Introduction 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

Results Discussion

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.

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.

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.

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 high dose 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).

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.

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.

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

Innate immune system

The limitations of this preliminary study are (a) the limited number of subjects studied and (b) the lack of a placebo controlled treatment group. Additional clinical trials to address these limitations are currently in progress.

* Corresponding author at Ophthalmos Research and Educational Institute.

Morfou 48, Engomi, Nicosia, Cyprus. E-mail address: [email protected] (Dr. Tassos Georgiou) Ophthalmos Research and Educational Institute 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