Syfte: Syftet med studien var att genom en litteraturstudie undersöka om tillskott av omega-3 har någon positiv påverkan på torra ögon och ögats främre delar. Kan denna fleromättade fettsyra lindra symtomen samt de kliniska tecknen av torra ögon? Metod: Artiklarna i litteraturstudien baserades på tidigare kliniska studier och vetenskapliga publikationer. De sökmotorer som användes var PubMed och Web of Science, sökningarna utfördes mellan 2020-03-30 och 2020-04-15. För att göra urvalsprocessen sattes inklusionskriterier och exklusionskriterier upp. Begränsningarna var att artiklarna skulle finnas tillgängliga i fulltext och vara publicerade från år 2015-2020. Sökorden som användes var “dry eye + omega” och “dry eye and omega”. Litteraturstudier/reviews exkluderades samt studier med färre än 50 deltagare. Utifrån resultatet av sökningarna valdes de fem mest relevanta artiklarna ut för att ingå i studien. Resultat: Studierna involverade totalt 2569 deltagare. Tillskotten som användes i studierna var omega-3 i olika sammansättningar. De subjektiva mätningarna gjordes med Ocular Surface Disease Index (OSDI) och Dry Eye Questionnaire and Scoring System (DESS) och visade statistiskt signifikant förbättring på symtompoäng i tre av fem studier. De objektiva mätningarna visade statistiskt signifikant förbättring på bland annat TBUT i fyra av fem studier och Schirmertest i två av fem studier. Slutsats: Det finns en positiv effekt på torra ögon, torra ögonsymtom och främre ytan av ögat med ett dagligt tillskott av omega-3-fettsyror, men en viss placeboeffekt kan inte uteslutas. Fler studier med fler deltagare under en längre period krävs för att fastställa den optimala dosen, behandlingsperioden samt sammansättningen av tillskottet av omega-3. / The aim of this study was through a literature review, investigate whether a dietary supplement of omega-3 has a positive effect on dry eye symptoms and the anterior surface of the eye. Can this polyunsaturated fatty acid relieve the symptoms and the clinical signs of dry eyes? The articles included in the literature study were based on previous clinical studies and scientific publications. The search engines used were PubMed and Web of Science. The searches were conducted between 2020-03-30 and 2020-04-15. Inclusion criteria and exclusion criteria were determined in advance. The restrictions were that the articles should be available in full text and be published from 2015-2020. The keywords used were “dry eye + omega” and “dry eye and omega”. Other literature reviews were excluded as well as studies with fewer than 50 participants in the randomized clinical trials (RCTs). Based on the results on the searches, 30 articles were selected that related to the topic dry eyes and omega-3. Subsequently, the articles abstracts were reviewed, and the least relevant articles were excluded. The remaining 13 articles were read in more detail and of these, the 5 most relevant articles were selected to be included in the study. The five selected studies involved a total of 2569 participants. The supplements used in the studies contained omega-3 in various compositions. The subjective measurements were made using the Ocular Surface Disease Index (OSDI) and the Dry Eye Questionnaire and Scoring System (DESS) and showed statistically significant improvement in symptom scores in three out of five studies. The objective clinical tests showed statistically significant improvement on for example TBUT in four out of five studies and Schirmer’s test in two out of five studies. The conclusion is that there is a positive effect on dry eyes, dry eye symptoms and the ocular surface of the eye with a daily supplement of omega-3 fatty acids, however a placebo effect cannot be ruled out. More studies with more participants over a longer period of time are required to determine the optimal dose, treatment period and composition of the supplement of omega-3.

Syfte. Syftet med denna litteraturstudie var att undersöka om orala tillskott av omega-3 har någon effekt på torra ögon. Metod. Den här litteraturstudien baserades på fem utvalda artiklar som söktes fram via sökmotorn Pubmed den 28 mars. Sökorden var “omega 3 supplement AND dry eye”. Olika begränsningar gjordes såsom tidsgräns för utgivning: mellan år 2015 till 2022 och Peer-reviewed randomiserad kontrollerade studier. Artiklar som inte gick i linje med den här litteraturstudiens syfte valdes bort, kvar fanns fyra artiklar. Den sista utvalda artikeln var en av tre ”given som förslag på citatmatchning” av sökmotorn Pubmed, vid angiven sökning ovan. Resultat. Av de fem artiklarna kunde två artiklar stödja en främjande effekt av omega-3 på dry eye disease (DED) och en artikel visade en statistisk signifikant positiv effekt på symtom i OSDI poäng i en subgrupp med svåra DED-symtom ≥ 52. Två av artiklarna kunde inte som slutsats stödja en positiv effekt av omega-3 på DED trots positiva effekter på korneal infärgning, Schirmer´s test, konjunktival infärgning samt TBUT, så var de inte statistiskt signifikanta, jämfört med placebogruppen. I de två artiklarna där en främjande effekt av omega-3 sågs på DED kunde det ses en positiv statistisk signifikant effekt på Ocular Surface Disease Index (OSDI) poäng, tårosmolaritet, TBUT med mera. Mängden deltagare varierade mellan studierna, även ålder, region, sammansättningen på fettsyrorna och biotillgängligheten av supplementen varierade, vilket kan ha påverkat studiernas resultat.Slutsats. Effekten av omega-3 på DED varierade mellan studierna. Själva sammansättningen på fettsyrorna påverkade resultaten där ökad biotillgänglighet hos omega-3, i återförestrad form och i form av krillolja (triglyceridform) visades ha en större effekt än omega-3 i etylesterform vid DED. Även addition av GLA till omega-3 supplementen hade en positiv effekt på symtom hos personer med svåra DED symtom. Fler studier behövs för en fullständig förståelse vad gäller dos och form av omega-3 samt för att utreda vilken svårighetsgrad av DED som kan dra nytta av omega-3-behandling. Framtida studier behöver även undersöka huruvida individanpassad terapi med Omega-3 kan användas vid DED. / Purpose. This literature study aimed to investigate whether oral omega-3 supplements affect dry eyes. Method. This literature review was based on five selected articles from the search engine Pubmed on 28 March. The keywords were "omega 3 supplement AND dry eye". There was inclusion criteria such as articles published between the years 2015 and 2022 and the articles needed to be Peer-reviewed randomized controlled trials. Articles in line with the purpose of this literature study were selected, and the outcome was four articles. The last article selected was one out of three included in the “suggestions for citation matching” by Pubmed, using the above-mentioned criteria. Results. Of the five articles, two articles could support a promoting effect of omega-3 on DED. One article showed a statistically significant positive impact on symptoms in OSDI scores in a subgroup with severe symptoms ≥ 52. In the two articles that could support a promoting effect of omega-3 on DED, a positive, statistically significant impact could be seen on OSDI scores, tear osmolarity, TBUT, and more. Two of the articles could not support a positive effect of omega-3 on DED. Even though there were positive effects on corneal staining, Schirmer´s test, conjunctival staining, and TBUT, they were not statistically significant compared with the placebo group. However, the number of participants varied between studies, which also varied for age, region, the composition of the fatty acids, and bioavailability of the supplement.Conclusion. The effect of omega-3 on DED varies between studies. The actual composition of the fatty acids seems to impact the result where increased bioavailability of omega-3, which is in re-esterified form, and krill oil that is in triglyceride form has a more significant effect than omega-3 in ethyl ester form. The addition of GLA to the omega-3 supplement also positively impacted symptoms in people with severe symptoms. More studies are needed to thoroughly understand the dose and form of omega-3, and severity of DED. But studies are also required to learn about individualized therapy, and if it can be applicable using omega-3 on DED.

Thesis (MPH.) -- University of Limpopo, 2021 / Dry eye disease (DED) is defined as a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolality of the tear film and inflammation of the ocular surface. DED is one of the most frequently established diagnoses in ophthalmology and represents a growing public health concern, with consequences that remain widely underestimated. There is variability of clinical manifestations and diagnostic criteria which leads to poor correlation between clinical signs and symptoms, therefore resulting in difficulties to assess prevalence of DED despite an improved understanding of pathogenic factors of acquired DED. However, its prevalence has been reported to range from 74% to 33% worldwide and the current study aimed to investigate the prevalence of DED and its determinants amongst people consulting at Focus Optometrists in Kwa-Mhlanga Township in Mpumalanga Province. Methodology: The current study was quantitative in nature and it followed a cross-sectional descriptive design to address the research question. The study population were people consulting at Focus Optometrists in Kwa-Mhlanga Township in Mpumalanga Province in which two standardized optometry diagnostic tests (Schimer test and the tear film break up time) were used for data collection coupled with a comprehensive case history which was taken for all participants. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Frequency tables were used to make comparisons between groups for continuous and categorical variables using student t-test, and chi-square test. P-value less than 0.05 at 95% confidence level were regarded as significant. Results: A total of 236 participants were recruited and the mean age of the participants was 39.7 in which majority of participants were females and there was a statistical significance difference in age groups of both males and females at p-value=0.011. Majority of the participants have reported to have experience of sensitivity to light vi and foreign body sensation sometimes. The poor vision and blurred vision have been reported by majority of participants sometimes and the prevalence of dry eye disease was found to be 80.9% and the risk of the dry eye disease in the current study was found significantly increasing with old age. Those who were older (35 years above) were 4.2 times more likely to develop dry eye disease at p-value <0.001 as compared to young participants. Female gender was found not to be protective of developing dry eye disease in the current and participants who were single, having secondary and education qualifications were more likely to develop dry eye disease. Participants with ocular conditions, systemic disease, surgery and those with high blood pressure were more likely to develop dry disease Conclusion: The prevalence of dry eye disease in the current study was found to be very high and therefore, patients coming to the clinic from the age of 40 with underlying systemic diseases should be screened for dry eyes. Dry eye disease can be a major contributor of refractive error in the visual systems and or can also be a sign or a symptom of hormonal or related ocular or systemic disease. More eye care awareness should be done at primary eye care level to detect the cause or to eliminate future associated symptoms.

Syfte: Syftet med studien var att utvärdera NIBUT (Non-Invasive Break-Up Time) och TBUT (Tear Break-Up Time) hos heltidsstuderande vid Linnéuniversitetet samt bidra till en ökad förståelse av ögonhälsan hos denna grupp. Metod: Tårfilmens stabilitet kontrollerades med NIBUT och TBUT, tiden mättes direkt efter en blinkning till första uppsprickningen av tårfilmens yta eller ny blinkning. NIBUT utfördes icke invasivt i Sirius och TBUT mättes i biomikroskop med fluorescein. Deltagarna fick inledningsvis svara på en enkät som gjorde det möjligt att analysera insamlad data utifrån ålder, kön, termin, skärmtid och poäng på DEQ-5 (5-Item Dry Eye Questionnaire). Svaren från DEQ-5 möjliggjorde att resultaten från NIBUT och TBUT mätningarna kunde jämföras mot upplevda symtom på torra ögon. Resultat: Studien inkluderade 36 studenter i åldersspannet 18–39 år (medianålder 23 år, IQR 5,25 år). NIBUT och TBUT visade en positiv signifikant korrelation (p &lt;0,001). En kortare TBUT korrelerade negativt med en högre totalpoäng på DEQ-5 (p = 0,004) samt antalet terminer som studerats (p = 0,025). NIBUT visade inte några liknande samband. Referensvärdet för torra ögon diagnostisering med hjälp av NIBUT och TBUT är en tid &lt;10 sekunder. Över hälften av deltagarna i studien, NIBUT 58% och TBUT 53%, hade en nedsatt break-up time &lt;10 sekunder. Vilket kan vara en indikation för torra ögon problematik. Slutsats: Denna studie visar att det finns ett signifikant samband mellan NIBUT och TBUT mätningarna. Kortare TBUT har visat en signifikant korrelation med högre totalpoäng på DEQ-5, likaså har signifikanta samband mellan TBUT och fler lästa terminer konstaterats. Trots korrelationen mellan NIBUT och TBUT påverkades resultaten av skillnader mellan de två mätmetoderna. / Purpose: The purpose of the studies was to evaluate NIBUT (Non-Invasive Break-Up Time) and TBUT (Tear Break-Up Time) in full-time students at Linnaeus University and to contribute to an increased understanding of the eye health of this group. Method: The stability of the tear film was checked with NIBUT and TBUT, the time was measured directly after a blink to the first break-up of the tear film surface or a new blink. NIBUT was performed non-invasively in Sirius and TBUT was measured in a biomicroscope with fluorescein. The participants initially had to answer a questionnaire that made it possible to analyze collected data based on age, sex, number of semesters studied, screen time and score on the DEQ-5 (5-Item Dry Eye Questionnaire). The responses from the DEQ-5 allowed the results from the NIBUT and TBUT measurements to be compared against perceived symptoms of dry eye. Results: The study included 36 students in the age range 18–39 years (median age 23 years, IQR 5.25 years). NIBUT and TBUT showed a positive significant correlation (p &lt;0.001). A shorter TBUT correlated negatively with a higher DEQ-5 total score (p = 0.004) as well as the number of semesters studied (p = 0.025). NIBUT did not show any similar correlations. The reference value for dry eye diagnosis using NIBUT and TBUT is a time &lt;10 seconds. Over half of the participants in the study, NIBUT 58% and TBUT 53%, had a reduced break-up time &lt;10 seconds. Which can be an indication of dry eye problems. Conclusion: This study shows that there is a significant connection between the NIBUT and TBUT measurements. Shorter TBUT has shown a significant correlation with higher total scores on the DEQ-5, likewise significant connections between TBUT and more semesters read have been established. Despite the correlation between NIBUT and TBUT, the results were influenced by differences between the two measurement methods.

Syfte: Syftet med studien var att jämföra två metoder vid undersökning av tårfilmsanalys; tårflödesbeteende-metoden och fluorescein break-up mönster och om deras mätresultat överensstämmer med varandra. Detta för att diskutera om någon av metoderna kunde vara ett bättre alternativ att adaptera ute i praktiken för vårdgivare inom ögonvården. Metod: Initialt fick deltagarna besvara en OSDI-enkät (ocular surface disease index), därefter gjordes resterande mätningar i biomikroskopet. I biomikroskopet utfördes initialt dem icke-invasiva mätningarna som tillhörde tårflödesbeteende-metoden (mätning av TMH (tårmeniskhöjd), debrishastighet efter blinkning och mätning av lipidlagrets interferensmönster) även NiBUT (non-invasive tear break-up time) utfördes. Efter dem icke-invasiva mätningarna tillsattes fluorescein i inferiora temporala fornix och dem invasiva testerna; TBUT (tear break-up time) och FBUP (fluorescein break-up mönster) utfördes tre gånger. Alla mätningar dokumenterades med video. Tre oberoende bedömningar utfördes. Studien undersökte om resultatet av tårflödesbeteendet och FBUP hade ett samband och vilken utav metoderna som fick en högre intravaliditet utefter dem bedömningar som utfördes. Resultat: Totalt deltog 26 deltagare varav 4 exkluderades. Deltagarna var mellan 19–57 år gamla med en genomsnittsålder på 35 år och en standardavvikelse på ±12,3 år. Samtliga presenterade med en OSDI ≥13, alternativt hade en visuellt frekvent blinkfrekvens. Det återfanns ett samband mellan tårflödesbeteende-metoden och FBUP i studien, dock ingen av klinisk signifikans ((bedömare 1, Cramer’s V= 0,46 p=0,06) (bedömare 2, Cramer’s V=0,33 p=0,32) (bedömare 3, Cramer’s V=0,33 p=0,34)). Tårflödesbeteende-metoden (Fleiss kappa =0,29, p=0,40) och FBUP (Fleiss kappa =0,25, p=0,40) uppvisade båda på en mindre god intra-validitet Slutsats: Det finns ett samband mellan tårflödesbeteende-metoden och FBUP men ingen statistisk signifikans. Intravaliditeten är marginellt högre vid tårflödesbeteende-metoden än vid FBUP i studien. / Aim: The aim of this study was to compare two methods used during tear-film analysis; tear-flow behaviour, and fluorescein break-up pattern and if their measured results are in an agreement. This in order to discuss which one of the methods would be more suitable to apply in clinical practice for healthcare workers in the field of optometry.  Method: Initially the participants filled out an OSDI questionnaire (ocular surface disease index), thereafter measurements were done in the biomicroscope. Initially the non-invasive measurements such as the tear-flow behaviour method (measurements of TMH (tear meniscus height), speed of debris movement across the tear film after blinking and measurements of the lipid layer interference) and NiBUT (non-invasive break-up time) were measured. Afterwards fluorescein was applied in the inferior temporal fornix and the invasive measurements; TBUT (tear break-up time) and FBUP (fluorescein break-up pattern) were measured three times. All measurements done in the biomicroscope were documented with video and three independent assessments were done. This study looked at the results from the tear-flow behaviour and FBUP and if they agreed with one another. It also looked into which one of the methods presented a higher intra-validity in regard to the assessments made. Results: The study had a total of 26 participants, of which 4 were excluded. The participants were between the ages of 19-57 years old with an average age of 35 years with a standard deviation of ±12,3 years. The participants presented with an OSDI of ≥13, with exceptions made if a participant visually had a high blink frequency. A correspondence between the tear-flow behaviour method and  FBUP could be observed, however none of statistical significance ((assessor 1, Cramer’s V= 0,46 p=0,06) (assessor 2, Cramer’s V=0,33 p=0,32) (assessor 3, Cramer’s V=0,33 p=0,34)). The intra-validity of the tear-flow behaviour method (Fleiss kappa =0,29, p=0,40) and FBUP (Fleiss kappa =0,25, p=0,40) were both categorized as weak intra-validity.  Conclusion: There is a correspondence between the tear-flow method and FBUP, without statistical significance. The intra-validity was marginally higher within the tear-flow method compared to FBUP in the study.