This article was originally published in a sponsored newsletter.

Introducing nutrition as a cornerstone of daily eye health is an essential conversation to have with our patients. While we emphasize treatments like artificial tears or lid hygiene, the role of diet in maintaining ocular health can't be understated. Nutritional support is not only preventive; it can also enhance the effectiveness of other treatments, particularly for chronic conditions such as dry eye disease (DED).

Evidence shows that Vitamin D, curcumin, lutein and zeaxanthin may benefit those with DED by promoting healthy tear production and improving both tear film quality and ocular surface health.¹

Omega-3 fatty acids have long been recognized for their anti-inflammatory properties, which are beneficial in managing DED, reducing the risk of diabetic retinopathy and supporting our macular degeneration and glaucoma patients.^2-5 However, there are many conflicting opinions and studies on Omega-3s, leaving an inconclusive consensus regarding their benefits. When considering the use of Omega fatty acids, prioritize the form, dose and ratio.
 
A well-known clinical trial, published in 2023 by Bhargava et al., demonstrated that Omega-3 supplementation can reduce both signs and symptoms of dry eye by improving the tear film's stability and reducing tear evaporation.² These fatty acids, found in fish oil and flaxseed, help maintain the integrity of the meibomian glands, which are crucial for producing the oily layer of the tear film. This layer is essential for preventing rapid tear evaporation and maintaining ocular surface health.

When introducing the topic of nutrition to patients, it's important to explain that these dietary adjustments are not just about eye health in isolation. Rather, they are part of a holistic approach to overall well-being. Encouraging patients to consume a diet that is rich in leafy greens, fatty fish, nuts and seeds can have wide-ranging benefits for cardiovascular health and cognitive function as well.
 
Supplements also offer a targeted approach for those who might struggle to get adequate nutrients from diet alone. While I always recommend getting nutrients from whole foods first, supplements can be a useful adjunct, especially for patients with specific conditions, including dry eye. By integrating these nutritional strategies into our patient care protocols, we can offer a more comprehensive approach to managing ocular health that goes beyond the surface and addresses underlying systemic factors.

While it may take an extra minute or two in the exam lane, incorporating discussions about nutrition into your practice is a simple yet powerful way to enhance patient outcomes. By educating patients about the benefits of vitamin D, curcumin, lutein, zeaxanthin and Omega-3 fatty acids, we can empower them to take an active role in maintaining their eye health. This approach not only supports their current treatment plans, but also provides a foundation for long-term ocular wellness.

References:

1. Gioia N, Gerson J, Ryan R, et al. A novel multi-ingredient supplement significantly improves ocular symptom severity and tear production in patients with dry eye disease: results from a randomized, placebo-controlled clinical trial. Front Ophthalmol. 2024 Apr 24;4:1362113. doi: 10.3389/fopht.2024.1362113
2. Bhargava R, Pandey K, Ranjan S, Mehta B, Malik A. Omega-3 fatty acids supplements for dry eye - Are they effective or ineffective? Indian J Ophthalmol. 2023 Apr;71(4):1619-1625. doi: 10.4103/IJO.IJO_2789_22
3. Sala-Vila A, Díaz-López A, Valls-Pedret C, et al. Dietary marine omega-3 fatty acids and incident sight-threatening retinopathy in middle-aged and older individuals with type 2 diabetes: prospective investigation from the PREDIMED Trial. JAMA Ophthalmol. 2016 Oct;134(10):1142-1149. doi: 10.1001/jamaophthalmol.2016.2906
4. Christen WG, Cook NR, Manson JE, et al. Effect of vitamin D and ω-3 fatty acid supplementation on risk of age-related macular degeneration: an ancillary study of the VITAL randomized clinical trial. JAMA Ophthalmol. 2020 Dec;138(12):1280-1289. doi: 10.1001/jamaophthalmol.2020.4409
5. Acar N, Berdeaux O, Juaneda P, et al. Red blood cell plasmalogens and docosahexaenoic acid are independently reduced in primary open-angle glaucoma. Exp Eye Res. 2009 Dec;89(6):840-853. doi: 10.1016/j.exer.2009.07.008

Cecelia Koetting, OD, FAAO is a clinical instructor at the University of Colorado School of Medicine. She is a fellow of the American Academy of Optometry, diplomate of the American Board of Optometry, an active American Optometric Association member, and she consults for multiple companies. Email her at Dr.CeceliaKoetting@gmail.com.