title: Epithelial healing and visual outcomes of patients using omega-3 oral nutritional supplements before and after photorefractive keratectomy: a pilot study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla, CA 92093-0946, USA. nikkiheidimd@yahoo.com
authors.forename: Nikki Heidi
authors.initials: NH
authors.lastname: Ong
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Purcell
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Roch-Levecq
authors.forename: Dorothy
authors.initials: D
authors.lastname: Wang
authors.forename: Marichelle A
authors.initials: MA
authors.lastname: Isidro
authors.forename: Katia M
authors.initials: KM
authors.lastname: Bottos
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Heichel
authors.forename: David J
authors.initials: DJ
authors.lastname: Schanzlin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D019587:Dietary Supplements; D019573:Epithelium, Corneal / Q000502:physiology*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009216:Myopia / Q000601:surgery; D018903:Photorefractive Keratectomy; D010865:Pilot Projects; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D016037:Single-Blind Method; D013666:Tears / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014945:Wound Healing / Q000502:physiology*
chemical_list: D015525:Fatty Acids, Omega-3