed to date are the Age Related Eye Disease Study (AREDS) and a second version with modifications of the supplements (AREDS2).15,16 The supplements in the AREDS2 study included vitamins C and E, zinc, lutein, zeaxanthin, and omega-3 fish oil. Both provided some understanding and direction with regard to limiting progression and loss of vision from AMD in a small percentage of subjects. There were, however, many considerations of importance in AREDS2.

  • The population studied was very well nourished, with 89% taking Centrum Silver; and this would not be representative of the general population
  • The omega-3 dosage was below "maintenance" by most standards with low DHA percentages, and the omega form (ethyl ester) has lower absorbability and bioavailability
  • It is likely more difficult for nutritional interventions to halt disease progression in older individuals with early disease and a high risk of progression

Other recent studies involved individuals whose diets are either rich or deficient in omega-3s or have low ratios of omegas 3 to 6, or who are taking supplements containing various amounts of EPA + DHA. The results are quite consistent and provide another opportunity to enhance the protection and health of the retinal tissues from structural changes that lead to macular degeneration.17,18 One study of particular interest uses high dosage EPA + DHA (5000 mg/day) for a period of 6 months on 25 subjects with AMD with beginning visual acuity of 20/25 to 20/100. All subjects improved visual acuity from a minimum of 1 line to a maximum of 3 lines, using standardized measures.19

When considering omega-3 oils, it is important to understand that the dosage and form will have a profound impact on the outcome of the desired treatment and management of the targeted conditions. The total amount of EPA + DHA must be 3000 to 4000 mg to reach anti-inflammatory levels, which is critical to manage the early acute phases of the anterior segment. Once inflammation is under control, maintenance levels of at least 2000 mg EPA + DHA are effective. Retina treatments begin at 2000 mg, and can range to levels of 4000 to 5000 mg.
The form of omega-3 is an equally critical consideration when assessing treatments for anterior or posterior areas of the eye. Studies comparing the ethyl ester and triglyceride forms of fish oil reveal superior bioavailability in the concentrated triglyceride form of fish oil.20 With up to 70% greater absorbability, triglyceride-form fish oil concentrates are becoming the primary choice of eye care professionals to obtain improved patient outcomes.
Overall, omega-3 fish oil high in EPA and DHA is a valuable treatment for the eye and adnexa, which provides the best option for long-term management of both anterior and posterior segment conditions.

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14. Stringham JM, Snodderly DM. Enhancing performance while avoiding damage: a contribution of macular pigment. IOVS Sept 2013;54(9): 6298–6306.
15. Chew E et al. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol. 2001;119(10):1417–1436.
16. Chew E et al. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration. JAMA. 2013;309(19):2005–2015.
17. Arnold C, Winter L, et al. Macular xanthophylls and w-3 long-chain polyunsaturated fatty acids in age-related macular degeneration: a randomized trial. JAMA Ophthalmol May 2013;131(5):564–572.
18. Chui CJ, Lui S, et al. Informing food choices and health outcomes by use of the dietary glycemic index. Nutr Rev Apr 2011;69(4):231–242.
19. Georgiou T, Neokleous A, et al. Pilot study for treating dry age-related macular degeneration (AMD) with high-dose omega-3 fatty acids. PharmaNutrition. January 2014;2(1):8–11.
20. Dyerberg J, Madsen P, et al. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fatty Acids. Sept 2010;83(3):137–141.

Dr John LahrDr. John Lahr is a nationally recognized speaker, educator, and consultant on eye-care topics, including ocular surface disease, eye-care delivery in managed health care, nutritional supplements in eye health and prevention, eye health protection and disease prevention, pre- and postoperative care in cataract and refractive surgery, and posterior segment diseases of the eye. He is the founder of the Eye Clinics, a five-office primary eye care group practice in East Central Minnesota. He currently serves as the vice president of provider relations and medical director for EyeMed Vision Care, the second largest vision-benefits organization in the country. Dr. Lahr received his doctor of optometry degree from the Indiana University School of Optometry in 1974. He currently serves on the advisory board for Nordic Naturals.

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