TNOA Journal of Ophthalmic Science and Research

: 2019  |  Volume : 57  |  Issue : 1  |  Page : 88--89

Journal scan

Aditya Pradhan 
 Department of Cornea, Disha Eye Hospital, Kolkata, West Bengal, India

Correspondence Address:
Dr. Aditya Pradhan
88 (63A), Ghoshpara Road, Kolkata - 700 120, West Bengal

How to cite this article:
Pradhan A. Journal scan.TNOA J Ophthalmic Sci Res 2019;57:88-89

How to cite this URL:
Pradhan A. Journal scan. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jul 4 ];57:88-89
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 N-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease

Dry Eye Assessment and Management Study Research Group, Asbell PA, Maguire MG, Pistilli M, Ying GS, Szczotka-Flynn LB, et al. N-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med 2018;378:1681-90.

Background: Dry eye disease is a common chronic condition that is characterized by ocular discomfort and visual disturbances that decrease quality of life. Many clinicians recommend the use of supplements of n-3 fatty acids (often called omega-3 fatty acids) to relieve symptoms. Methods: In a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n-3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group). The primary outcome was the mean change from baseline in the score on the ocular surface disease index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity), which was based on the mean of scores obtained at 6 and 12 months. Secondary outcomes included mean changes per eye in the conjunctival staining score (ranging from 0 to 6) and the corneal staining score (ranging from 0 to 15), with higher scores indicating more severe damage to the ocular surface, as well as mean changes in the tear break-up time (TBUT) (seconds between a blink and gaps in the tear film) and the result on Schirmer's test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs. Results: A total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively. The mean change in the OSDI score was not significantly different between the active supplement group and the placebo group (−13.9 points and − 12.5 points, respectively; mean difference in change after imputation of missing data, −1.9 points; 95% confidence interval (CI), −5.0–1.1; P = 0.21). This result was consistent across prespecified subgroups. There were no significant differences between the active supplement group and the placebo group in mean changes from baseline in the conjunctival staining score (mean difference in change, 0.0 points; 95% CI, −0.2–0.1), corneal staining score (0.1 point; 95% CI, −0.2–0.4), TBUT (0.2 s; 95% CI, −0.1–0.5), and result on Schirmer's test (0.0 mm; 95% CI, −0.8–0.9). At 12 months, the rate of adherence to treatment in the active supplement group was 85.2%, according to the level of n-3 fatty acids in red cells. Rates of adverse events were similar in the two trial groups. Conclusions: Among patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n-3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo.

Take clinic message

The trial found no evidence of a better outcome in the group who received oral n-3 fatty acid supplementation. Thus, there is no benefit in prescribing such supplements. However, patients who have been prescribed oral n-3 fatty acids elsewhere for systemic indications such as cardiovascular disease, inflammatory bowel disease, cognitive disorders, and other inflammatory diseases should continue their intake.

 Effects of Prolonged Reading on Dry Eye

Karakus S, Agrawal D, Hindman HB, Henrich C, Ramulu PY, Akpek EK. Effects of prolonged reading on dry eye. Ophthalmology 2018;125:1500-5.

Purpose: The purpose of this study is to demonstrate the effects of prolonged silent reading on tear film and ocular surface parameters. Design: This was a prospective, observational clinical study. Participants: A total of 177 patients with dry eye and 34 normal controls aged 50 years and older were included in this study. Methods: After evaluating symptoms using the ocular surface disease index (OSDI) questionnaire, the following tests were performed in consecutive order: automated noninvasive tear break-up time (TBUT), surface asymmetry and regularity indices, Schirmer's testing without anesthesia, corneal staining using fluorescein, and conjunctival staining using lissamine green. The participants were then asked to read a 30-min validated passage silently. The tests were repeated after the reading task. Main Outcome Measures: Changes in tear film and ocular surface parameters after reading. Results: All parameters, with the exception of surface asymmetry index, worsened after the reading task in patients with dry eye and controls. The worsening reached a statistical significance for corneal and conjunctival staining in the dry eye group (P < 0.001) and for corneal staining in the control group (P < 0.01). At baseline, OSDI scores correlated only with corneal and conjunctival staining scores (r = 0.19, P = 0.006 and r = 0.27, P < 0.001). Among postreading measurements, baseline OSDI scores correlated with TBUT (r = −0.15, P = 0.03) in addition to corneal and conjunctival staining (r = 0.25, P < 0.001 and r = 0.22, P = 0.001). Changes in TBUT and Schirmer's test correlated significantly with their respective baseline values (r = −0.61, P < 0.001 and r = −0.44, P < 0.001), indicating that the more unstable the tear film and the lower the aqueous tear secretion, the worse they became after the prolonged reading task. Worsening in corneal staining directly correlated with the baseline conjunctival staining (r = 0.17, P = 0.02) and surface regularity index (r = 0.21, P = 0.01). Conclusions: Evaluating tear film and ocular surface parameters at rest may miss clinical findings brought about by common everyday tasks such as reading, leading to discordance between patient-reported symptoms and clinician-observed signs. Quantifying dry eye after visually straining activities such as prolonged silent reading may help better understand patient symptomatology.

Take clinic message

This is a thought-provoking study which has shown that important tear film and surface parameters change significantly when exposed to a stress test of reading a standard passage in elderly individuals. This also reminds us that all the previous clinical trials have assessed these parameters at rest and the results may not hold true after exposure to a stress test.

 Surgical Management of Peripheral Corneal Thinning Disorders

Lohchab M, Prakash G, Arora T, Maharana P, Jhanji V, Sharma N, et al. Surgical management of peripheral corneal thinning disorders. Surv Ophthalmol 2018. pii: S0039-6257(18) 30049-3.

The peripheral corneal thinning disorders are associated with degenerative, autoimmune, or infective causes. Corneal thinning can subsequently affect the visual acuity either by inducing severe astigmatism or by progressive involvement of the central cornea. In addition to this, the integrity of the eye is at risk. Medical management is necessary to address the underlying inflammatory or infectious causes; however, most of the cases require surgical intervention for tectonic support or visual rehabilitation in patients with severe astigmatism. Preoperative investigations help in mapping the corneal curvature and thickness, thereby facilitating planning of treatment. Routine corneal transplantation techniques do not yield good results in peripheral corneal thinning disorders. Various surgical modifications have been described to manage these challenging cases. We review the available literature on causes and management of peripheral corneal thinning disorders.

Take clinic message

This is a comprehensive review article of the proper surgical management of peripheral thinning disorders and discusses the current literature and also certain modifications for optimal outcomes.

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Conflicts of interest

There are no conflicts of interest.