Friday, February 15, 2008

Rebecca's journal: On to lemon

Well, my new breakfast routine of yoghurt with cinnamon flavored Barleans flaxseed oil has worked out so well that I thought I would venture to the next level: Lemonade flavor. (I'm not ready for the plain stuff yet, even in yoghurt.)

First, I had to get over my mostly-negative associations with the idea of "lemonade flavor". To me, this conjures up a host of artificially sweetened and colored lemonade products which I've always found abhorrent, even before I knew how bad any of the ingredients were.

So, my first step was a quick look at the label:

INGREDIENTS: Unrefined, unfiltered organic flaxseed oil, all-natural lemonade flavoring.

What, no Yellow Number Five?

So far so good.

Squirt squirt.

Stir stir.

Tentative lick.


Hm, seems fine. In fact, it reminds me that as a kid, when Mom would get those little Lucerne yoghurts on a 10-for-a-dollar sale, I always picked lemon flavor because I couldn't stand plain (this was decades before the revival of GOOD creamy yoghurt) but also disliked the sweet flavors. Haven't had one of those little flavored yoghurts in eons.

I think I'll stick with cinnamon for the present but it's nice to know lemon is an option. And (sigh) I suppose it's my bounden (is that a word?) duty to try the plain stuff one of these days. Stay tuned.

Wednesday, February 13, 2008

Study: Topical Omega-3 and Omega 6

Interesting. Maybe. But this is one of those studies that leaves me groaning. Like so many treatments, this is one where I can oh so easily visualize a small stampede of patients heading for the compounding pharmacy to get some new goop to try out, especially after all the recent discussions on Dry Eye Talk about application of various lipids on or near the eyes.

To all of whom my only comment is this:

Unless you are a small rodent that was recently injected with subcutaneous scopolamine to induce ocular dryness, are satisfied with experiencing 2 to 10 days of improved clinical signs of dry eye, and don't mind being euthanized within a few days, don't waste your time, money and emotional energy trying to personally replicate these results.

According to MedPage Today, Dr. Dana says "...clinical trials are being planned to see whether the results translate to restore the tear film in patients with dry eye. If successful, he said, topical application of fatty acids could alter the method by which this common condition is treated."

Frankly, I can hardly imagine a longer leap than from improved SIGNS in mice with some kind of artificially induced superficial dryness to improved SIGNS AND SYMPTOMS in humans. Wake me up when the double blind randomized human studies are complete, please.

If I sound overly skeptical, forgive me. My problem is not with what the authors are doing but with the ever-greater hype surrounding anything akin to a new idea in dry eye treatment. For goodness' sakes, even the ancient Greeks put fat in the eye for xerophthalmia.

Topical omega-3 and omega-6 Fatty acids for treatment of dry eye.
Rashid S, Jin Y, Ecoiffier T, Barabino S, Schaumberg DA, Dana MR
Arch Ophthalmol. 2008 Feb;126(2):219-25

OBJECTIVE: To study the efficacy of topical application of alpha-linolenic acid (ALA) and linoleic acid (LA) for dry eye treatment.
METHODS: Formulations containing ALA, LA, combined ALA and LA, or vehicle alone, were applied to dry eyes induced in mice. Corneal fluorescein staining and the number and maturation of corneal CD11b(+) cells were determined by a masked observer in the different treatment groups. Real-time polymerase chain reaction was used to quantify expression of inflammatory cytokines in the cornea and conjunctiva.
RESULTS: Dry eye induction significantly increased corneal fluorescein staining; CD11b(+) cell number and major histocompatibility complex Class II expression; corneal IL-1alpha and tumor necrosis factor alpha (TNF-alpha) expression; and conjunctival IL-1alpha, TNF-alpha, interferon gamma, IL-2, IL-6, and IL-10 expression. Treatment with ALA significantly decreased corneal fluorescein staining compared with both vehicle and untreated controls. Additionally, ALA treatment was associated with a significant decrease in CD11b(+) cell number, expression of corneal IL-1alpha and TNF-alpha, and conjunctival TNF-alpha.
CONCLUSIONS: Topical ALA treatment led to a significant decrease in dry eye signs and inflammatory changes at both cellular and molecular levels. Clinical Relevance Topical application of ALA omega-3 fatty acid may be a novel therapy to treat the clinical signs and inflammatory changes accompanying dry eye syndrome.

Study: Dry eye in children

No actual data in the abstract, but I'm pleased to see a non pediatric journal drawing attention to dry eye in children as it will raise awareness. Too often, dry eye or MGD goes undetected in kids.

If you have kids, take note please, especially if they seem to get infections or pink eye rather frequently. Don't get into the rut of fighting the fire of the day, and don't forget sometimes trees are evidence of a forest. Make sure their entire ocular surface health is carefully checked out.

Dry Eye in Childhood: Epidemiological and Clinical Aspects.
Alves M, Dias AC, Rocha EM.
Ocul Surf. 2008 Jan;6(1):44-51.

ABSTRACT Because dry eye disease is rare in children and its pathogenesis is less well known than in adults, its diagnosis is often overlooked. It can occur in association with a number of congenital, autoimmune, endocrine, and inflammatory disorders, or under certain environmental and nutritional conditions. In some cases, early detection allows the underlying cause of the dry eye to be successfully treated and eliminated. In other cases, the disease may represent a lifelong problem, whose proper management can prevent ulceration and scarring of the ocular surface. Because of the association of pediatric dry eye with other conditions, a multidisciplinary approach to diagnosis and treatment is usually required. The purpose of this review is to enhance physician awareness of dry eye in children, to describe the most frequently associated conditions, and to discuss the diagnostic and therapeutic options available.

Newsblurb: Botox and dry eye

A little clip from Korea:

Korean FDA warns of Botox side effects
Feb 13, 2008

Of the 52 cases, 17 complained of droopiness around the eyes, five of swelling and four of pain. Other complaints included three each of fever, tear secretion disorder, eye irritation, lagophthalmos (inability to close the eye), dry eye, and muscle weakness.

I think Botox is so firmly entrenched in the US that the "lesser" side effects related to dry eye are not getting much attention but this little snippet sums up some of my concerns about the mixed reports about Botox results - affecting tear film via several different mechanisms.

These 52 cases were from ~1300 samples. That's 4%.