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Epithelial Healing and Visual Outcomes of Patients Using Omega-3 Oral Nutritional Supplements Before and After Photorefractive Keratectomy: A Pilot Study

Ong, Nikki Heidi MD; Purcell, Tracy L. PhD; Roch-Levecq, Anne-Catherine PhD; Wang, Dorothy OD; Isidro, Marichelle A. MD; Bottos, Katia M. MD; Heichel, Christopher W. MD; Schanzlin, David J. MD

doi: 10.1097/ICO.0b013e31826905b3
Clinical Science

Purpose: To investigate the effect of omega-3 oral nutritional supplementation on corneal reepithelialization, visual acuity, and tear stability after photorefractive keratectomy (PRK).

Methods: This is a prospective, randomized, single-blinded controlled therapeutic trial using omega-3 oral nutritional supplements (TheraTears Nutrition for Dry Eyes; Advanced Vision Research—Akorn, Ann Arbor, MI) conducted at our center. Eighteen healthy patients with refractive error between −1 and −8 diopters were recruited and had bilateral PRK. The treatment group (n = 9 subjects) received omega-3 2 weeks before surgery through 1 month after PRK. The control group (n = 9 subjects) was not given omega-3. Epithelial defects were photographed on postoperative days 0 to 5. Reepithelialization (area in square millimeters) was assessed by fluorescein staining until healing. Tear breakup time (TBUT) and uncorrected distance visual acuity were measured at 1 week, and 1 and 3 months postoperatively.

Results: Epithelial defect in the treatment group eyes healed faster compared with that of the controls (P = 0.04). The treatment group eyes healed at an average rate of 1.19% [SD = 0.002; 95% confidence interval (CI), 1.04%–1.34%] per hour, versus 0.83% (SD = 0.0008; 95% CI, 0.77%–0.89%) for controls (Mann–Whitney rank-sum test, P < 0.001). The treatment group eyes maintained a significantly longer TBUT from week 1 through 3 months (mean = 9.52 seconds, SD = 0.81; 95% CI, 8.93–10.10), compared with the controls (mean = 5.52 seconds, SD = 0.81; 95% CI, 4.93–6.10; P < 0.001), and all reached 20/20 vision versus only 4 in the control group 1 month after surgery (P = 0.03).

Conclusions: Omega-3 oral nutritional supplements decreased the average time for epithelial healing, and improved TBUT and visual acuity recovery in PRK. These findings suggested that omega-3 oral nutritional supplementation may be a beneficial adjunct therapy for PRK patients.

Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla, CA.

Reprints: Nikki Heidi Ong, Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, 9415 Campus Point Dr, La Jolla, CA 92093-0946 (e-mail:

Presented at the American Society of Cataract and Refractive Surgery, March 27, 2011, San Diego, CA.

The authors state that they have no financial or proprietary interest in the materials or methods mentioned in this article.

Received May 19, 2012

Accepted July 9, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.