Key Findings
Modulating the ocular immune response should be beneficial for reducing contact lens discomfort (CLD). The aim of this study was to compare different anti inflammatory approaches, comprising a topical corticosteroid (as a ‘gold-standard’ anti-inflammatory drug suitable for acute modulation of inflammatory responses) and three forms of omega-3 EFA supplements (long-chain, combined long- and short chain, and long-chain topical), as therapeutic approaches for modulating the chronic low-grade inflammatory response in CLD. Using a within-subject design, the data show that acute application of a low-potency topical corticosteroid (FML 0.1%, tid for 2 weeks) significantly reduces some tear inflammatory markers in CLD. The degree of improvement is similar to the effect imparted by long-term oral long-chain omega-3 supplements (fish oil: 900 mg/d EPA and 600 mg/d DHA for 12 weeks). At week 12, tear levels of IL-17A were reduced from baseline in both the oral fish oil and topical omega-3 groups, compared with placebo; a similar trend was observed in the oral combined long- and short-chain omega-3 supplement group. Eye drop formulations of omega-3 fatty acids may be a viable alternative for people who would prefer not to consume oral supplements. In conclusion, this trial demonstrates parallels between how inflammation in CLD is modulated with an acutely administered, low-potency topical corticosteroid and longer term (12 week) use of omega-3 EFA supplements. Both oral and topical forms of omega-3 supplements also induced relative reductions in the tear concentration of key proinflammatory cytokines. Addition of short-chain omega-3 fatty acids did not provide any additional benefit in modulating tear inflammatory cytokines, compared with a long-chain supplement alone.
ABSTRACT
Purpose: To assess the efficacy of anti-inflammatory approaches, comprising a topical corticosteroid and omega-3 supplements, for modulating the inflammatory overlay associated with contact lens discomfort (CLD). Methods: This randomized controlled trial involved 72 adults with CLD, randomized (1:1:1:1) to one of the following: placebo (oral olive oil), oral fish oil (900 mg/d eicosapentaenoic acid [EPA] + 600 mg/d docosohexaenoic acid [DHA]), oral combined fish+flaxseed oils (900 mg/d EPA + 600 mg/d DHA + 900 mg/d alpha-linolenic acid), or omega-3 eye-drops (0.025% EPA + 0.0025% DHA four times per day [qid]) for 12 weeks, with visits at baseline, weeks 4 and 12. At week 12, participants who received placebo were assigned a low-potency corticosteroid (fluorometholone [FML] 0.1%, drops, three times per day [tid]) for 2 weeks (week 14). Results: Sixty-five participants completed the primary endpoint. At week 12, contact lens dry-eye questionnaire (CLDEQ-8) score was reduced from baseline with oral fish oil (-7.3 ± 0.8 units, n = 17, P < 0.05), compared with placebo (-3.5 ± 0.9 units, n = 16). FML produced significant reductions in tear IL-17A (-71.1 ± 14.3%, n = 12) and IL-6 (-47.6 ± 17.5%, n = 12, P < 0.05) relative to its baseline (week 12). At week 12, tear IL-17A levels were reduced from baseline in the oral fish oil (-63.2 ± 12.8%, n = 12, P < 0.05) and topical omega-3 (-76.2 ± 10.8%, n = 10, P < 0.05) groups, compared with placebo (-3.8 ± 12.7%, n = 12). Tear IL-6 was reduced with all omega-3 interventions, relative to placebo (P < 0.05) at week 12. Conclusions: CLD was attenuated by oral long-chain omega-3 supplementation for 12 weeks. Acute (2 week) topical corticosteroids and longer-term (12 week) omega-3 supplementation reduced tear levels of the proinflammatory cytokines IL-17A and IL-6, demonstrating parallels in modulating ocular inflammation with these approaches.
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