Review of Nutritional Supplementation Options for the Anterior Segment: An Evidence Based Approach

Authors

  • Allan Slomovic, MD, FRCSC Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto
  • Manokamna Agarwal, MD Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto

DOI:

https://doi.org/10.58931/cect.2024.3241

Abstract

The anterior segment of the eye is a metabolically active system, which includes the ocular surface of the eye and extends posteriorly to the crystalline lens. Ocular surface diseases often disrupt the complex interplay of cornea, conjunctiva, meibomian glands, eyelids, and the lacrimal system, leading to diminished visual acuity and discomfort, and occasionally to frank pain. This can negatively impact the patient’s quality of life. Other anterior segment diseases including keratoconus, glaucoma, and cataract may also affect visual acuity. Oxidative stress and inflammation have been investigated in pathogenesis of these diseases. There has been an increase in the number of studies investigating various nutritional supplements benefiting the anterior segment structures. This review discusses the role of these supplements with supported clinical evidence. 

Author Biographies

Allan Slomovic, MD, FRCSC, Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto

Dr. Slomovic is the Vice Chair of Education and Continuing Education Director for the Department of Ophthalmology and Vision Sciences at the University of Toronto. He is also the Clinical Director of the Cornea/External Disease Service at the Toronto Western Hospital, University Health Network. He is the past President of the Canadian Ophthalmologic Society and previous Chair of the Canadian Cornea and External Disease Society for the Canadian Ophthalmological Society. Dr. Slomovic is a Professor of Ophthalmology at the University of Toronto and the Marta and Owen Boris Endowed Chair in Cornea and Stem Cell Research at the University Health Network. Prior to starting medical school, Dr. Slomovic completed a master’s degree in Clinical Psychology at the University of Montreal. He then went on to do his medical school training at Memorial University in St. John’s Newfoundland, followed by an internship in Internal Medicine at The Montreal General Hospital. Dr. Slomovic then went on to complete a 3-year residency training program at the New York University School of Medicine in Manhattan, New York. This was followed by 2 separate Fellowship programs at the Bascom Palmer Eye Institute in Miami, Florida. The first fellowship was in Cornea/External Ocular Diseases and the second was in Laser Microsurgery. Dr. Slomovic has been involved with teaching residents and fellows, research and clinical practice over the past 35 years at the University Health Network. He was the program Director for Ophthalmology for the University of Toronto for 10 years (1991-2001) and has led the program through 2 successful Royal College reviews. He has also trained 47 fellows in Cornea/External Ocular Diseases of the Eye from all over the world, including Canada, United States, Israel, Australia, Singapore, Malaysia, Thailand, the Philippines, and Great Britain. In 2001, Dr. Slomovic was awarded the Mentor of the Year Award by the Royal College of Physicians of Canada.  Dr. Slomovic is the inaugural winner of this award in the province of Ontario. Dr. Slomovic has published numerous articles in the area of Cornea/External Diseases of the Eye and Refractive Surgery and has also lectured on these topics locally, nationally and internationally. In March 2014, Dr Slomovic was nominated by Toronto Life as one of Toronto’s best doctors. He has been nominated as one of Toronto’s “Top Doctors” by City Post for the past 3 consecutive years. 

Manokamna Agarwal, MD, Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto

Dr. Agarwal is currently working as a Cornea, External Diseases, and Refractive surgery fellow at the University of Toronto. After completing her residency in Ophthalmology and a long-term Cornea fellowship in India, she worked with Dr. Allan Slomovic as a research fellow in ocular surface disorders. Additionally, she also holds a postdoctoral fellowship in paediatric corneal diseases from SickKids in Toronto.

References

Snell RS, Lemp MA. Clinical anatomy of the eye. John Wiley & Sons; 2013 Apr 9.

Dogru M, Wakamatsu T, Kojima T, et al. The role of oxidative stress and inflammation in dry eye disease. Cornea. 2009 Oct 1;28(11):S70-4. DOI: https://doi.org/10.1097/ICO.0b013e3181ae8689

Celebi AR, Ulusoy C, Mirza GE. The efficacy of autologous serum eye drops for severe dry eye syndrome: a randomized double-blind crossover study. Graefe’s Arch Clin Exp Ophthalmol. 2014 Apr;252:619-26. DOI: https://doi.org/10.1007/s00417-014-2599-1

Hussain M, Shtein RM, Sugar A, et al. Long-term use of autologous serum 50% eye drops for the treatment of dry eye disease. Cornea. 2014 Dec 1;33(12):1245-51. DOI: https://doi.org/10.1097/ICO.0000000000000271

Tananuvat N, Daniell M, Sullivan LJ, et al. Controlled study of the use of autologous serum in dry eye patients. Cornea. 2001;20:802-6. DOI: https://doi.org/10.1097/00003226-200111000-00005

Noble BA, Loh RSK, MacLennan S, et al. Comparison of autologous serum eye drops with conventional therapy in a randomised controlled crossover trial for ocular surface disease. Br. J Ophthalmol. 2004;88:647-52. DOI: https://doi.org/10.1136/bjo.2003.026211

Kojima T, Ishida R, Dogru M, et al. The effect of autologous serum eyedrops in the treatment of severe dry eye disease: A prospective randomized case-control study. Am J Ophthalmol. 2005;139:242-66. DOI: https://doi.org/10.1016/j.ajo.2004.08.040

Wang L, Cao K, Wei Z, et al. Autologous serum eye drops versus artificial tear drops for dry eye disease: a systematic review and meta-analysis of randomized controlled trials. Ophthalmic Res. 2020 Aug 19;63(5):443-51. DOI: https://doi.org/10.1159/000505630

Alio JL, Rodriguez AE, WróbelDudzińska D. Eye platelet-rich plasma in the treatment of ocular surface disorders. Curr Opin Ophthalmol. 2015;26(4):325-32. DOI: https://doi.org/10.1097/ICU.0000000000000169

Wróbel-Dudzińska D, Alio J, Rodriguez A, et al. Clinical efficacy of platelet-rich plasma in the treatment of neurotrophic corneal ulcer. J Ophthalmol. 2018;2018: 3538764. DOI: https://doi.org/10.1155/2018/3538764

Ronci C, Ferraro AS, Lanti A, et al. Platelet-rich plasma as treatment for persistent ocular epithelial defects. Transfus Apher Sci. 2015;52(3):300-4. DOI: https://doi.org/10.1016/j.transci.2014.12.027

Alio JL, Rodriguez AE, Abdelghany AA, et al. Autologous platelet-rich plasma eye drops for the treatment of post-LASIK chronic ocular surface syndrome. J Ophthalmol. 2017;2017:2457620-2457626. DOI: https://doi.org/10.1155/2017/2457620

Panda A, Jain M, Vanathi M, et al. Topical autologous platelet-rich plasma eyedrops for acute corneal chemical injury. Cornea. 2012 Sep 1;31(9):989-93. DOI: https://doi.org/10.1097/ICO.0b013e3182114661

Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;105(SUPPL. 1):13-33. DOI: https://doi.org/10.1160/THS10-11-0720

Metheetrairut C, Ngowyutagon P, Tunganuntarat A, et al. Comparison of epitheliotrophic factors in platelet-rich plasma versus autologous serum and their treatment efficacy in dry eye disease. Sci Rep. 2022;12(1):8906. DOI: https://doi.org/10.1038/s41598-022-12879-x

Akowuah PK, Obinwanne CJ, Owusu E, et al. Platelet-rich plasma for treating dry eye disease–A systematic review and meta-analysis. Cont Lens and Anterior Eye. 2023 Nov 10:102091. DOI: https://doi.org/10.1016/j.clae.2023.102091

Rocha GA, Acera A, Durán JA. Laser in situ keratomileusis flap necrosis after trigeminal nerve palsy. Arch Ophthalmol. 2007 Oct 1;125(10):1423-5. DOI: https://doi.org/10.1001/archopht.125.10.1423

López-Plandolit S, Morales MC, Freire V, et al. Plasma rich in growth factors as a therapeutic agent for persistent corneal epithelial defects. Cornea. 2010 Aug 1;29(8):843-8. DOI: https://doi.org/10.1097/ICO.0b013e3181a81820

Guarnieri A, Alfonso-Bartolozzi B, Ciufo G, et al. Plasma rich in growth factors for the treatment of rapidly progressing refractory corneal melting due to erlotinib in nonsmall cell lung cancer. Medicine (Baltimore). 2017 Jun 1;96(22):e7000. DOI: https://doi.org/10.1097/MD.0000000000007000

Merayo-Lloves J, Sanchez RM, Riestra AC, et al. Autologous plasma rich in growth factors eyedrops in refractory cases of ocular surface disorders. Ophthalmic Res. 2015;55:53-61. DOI: https://doi.org/10.1159/000439280

Lozano-Sanroma J, Barros A, Alcalde I, et al. Impact of plasma rich in growth factors (PRGF) eye drops on ocular redness and symptomatology in patients with dry eye disease. Medicina. 2023 May 11;59(5):928. DOI: https://doi.org/10.3390/medicina59050928

Sanchez-Avila RM, Merayo-Lloves J, Riestra AC, et al. Treatment of patients with neurotrophic keratitis stages 2 and 3 with plasma rich in growth factors (PRGF-Endoret) eye-drops. Int Ophthalmol. 2018;38:1193-1204. DOI: https://doi.org/10.1007/s10792-017-0582-7

Unterlauft JD, Kohlhaas M, Hofbauer I, et al. Albumin eye drops for treatment of ocular surface diseases. Der Ophthalmologe. 2009 Oct;106:932-7. DOI: https://doi.org/10.1007/s00347-009-2057-3

Higuchi A, Ueno R, Shimmura S, et al. Albumin rescues ocular epithelial cells from cell death in dry eye. Curr Eye Res. 2007 Jan 1;32(2):83-8. DOI: https://doi.org/10.1080/02713680601147690

Seki JT, Sakurai N, Moldenhauer S, et al. Human albumin eye drops as a therapeutic option for the management of keratoconjunctivitis sicca secondary to chronic graft-versus-host disease after stem-cell allografting. Curr Oncol. 2015 Oct;22(5):357-63. DOI: https://doi.org/10.3747/co.22.2620

Gürlü VP, Demir M, Alimgil ML, et al. Systemic and topical fresh-frozen plasma treatment in a newborn with ligneous conjunctivitis. Cornea. 2008 May 1;27(4):501-3. DOI: https://doi.org/10.1097/ICO.0b013e318162a8e0

Heidemann DG, Williams GA, Hartzer M, Ohanian A, Citron ME. Treatment of ligneous conjunctivitis with topical plasmin and topical plasminogen. Cornea. 2003 Nov 1;22(8):760-2. DOI: https://doi.org/10.1097/00003226-200311000-00009

Dudok DV, Nagdee I, Cheung K, et al. Effects of amniotic membrane extract on primary human corneal epithelial and limbal cells. Clin Exp Ophthalmol. 2015 Jul;43(5):443-8. DOI: https://doi.org/10.1111/ceo.12480

Murri MS, Moshirfar M, Birdsong OC, et al. Amniotic membrane extract and eye drops: a review of literature and clinical application. Clin Ophthalmol. 2018 Jun 18:1105-12. DOI: https://doi.org/10.2147/OPTH.S165553

Pérez ML, Barreales S, Sabater-Cruz N, et al. Amniotic membrane extract eye drops: a new approach to severe ocular surface pathologies. Cell and Tissue Bank. 2022 Sep;23(3):473-81. DOI: https://doi.org/10.1007/s10561-021-09962-4

Sabater-Cruz N, Figueras-Roca M, Ferrán-Fuertes M, et al. Amniotic membrane extract eye drops for ocular surface diseases: use and clinical outcome in real-world practice. Int Ophthalmol. 2021 Sep;41:2973-9. DOI: https://doi.org/10.1007/s10792-021-01856-4

Kim EC, Choi JS, Joo CK. A comparison of vitamin a and cyclosporine a 0.05% eye drops for treatment of dry eye syndrome. Am J Ophthalmol. 2009 Feb 1;147(2):206-13. DOI: https://doi.org/10.1016/j.ajo.2008.08.015

Toshida H, Funaki T, Ono K, et al. Efficacy and safety of retinol palmitate ophthalmic solution in the treatment of dry eye: a Japanese Phase II clinical trial. Drug Des Devel Ther. 2017 Jun 23:1871-9. DOI: https://doi.org/10.2147/DDDT.S137825

Chelala E, Dirani A, Fadlallah A, et al. The role of topical vitamin A in promoting healing in surface refractive procedures: a prospective randomized controlled study. Clin Ophthalmol. 2013 Sep 24:1913-8. DOI: https://doi.org/10.2147/OPTH.S52280

Ozen S, Ozer MA, Akdemir MO. Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain. Graefe’s Arch Clin Exp Ophthalmol. 2017 Jun;255:1173-7. DOI: https://doi.org/10.1007/s00417-017-3632-y

Schiffman RM, Bradford R, Bunnell B, et al. A multicenter, double-masked, randomized, vehicle-controlled, parallel-group study to evaluate the safety and efficacy of testosterone ophthalmic solution in patients with meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2006;47: E-Abstract 5608.

Dogru M, Matsumoto Y, Yamamoto Y, et al. Lactoferrin in Sjögren’s syndrome. J Ophthalmol. 2007 Dec 1;114(12):2366-7. DOI: https://doi.org/10.1016/j.ophtha.2007.06.027

Higuchi A, Takahashi K, Hirashima M, et al. Selenoprotein P controls oxidative stress in cornea. PLoS One. 2010 Mar 29;5(3):e9911. DOI: https://doi.org/10.1371/journal.pone.0009911

Asbell PA, Maguire MG, Peskin E, et al. Dry eye assessment and management (DREAM) study: study design and baseline characteristics. Contemp Clin Trials. 2018 Aug 1;71:70-9. DOI: https://doi.org/10.1016/j.cct.2018.06.002

Medeiros-de-Moraes IM, Gonçalves-de-Albuquerque CF, Kurz AR, et al. Omega-9 oleic acid, the main compound of olive oil, mitigates inflammation during experimental sepsis. Oxid Med Cell Longev. 2018 Oct;2018. DOI: https://doi.org/10.1155/2018/6053492

O’Byrne C, O’Keeffe M. Omega‐3 fatty acids in the management of dry eye disease—An updated systematic review and meta‐analysis. Acta Ophthalmologica. 2023 Mar;101(2):e118-34. DOI: https://doi.org/10.1111/aos.15255

Kris-Etherton PM, Harris WS, Appel LJ. Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol. 2003 Feb 1;23(2):151-2. DOI: https://doi.org/10.1161/01.ATV.0000057393.97337.AE

Christen WG, Manson JE, Glynn RJ, et al. A randomized trial of beta carotene and age-related cataract in US physicians. Arch Ophthalmol 2003;121:372-8. DOI: https://doi.org/10.1001/archopht.121.3.372

A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Arch Ophthalmol 2001;119:1439-52. DOI: https://doi.org/10.1001/archopht.119.10.1439

McNeil JJ, Robman L, Tikellis G, et al. Vitamin E supplementation and cataract: randomized controlled trial. J Ophthalmol. 2004;111:75-84. DOI: https://doi.org/10.1016/j.ophtha.2003.04.009

Christen W, Glynn R, Sperduto R, et al. Age-related cataract in a randomized trial of beta-carotene in women. Ophthalmic Epidemiol. 2004;11:401-12. DOI: https://doi.org/10.1080/09286580490515152

Ramdas WD, Schouten JS, Webers CA. The effect of vitamins on glaucoma: a systematic review and meta-analysis. Nutrients. 2018 Mar 16;10(3):359. DOI: https://doi.org/10.3390/nu10030359

Meng YF, Lu J, Xing Q, et al. Lower serum vitamin D level was associated with risk of dry eye syndrome. Med Sci Monit. 2017;23:2211. DOI: https://doi.org/10.12659/MSM.901857

Askari G, Rafie N, Miraghajani M, et al. Association between vitamin D and dry eye disease: A systematic review and meta-analysis of observational studies. Cont Lens Anterior Eye. 2020 Oct 1;43(5):418-25. DOI: https://doi.org/10.1016/j.clae.2020.03.001

Akkaya S, Ulusoy DM. Serum vitamin D levels in patients with keratoconus. Ocul Immunol and Inflamm. 2020 Apr 2;28(3):348-53. DOI: https://doi.org/10.1080/09273948.2019.1604002

Gorimanipalli B, Shetty R, Sethu S, et al. Vitamin D and eye: Current evidence and practice guidelines. Indian J Ophthalmol. 2023 Apr 1;71(4):1127-34. DOI: https://doi.org/10.4103/IJO.IJO_3174_22

Downloads

Published

2024-06-18

How to Cite

1.
Slomovic A, Agarwal M. Review of Nutritional Supplementation Options for the Anterior Segment: An Evidence Based Approach. Can Eye Care Today [Internet]. 2024 Jun. 18 [cited 2024 Jul. 24];3(2):4–9. Available from: https://canadianeyecaretoday.com/article/view/3-2-slomovic_et_al

Issue

Section

Articles