Dry Eye - a new approach

Dry Eye - a new approach

Dry Eye Disease is a chronic, or long term condition which can cause ongoing discomfort, poor vision and at its worst serious permanent damage to the eyes.  With our current lifestyle and environment, it is also a condition which we are encountering more and more often.

Dry Eye is perhaps a poor name for a multi-factor condition, there may be not enough tears present, or the tears could be of a poor constitution with too much oil or protein in them.  At times we can even have too much tears, but they are watery and not very good at lubricating the eyes.

Surely tears are just tears?

Tears are a very complex structure:

They are designed to ensure the front surface of the eye is properly hydrated, protected from infection, environmental irritants and foreign bodies.  They are essential for good vision, when light enters the eye the tear film is the first layer that it must go through.  A poor quality tear film will interfere with our overall quality of vision, just think how bad it is to look through a car's windshield when it is smeared with greasy/muddy water.

In the past all we could really recommend to alleviate this condition was artificial tears to lubricate the eyes.  With continuing understanding of the tear film and the factors that affect it, though, we are now much better able to look at the causes of tear film and ocular surface issues and recommend personal regimes to restore balance to them.

Proper diagnosis is key.

Our TFOS (Tear Film and Ocular Surface) appointments will gather many different assessments of the eye, including the volume and osmolarity (saltiness) of the tear film.

Establishing baseline measurements and creating personal wellbeing programs ensures that as the condition is brought under control, not only does vision and comfort improve, but we can appropriately measure the success of the different steps that we take.

Dr. Euan McGinty and Dr. John Wilson have undertaken hours of specific training and education in this field to ensure that they are able to offer appropriate advice and care.  To book a TFOS assessment, please contact our office for an appointment.

Omega 3 Supplements (Part 2)

We continue our series of questions reviewing the benefits of Omega-3 fish oils with Drs. Wilson and McGinty (part one available here).

4. Can I not just eat more fish and not use supplements?

"YES!!!!!!! is the short answer. You would need to eat approximately 3.5oz of fish every day to acquire the desired daily amount of Omega 3 oil. You also need to remember that this figure can vary due to things like the variety of fish you choose or how it's prepared." Dr. Wilson answers, "As with most things fish is much healthier baked or broiled. Deep­ frying may just undo all the good work you're trying to do."

He goes on to add, "With supplements you have the really big advantage of consistency - you can know that you are consistent with your doctor recommended dosing regime.  Another advantage of using a supplement for Omega 3 is all reputable manufacturers screen their product for unwanted elements, like mercury, thus reducing the health risks associated with these heavy metals.  The supplements also make it easier to add in to a busy lifestyle, whereas switching to a fish rich diet may mean a major change for some."

5. So if I'm going to start taking these supplements, is there an omega 3 fish oil that is better quality?

"That's a really interesting question," Dr. McGinty responds, "To answer this it really is best to look at the kinds of fish oil supplements available, there two different kinds:

a) Triglyceride or TG and

b) Ethyl Ester or EE

TG is naturally occurring and the EE is synthesized chemically. Putting it another way. EE omega 3 is like having fruit juice made from concentrate and I for one prefer my juice freshly squeezed. TG
for me then!"

"Great point!" Dr. Wilson adds to the explanation, "There has been various studies into the comparison between the two forms and the long and short is that the EE is not absorbed nearly as effectively as the TG. Some studies showing an absorption rate up to 50 times slower for the EE derivative. Strike 2 for EE!"

"Looking into it further, there's also some debate about the harm that could come from the metabolism of the EE type in the intestines. During it's synthesis the EE form has a single fatty acid molecule bonded to an ethanol “backbone” whereas the naturally occurring TG has 3 fatty acid molecules bonded to a glycerol “backbone”. The ethanol is released when broken down in the gut and this for many is a cause for concern. That said, tests have shown that the amounts of ethanol (an alcohol) should be safe for humans. Not quite strike 3 but that bonding to the ethanol “backbone” also means technically that the EE form isn't a true oil.

That's a home run for TG in my game!"

6. Can I not just take omega 3,6 and 9 combined?

Dr. Wilson is enthusiastic to answer this question, "Firstly Omega 3 and 6 are essential acids and need to be consumed in our basic human diet through food sources or supplements. Omega 9 is non-­essential and as such isn't actually required so why supplement it at all.

Omega 3 has a potent anti­-inflammatory response in the body. This helps reduce the pain and swelling from most inflammatory responses in the body whereas Omega 6 has the complete polar opposite being pro-­inflammatory. Maintaining a balance between these two important acids is critical. The kicker is that Omega 6 is abundant in the Western diet so you're much less likely to need a supplement.

So, yes, you could take an Omega 3, 6 and 9 supplement but in the words of my esteemed business partner, Dr. Euan McGinty, “You can but you'd be wrong!”

In conclusion, I believe supplementation of Omega 3 fish oil in the Western diet is essential, but, as with many things, the simple rule is everything in moderation. Obtaining it in it's most natural form is always preferred and regularity works best. Always check with your doctor before starting any new medication or supplements.

Remember, we're always interested in peoples experiences, comments or concerns and would love to hear from you so please do not hesitate to fill in our contact form or reach us through our social media with a tweet or a post."

Many thanks to optometrists Dr. John Wilson and Dr. Euan McGinty for taking the time to answer these questions.

Omega 3 Supplements (Part 1)

Here at Ocean, Dr's Wilson and McGinty are strong advocates of the use of Omega-3 fish oil for the health of your eyes, especially when a patient has dry eyes.  We decided to interview our optometrists to find out more and answer some of the common questions that you may have about Omega-3 fish oils and the eyes.

1. Why Omega-3 fish oil? Won't flax seed or hemp oil do?

"There are 3 acids that make a complete omega 3 molecule. These are ALA, DHA and EPA.  ALA is found mainly in nuts and plants, e.g. walnuts and flax seed, but to a lesser degree in fish.  DHA and EPA are found to be more concentrated in fish derived Omega 3."  Dr. Wilson explains.

"Until recently, this wasn't considered an issue as all Omega-3 was really considered equally beneficial. More recently, however,  studies have found that the processing of ALA in the human body isn't nearly as efficient. It's conversion to the more usable DHA derivative is limited and slow."

"Now, I'm not saying there are no benefits to the ALA form."  Dr. Wilson adds, "It's still beneficial as a supplement for vegans and vegetarians who may wish not to take the fish oil, but you need to consume approximately 80% more than the equivalent fish oil supplement to achieve the same effect."

2. When should I take my fish oil?

Dr. McGinty responded, "Conventional reasoning states that Omega-3 supplementation should take place with meals, or just prior to meals. Probably to help combat the fishy aftertaste that is sometimes encountered by some and also to promote good uptake through digestion. It is also wise not to take fish oil prior to working­ out as this may cause gastrict distress."  

"Did you know that I used to have really trouble with taking them?" Dr. Wilson asks, "Then I was chatting about them with a retired pharmacist who said “Why don't you just freeze them and take them at night before bed?” I was amazed that this worked so quite often will recommend this to my patients and so far no-­one has complained of any gastric­ distress through the night"

"I had never heard of that" remarked a surprised Dr. McGinty, "every day's a school day!"

"Indeed!  I would value your feed­back if anyone tries it (good or bad I'm interested) so if you do try this tip, please e-mail me with how you get on: dr.john@oceanoptometry.ca."

3. How much fish oil should I take?

"Now, as optometrists we are dealing with the eyes primarily, but have to remember that the eyes are connected to the rest of the body and therefore have to consider any potential side ­effects." explains Dr. Wilson, "I never recommend more than the daily recommended amount of Omega-3 fish oil, which is between 900-­1200mg/day. This amount should contain a minimum of 600mg of DHA so check those labels carefully."

Dr. McGinty adds, "Sometimes you actually have to take 2-­3 times the amount of “oil” to get the appropriate concentrations depending on the quality and type of fish oil you choose. 

There are also times that amounts higher than this that may be recommended by your Physician for other health issues, especially increased blood triglycerides, but this is done in careful consideration of any other medications you're taking at the time. Omega-3 acids can both enhance and decrease the effectiveness of a number of medications."

"Absolutely" agrees Dr. Wilson, "There is even evidence that excessive amounts of Omega-3 can, in some people, increase their risk of stroke. I, for one, believe in everything in moderation so the daily recommended amount values sit well within my ethics and personal feelings."

To be continued .../ (Part 2)

Dry Eye - an interview with our optometrists

Dry eye complaints are something both our optometrists, Dr. John Wilson and Dr. Euan McGinty are seeing more and more of in their day to day consultations.

With people spending more time doing visually intensive tasks, working on computer screens for extended periods and working in environments with controlled atmospheres which are often dry, it is perhaps not surprising that it is becoming an increasingly common complaint.

Therefore, we decided to quiz our doctors a little further about dry eyes.

"While the symptoms of dry eyes can be very frustrating", John says, "the clinical issues associated with it can be equally significant.  A dry eye can often be a compromised eye and therefore more vulnerable to infections or even scar tissue formation.  These both can further complicate the picture and early intervention to provide long term management really is key."

"If you suffer from dry eyes, which can often be recognised through its signs and symptoms, then it is important to have it properly assessed so that we can give you the correct advice specific to your condition."

"This is important", Euan adds, "not all dry eyes are the same.  From that point of view we often have people whose symptoms can range from a burning/gritty sensation, an itchy sensation, to just some discomfort.  What is surprising is we also have patients whose eyes are watering, they can find it strange when we start to talk about 'dry eyes'."

"Looking at the eyes, patients can present with red eyes or inflammation of the tissues of the eye and eyelids, at other times the eye looks quiet and healthy, but the symptoms are all there.  From this point of view dry eyes can be an incorrect label, really we are talking about the tear film not functioning properly."

"When we are performing a dry eye assessment we will be looking at all of these factors, taking into account the symptoms, the appearance of the eye and the tear film and the quality and quantity of tears present.  This will help us to arrive at a care plan which is individual and appropriate for each patient."

"I can't agree more", adds John.  "This really isn't a one-size-fits-all type condition.  With an appropriate manage plan, the condition can often be turned completely around.  It does take effort and commitment from both the patient and ourselves, especially in the early days and weeks.  When we review patients and compare their initial metrics to those after appropriate management, the improvements can be marked."

"This can translate into real world differences, not just in their comfort, but also in their quality of vision."

We asked, is there any general advice which could be helpful?

Euan replied, "It's hard to be general, but there are some things which I do keep going back to.
 Firstly, not all artificial tears are the same.  It is important to find one which works well for you, although I would say that preservative free artificial tears are generally all better than others."

"There may be an element of trial and error to begin with, however, my go-to artificial tear at the moment is one called "Hylo".  This contains an excellent agent for nourishing and protecting the eye, Sodium Hyaluronate, which is found naturally in the tear film.  It comes in unique bottle allowing it to be both preservative free and usable for up to six months from first opening."

We have found this to be so successful we have decided to stock it in our office to make it easier to find, it is available at pharmacies and drug stores, however, some patients did comment that it was difficult to find.

As Hylo is preservative free it is also suitable for contact lens wearers to use, even with their contact lenses in.  So if you find that your contact lenses dry out your eyes or have difficulty in handling your lenses at the end of the day, this may just be the solution you are looking for.

"There are two things I keep coming back to as well," responds John, "Omega-3 fish oils and an eye mask"

Dr. John Wilson using a Thera Pearl Eye Mask

"The Omega-3 supplements have been shown to be useful in helping manage dry eye conditions, it is important to choose the fish oil, however, and not the flax seed oil (which may have other benefits).  There are certain things to look for, so a little research is definitely useful to ensure it will fit in with your needs and lifestyle."

"Eye masks are a great resource for patients with dry eyes.  We recommend the Thera Pearl eye mask and again have decided to always have it available here at Ocean, as we were so impressed.  It can be used for both warm compresses, to help open up the meibomian glands and improve their function, and cold compresses, to help calm down an angry and inflamed eye.  I have been so impressed with this simple product that I have one at home for myself to use!"

John concludes, "While this advice may not be for every patient, it may be beneficial for many patients and, at times, I do wonder if we should all be performing eye-lid cleaning and warm compresses as part of our daily routine, like brushing and flossing our teeth."

One final piece of advice from both or our optometrists: Don't forget the 20/20/20 rule - for every 20 minutes you are using your computer (or tablet/smartphone) you need to look at something 20 feet away for at least 20 seconds.

If you have any concerns about dry eye, please feel free to make an appointment.  The first step is a comprehensive eye examination to rule out other factors and then, if appropriate, we can schedule a dry eye assessment appointment.