Use of High-Dose Omega-3 Fatty Acids to Treat Macular Dystrophies.
Tassos Georgiou*, Anastasia Neokleous, Despina Nicolaou, Panagiotis Kolovos
Ophthalmos Research and Educational Institute. Nicosia, Cyprus
Introduction
Retinal Dystrophies refer to a range of eye
conditions which cause progressive damage to
rod and cone photoreceptors and most patients
eventually become blind. Retinitis Pigmentosa is
the most common retinal dystrophy. Yoshida et al
(1,2)
suggested that low grade chronic
inflammation may contribute to the disease
pathogenesis.
Results
The mean age of patients is 49 years ranging from 18 to 67 years old. Visual acuity ranged
from 20/25 to 20/400 with mean of 20/45. Eight right eyes and 8 left eyes. Ten eyes had
Retinitis Pigmentosa, 2 eyes had Best disease, 2 eyes had Adult Vitelliform dystrophy and 2
eyes had Cone dystrophy. We used a finger prick test to measure the blood ratio of
Arachidonic Acid to Eicosapentaenoic Acid (AA/EPA) for all patients.
Discussion
Our open pilot study indicates that high-dose omega-3 fatty
acids (5 to 10 grams of EPA and DHA per day) represents a
potentially new therapeutic approach for the treatment of
macular dystrophies. The dose of each patient should be
adjusted so that the AA/EPA is less than 2 to have the
maximum clinical benefit.
There is no cure for macular dystrophies. However, since these
appear to be inflammatory-mediated conditions, the use of highdose anti-inflammatory omega-3 fatty acids may offer a potential
long-term management approach. Our working hypothesis is
that resolution of inflammation in the eye may be mediated by
resolvins, especially those derived from EPA (3,4).
Currently there is no treatment to stop
progression or improve vision in these patients.
We hypothesized that high-dose omega-3 fatty
acids may provide improvement of visual function
due to its anti-inflammatory effects. This pilot
study was done to support that hypothesis.
Methods and Materials
The
Inflammation
Research
Foundation,
Marblehead, MA, supplied the omega-3 fatty acid
concentrates for the study.
The omega-3
concentrates consisted of purified ethyl esters
rich in EPA (400 mg) and DHA (200 mg) per
gram for the liquid formulation.
Sixteen eyes of 9 patients with retinal dystrophy
were treated with 5-10g of EPA/DHA orally in
liquid form. Best corrected visual acuity
measurements were noted using the ETDRS
electronic chart. Clinical examination and OCT
scans were performed to exclude any other
pathology. Patients were followed up for 6
months every 6 weeks. A blood test to check the
AA/EPA ratio was also measured using Gas
Chromatography.
* Corresponding author at Ophthalmos Research and Educational Institute.
Morfou 48, Engomi, Nicosia, Cyprus.
E-mail address: tassosgeorgiou@hotmail.com (Dr. Tassos Georgiou)
Ophthalmos Research and
Educational Institute
Figure 1. Visual acuity gain in letters. The eyes that had the greatest gain in vision were those who were taking 8-10g/day.
Patients taking 8-10g day had 11.1 letters gain at 6 months and patients taking 5g/day had 6.33 letters gain at 6 months.
Average gain is 9.63 letters at 6 months.
Innate immune system
The limitations of this preliminary study are (a) the limited
number of subjects studied and (b) the lack of a placebocontrolled treatment group. Additional clinical trials to address
these limitations are currently in progress.
Figure 2. Visual acuity gain in relation to AA/EPA ratio. Patients who had a ratio of AA/EPA less than 2 gained more
letters than patients who had a ratio of >2
References
1. Yoshida N et al. Clinical evidence of sustained chronic inflammatory reaction in retinitis pigmentosa. Ophthalmology 2013;120:100-105.
2. Yoshida N et al. Laboratory evidence of sustained chronic inflammatory reaction in retinitis pigmentosa. Ophthalmology 2012;120:e 1-5.
3. Li N et al. Resolvin E1 improves tear production and decreases inflammation in dry eye mouse model. J Ocul Pharmacol Ther 2010; 26:431-4394
4. Georgiou T, et al. Pilot study for treating dry age-related macular degeneration (AMD) with high-dose omega-3 fatty acids. Doi.org/10.1016/j.phanu.2013.10.001