I recommend a combined total of 1000-2000 mg/day of EPA and DHA. If you are not eating foods like wild tuna, salmon, mackerel, sardines, free range chicken, 100% grass fed and finished beef 2-3 times per week, you are likely deficient. Nutrigold Triple 3 Omega Gold fish oil provides 750 mg EPA and 250 mg DHA in one capsule. A 2:1 ratio of EPA to DHA would be preferred but it’s one pill in a pharmaceutical grade, certified source at a reasonable price. Ocean Blue Omega 3 2100 is a similar product. BlueCarlson, Nordic Naturals and Biosyntrx are other good brands and there are now algae based sources of EPA and DHA for vegetarians and people concerned with overfishing. Always keep Omega 3 supplements in the refrigerator to keep them fresh and take them with food.
While ground flaxseed is an excellent source of fiber and may may help prevent breast and prostate cancer, all plant based sources of Omega 3 provide ALA, which does not convert to EPA and DHA very well, especially in men.
Since the ratio of Omega 6 to Omega 3 in the diet is also important, try to reduce your intake of Omega 6 oils by eating less meat from grain fed animals and less processed foods (which typically use Omega 6 oils for their longer shelf life).
Supplements for Macular Degeneration
Oculair by Biosyntrx is an excellent quality full-spectrum vitamin/mineral/antioxidant nutritional supplement. See the Science tab for the scientific rationale for their formula. The recommended dosage is 4 capsules a day, two with breakfast and two with dinner. While I would recommend the full dose for any patient with macular degeneration or high risk of macular degeneration, even at half dose (one capsule with breakfast and one with dinner), Oculair is far superior to the ever popular, Centrum Silver, and includes 7.5 mg of lutein and 2.35 mg of zeaxanthine, which have been shown to reduce progression macular degeneration. Oculair can be purchased in our office or directly from Biosyntrx online.
Note: Biosyntrx does not include Omega 3s in their product because they have a much shorter shelf life so I would also add 1000-2000 mgs of EPA+DHA described above if you are not getting them in your diet naturally.
Alcon iCaps with Lutein and Omega 3 is an alternate vitamin/mineral supplement that is beneficial for patients with macular degeneration and is readily available in drugstores. It is only one capsule a day, the components are good quality and it contains 10 mg of lutein and 2 mg of zeaxanthin which has been shown to be protective against macular degeneration. However it is not a complete vitamin/mineral supplement and it only contains 280 mg of Omega 3 (of undisclosed type) so a multivitamin and an Omega 3 supplement (described above) should be taken along with the iCaps.
There are an increasing number of coconut oil products out there. The key is to use cold-pressed virgin coconut oil for maximum benefits. It will have a coconut flavor. Anything other than cold-pressed virgin oil is refined which, depending on the method used, can significantly decrease the benefits of the oil. That is true for other oils, like olive oil, too. I currently use Tropical Traditions Expeller-Pressed Coconut Oil when I don’t want the coconut flavor. It is not super-heated or chemically extracted so it still provides most of the benefits of the coconut oil without the coconut taste. For more information on coconut oil see my blog post In Defense of Coconut Oil.
HypoChlor lid cleanser- used twice daily for 2 weeks for treatment of blepharitis and some dry eye. It is available in our office or online.
Ocusoft Original or Plus formula Lid Scrubs, TheraTears Sterilid Eyelid Cleanser, Systane lid wipes or Blephadex lid wipes for daily maintenance care of lids.
Cliradex is a tea tree oil based formulation with convenient moist towelettes. I do not currently carry it in the office but it is available online. You can also make a tea tree oil formulation at home, if desired.
OTC Allergy Eye Drops
Look for products containing ketitofen including Alaway, Zaditor, Zyrtec Allergy Eyes, etc. They can be used twice a day as needed for allergy symptoms. Wait at least 15 min after using the drops before putting in contact lenses. The drops do sting quite a bit but they are far more effective than older allergy drops like Vasocon-A. If symptoms do not improve, you should schedule an appointment.
Look for brands such as Optive, Refresh, Genteal, Theratears, Bion Tears, Blink, Retaine, Systane, and Endura that come in either non-preserved and/or gentle preservative formulas. Avoid any products preserved with benzalkonium chloride (BAK or BAC). It is toxic to the cornea and can actually make your eyes dryer when used regularly.
Systane Balance and Refresh Optive Advanced are good for patients with problems with the oil layer of tears. Gel formulations last longer but tend to blur the vision so they are generally used in more severe cases of dry eye or at bedtime. Ointments like Refresh PM are generally reserved for use at bedtime.
Retaine by Ocusoft is a non-preserved artificial tear that uses a new nanoemulsion formula that prolongs the effect of the drop in the eye without causing blur like most longer-acting artificial tears. It is currently only available at Walgreens, online or at doctor’s offices. I have heard very positive reports from other doctors but I do not carry it in the office at this time.
Biotears Supplement For Dry Eyes
Biotears is a nutritional supplement specifically formulated for patients with dry eyes. It may also help increase lubrication of other mucous membranes and joints. I generally recommend supplementing with 1000-2000 mg of the Omega 3s EPA + DHA first since most people are deficient and that can help dry eye symptoms in addition to other health benefits. But if dryness persists, I recommend Biotears. The scientific rationale is provided on the Science tab of the webpage. We have the product in the office or you can order it directly from Biosyntrx. It takes a 4-6 wks for the full effect but they provide a 60 day money back guarantee.
F.lux is a freeware program that changes the color temperature of your computer monitor/iPhone/tablet so itmatches the lighting in the room, typically making it less blue after sunset, reducing eyestrain. If you do a lot of computer work in the evening, it may also help you sleep at night because the decrease in blue light triggers the production of melatonin which in turn helps make you sleepy. The program also allows you to easily change the intensity of the monitor with hotkeys and you can temporarily disable it if you are doing color sensitive work such as editing images.