March 2013

 

CORNEA

 

Racing toward omega-3


by Maxine Lipner EyeWorld Senior Contributing Writer

   
Treatment group

Control group

PRK patients receiving omega-3 healed significantly faster than those in the control group.

Source (all): Nikki Heidi Ong, M.D.

First over the line for PRK healing

Omega-3 has become an integral part of many ophthalmic practices, with practitioners relying on it for everything from treatment of meibomitis and posterior blepharitis to ocular rosacea. Now, new study results published in the November 2012 issue of Cornea indicate that for those undergoing PRK, use of omega-3 is likewise beneficial, shaving time off healing and spurring a more rapid visual return, according to David J. Schanzlin, M.D., professor of ophthalmology, University of California, San Diego, and in private practice, Gordon-Weiss-Schanzlin Vision institute, La Jolla, Calif.

The idea for the study came to light when Nikki Heidi Ong, M.D., an international fellow at the Shiley Eye Center, La Jolla, Calif., approached Dr. Schanzlin about this. "We were going over postop questions and discussions, and she said, 'It seems to me that if we could decrease the inflammation after PRK and improve the tear status, we would get the epithelium to heal faster,'" Dr. Schanzlin recalled. After some thought, he urged her to run with the idea.

PRK's lag time

Even in this age of LASIK, PRK remains a necessity for many patients. "Twenty percent of patients get PRK instead of LASIK because they have some abnormality of their topography or they're involved with activities where they may get hit in the eye," Dr. Schanzlin said. However, unlike with LASIK, the hitch with PRK is that it can have some significant downtime. "The problem with PRK is that typically it takes five days for the surface to heal so the vision is blurry during that time and it's not all that comfortable," Dr. Schanzlin said. "So anything that could speed up the healing curve would make this a much more attractive surgery for patients, as well as their doctors." Currently, he views the healing time associated with PRK as prohibitive in comparison to LASIK. However, that could change. "If we could get patients to heal over a weekend, so that they had surgery on a Friday and then were back to work on Monday, then we would see the number of LASIK cases drop off drastically," Dr. Schanzlin said. "All of us realize that PRK is a very safe procedure and the results are as good or in some aspects perhaps even better than with LASIK, but no one wants to put patients through five days of wearing a bandaged lens, being stuck in the house, and not being able to drive their car as the eye is healing." He sees anything that could potentially make the eye heal faster as a good idea.

Omega-3's healing edge

In the prospective, masked study involving 18 patients, half were given omega-3 and the other half placebo. All were told to take it three times a day for two weeks prior to undergoing bilateral PRK. "Right after the surgery they had a photograph done with fluorescein," Dr. Schanzlin said. This photograph was then digitized and the area where the epithelium had been removed traced to determine the percent of corneal surface that had an epithelial defect. The test was repeated daily until the defect healed. When investigators here tracked the healing rate, they determined that this was faster in eyes that received the omega-3 than the placebo, Dr. Schanzlin said. Those who received the omega-3 had an average healing rate of 1.19% versus 0.83% for controls. "The treatment eyes all healed before day four compared to the other group where everyone healed by day six," Dr. Schanzlin said. "We got eyes to heal a day sooner on average." In addition, the treatment group had a significantly longer tear film breakup time compared to the controls, a benefit that was maintained through the three-month mark. When it came to the ultimate visual acuity, this was also better in the treated group. One month after surgery all of those taking omega-3 had attained 20/20 acuity versus just four of the control patients. Dr. Schanzlin found the results surprisingan impression echoed by others in the field. "When I tell my colleagues about this they all say that can't be, there's no way that makes a difference," he said. "But when you think about it, the omega-3 helps with tear status, provides a more stable tear, and decreases inflammation." Less inflammation allows epithelial cells to divide faster and cover the surface more rapidly, he explained.

"The most basic take-home message is that the tear film of the eye is important in any refractive surgery and certainly in the postop outcome," Dr. Schanzlin said. "This showed us that healthy tear film is important even during the healing phase." He pointed out that practitioners routinely have patients use steroid drops and antibiotics four times daily for surgery. "We use omega-3 frequently in the practice to control inflammation and to stimulate normal tear function, so it was logical to extend it to the PRK group," Dr. Schanzlin said.

Overall, he urges practitioners to place patients on omega-3 for any laser refractive surgery. "It stabilizes the tear film," he said. "Don't forget about the tear film and don't forget that omega-3 is part of our routine management of tear film."

Editors' note: Dr. Schanzlin has no financial interests related to this article.

Contact information

Schanzlin: 858-455-6800, Dschanz123@aol.com

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