Fish Oil Pills, the Shingles Vaccine, Oh Eye!

HOT TOPIC

Fish Oil Does Not Protect Against AMD, New Study Finds

An abstract presented at the Association for Research in Vision and Ophthalmology meeting reported that fish oil supplements containing omega-3 fatty acids (EPA and DHA) do not reduce the risk of age-related macular degeneration (AMD). Researchers at Brigham and Women’s Hospital and Harvard Medical School analyzed data from the large-scale randomized controlled VITAL trial, which involved 25,871 participants 50 years of age and older, with a median follow-up of 5.3 years. A total of 555 participants developed incident AMD, including 363 with intermediate AMD and 192 with advanced AMD. Participants were assigned to receive either 1,000 mg/day of omega-3 supplements or a placebo. The hazard ratio for AMD incidence was 0.94, indicating no statistically significant protective effect of fish oil against AMD. This finding contradicts earlier observational studies, such as the Blue Mountains Eye Study, which suggested omega-3s might lower AMD risk due to their antiinflammatory properties and role in retinal health.

With its large sample size and randomized approach, the VITAL trial's robust design provides more substantial evidence that fish oil supplements do not prevent AMD. The study’s authors emphasize that lifestyle factors, particularly smoking cessation, have a greater effect on reducing AMD risk. For eye care professionals, this suggests a need to reassess recommendations about fish oil for AMD prevention. While omega-3s may still benefit cardiovascular and cognitive health, patients should be informed that current evidence does not support their use for AMD risk reduction. Instead, clinicians should focus on advising proven preventive measures, such as smoking cessation, UV protection, and a nutrient-rich diet, while awaiting further research on higher doses or extended supplementation periods.

My Two Cents

Although this trial seems exceptionally well thought out, it does contraindicate the Blue Mountains Eye Study. The potential lower effect of omega-3s on AMD risk inherently makes sense, as they have antiinflammatory effects. This tells us that perhaps the strong recommendation many of us make for our patients to include omega 3s in their diets to not only (potentially) benefit their dry eye and ocular surface issues, but also their systemic health may not be the homerun we all once thought it was.

Speaking of which, can you think of another supplement that has as many (or more) studies amounting to no real evidence that it has any benefit than omega-3 fish oils? It seems that for every study that shows the advantages of omega-3 fish oils, there is another saying it’s expensive urine our body isn’t getting anything out of. I take omega-3 supplements in pill form and The Dry Eye Drink PM, which contains the omega-3 DHA from algae, and I feel it helps my eyes and body.

OUTSIDE THE LANE

Shingles Vaccine Could Reduce Cardiovascular Risks

A study in the European Heart Journal reveals that the shingles vaccine may significantly reduce the risk of cardiovascular events, offering insights relevant to optometrists who often manage patients with systemic conditions affecting eye health.

Conducted by researchers in South Korea at Kyung Hee University, the study analyzed the medical records of more than 1.27 million individuals 50 years of age and older from 2012 to 2021. It found that those vaccinated with the live-attenuated shingles vaccine (SKYZoster, SK bioscience) had a 23% lower risk of cardiovascular conditions, a 26% reduced risk of significant events such as heart attacks and strokes, and a 22% lower risk of coronary heart disease. These benefits were most pronounced in the first 2 to 3 years post-vaccination but persisted up to 8 years. The protective effect is attributed to the vaccine’s ability to prevent shingles, which can cause inflammation, blood clots, and vascular damage—factors linked to cardiovascular and ocular complications such as herpes zoster ophthalmicus. For optometrists, this is significant, as herpes zoster ophthalmicus can lead to severe eye conditions, including keratitis and uveitis.

The study noted more substantial benefits in younger patients and in men, possibly due to immune response variations. However, it was limited to an Asian cohort, warranting further research in more diverse populations and with non-live vaccines such as the recombinant, adjuvanted zoster vaccine (Shingrix, GlaxoSmithKline). Optometrists should consider discussing shingles vaccination with patients, especially those with cardiovascular risk factors, as it may reduce systemic and ocular complications. Encouraging vaccination could complement existing preventive strategies, enhancing patient outcomes in both cardiovascular and eye health domains. Further studies are needed to confirm these findings and explore mechanisms linking shingles prevention to cardiovascular protection. (Read more here.)

My Two Cents

Yet another reason to talk to your patients about the shingles vaccine, as if helping them avoid the excruciating pain, lingering discomfort, and potential vision loss isn’t enough. If anyone ever asks whether they should get the shingles vaccine, you should emphatically answer YES!

CAN YOU RELATE

Another week, another report on reproxalap (Aldeyra) drama. After failing its second new drug application (NDA) submission, Aldeyra announced that its phase 3 clinical trial for reproxalap, a 0.25% ophthalmic solution for dry eye disease, met the primary endpoint of reducing ocular discomfort, achieving statistical significance (P = .002) compared with a vehicle in a controlled dry eye chamber trial. The results, which showed no notable baseline score differences across treatment arms, are believed to address prior FDA feedback following a rejected NDA. The company plans to resubmit the NDA in mid-2025, supported by a recent field trial.

So, what does this mean? Well, it’s a fascinating drama to observe from the outside. I’ve been extremely excited about reproxalap since I first heard about it from doctors at a convention just a few years ago. However, a failure is a failure. Is that something doctors will remember when they consider prescribing this medication if—or more than likely when—it becomes approved and available to prescribe? Will doctors be disenfranchised and never give this drug a fair shot? Let’s not forget, there are some notable prescription medications out there that also failed to gain FDA approval on their first try, including a pretty well-known drop (Restasis, AbbVie) that applied for and failed its NDA in 1999, then resubmitted it in 2002, when it gained approval. That seems to have worked out well for millions of our patients!

I’m not ready to rule this one out; I will keep an open mind about it and dig into the data of any medication that is safe and could help my patients with dry eye.

QUOTE OF THE WEEK

“Success is not final, failure is not fatal: It is the courage to continue that counts.”

— Winston Churchill