nutrition

Appease Ocular Surface Disease

Determine the need and amount of omega-3 supplementation.

Kimberly K. Reed, O.D., F.A.A.O.

Some of us have taken the “Try taking fish oil” approach with ocular surface disease (OSD). This may or may not relieve symptoms.

These tips enable a personalized plan:

1. Begin at the beginning.

During the case history, ask whether the patient takes any supplements. If so, take this into account when making recommendations for additional supplements. Next, ask about his/her overall diet and, specifically, how often he/she eats a normal serving of high omega-3 grilled, baked, poached or broiled wild, cold water salmon, mackerel and certain types of farmed or lake trout (see http://water.epa.gov/scitech/swguidance/fish shellfish/fishadvisories/general.cfm#tabs-3). Patients who rarely or never eat fish need higher supplement levels vs. those who eat it two or more times per week.

2. Use patient examples to determine amount.

Controversy surrounds daily omega-3 supplementation intake recommendations. Use these patient examples to guide you:

► Patient one. A 49-year-old black female, 5’5 and 120 lbs. has relatively new onset OSD. She occasionally experiences perimenopausal symptoms and takes hormone replacement and a daily multivitamin. She eats fish roughly twice a month. Prescribe a 1,000mg supplement in which EPA+DHA comprises at least 70% of the total amount of omega-3 fatty acid content. Some experts would suggest as high as 3,000 mg of EPA+DHA q.d., at least for the first four to six weeks.

► Patient two. A 68-year-old white male, 5’9 and 235 lbs. has an OSD history. He has hypertension, hypercholesterolemia, type 2 diabetes mellitus and had a “mild” heart attack two years ago. The patient has several small and a few large drusen O.U. He complies with his AREDS supplement and drugs. He eats fried shrimp twice a week. His in-office BP is 150/95. Recommend at least 1,500 mg EPA+DHA, with some experts suggesting 3,000mg q.d., or more with a physician to monitor potential bleeding risks.

Certain types of farmed or lake trout can provide the omega-3 needed to quiet OSD.

3. Use exam time.

Explain omega-3 intake and ocular surface health during biomiscroscopy and fundus exam time:

“A strong link exists between diet and eye health. Your dry eyes can very likely be significantly improved if we balance the fat types you eat. Although, ideally, we would meet all our nutritional needs through diet alone, that’s not always easy to do. Another, often easier, option is to take a high-quality omega-3 supplement.”

4. Provide written advice and sample supplements.

Give the patient specific written instructions and a sample supplement, if you sell them. If you don’t sell them, have the instructions include two or three supplement suppliers, in different price points, the recommended product, dosage, side effects and the possible benefits, including a time frame.

An extra minute or two

It takes only an extra minute or two to determine a general intake level, provide supplement patient education and recommend a specific intervention. OM

DR. REED IS AN ASSOCIATE PROFESSOR AT THE NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY IN FORT LAUDERDALE, FLA., A DIRECTOR OF THE OCULAR NUTRITION SOCIETY AND AUTHOR OF NUMEROUS ARTICLES ON OCULAR NUTRITION, DISEASE AND PHARMACOLOGY. SHE IS ALSO A FREQUENT CONTINUING EDUCATION LECTURER. E-MAIL DR. REED AT KIMREED@NOVA.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT.COM.