July 2019

Recently we had the opportunity to meet with PRN (Physician Recommended Nutraceutical), a company that produces the highest grade and the most “absorbable” fish oil.  Now many of you may wonder, what’s the difference between PRN and say Costco fish oil, which is what wondered also.   It turns out that the manufacturing and the final product is quite different.  Judy from PRN, told us that 99% of fish oil that you buy is sold as the ethyl ester form. So what does that mean?  Without going into too much detail, the ethyl ester form, the body first processes it though the liver by stripping out the ethanol and then converts the fatty acids back into a triglyceride form.  This conversion is said to have some side effects such as digestion problems, fishy burps (yuck), rash, body odor, etc.  The version that PRN sells is already in the triglyceride form and requires no conversion and is easily absorbed by the body.  The relative downside to PRN’s fish oil is the cost of producing this purified product. However, given the alternative, it seems very much worth it.

Possible benefits of Omega 3 – DHA and EPA

• Reduced risk of hypertension and coronary heart disease
• Improvement of eczema
• Improved blood glucose control

How does this pertain to the eye?

PRN’s engineered its fish oil to target those with dry eyes.  Although many studies have shown the benefits of omega-3 for dry eyes, there are also a number of studies that disproves the benefits of omega-3 for dry eye, most notably the recent DREAM study.  Unfortunately, nowadays it seems that data can be manipulated to prove almost anything.  All studies need to be met with a keen eye examining how the studies were set up, the number of data points, etc.  Being a person with mild dry eyes, I wanted to see if it would work for me and how long it would take for results.  Starting today we, the doctors and staff, will begin a trial with PRN fish oil.  We will report back in 3 months.    Best thing about this company is that they have a 90 day satisfaction guarantee, but you have to take the supplements for 90 days before you ask for money back.

Ocular melanoma in the US is about 6 persons per million according to Cancer Journal published in 2005.  In comparison, melanoma of the skin is about 153.5 per million.  Not only do ocular melanomas cause damage to the eyes and potential blindness,  they are responsible for deaths of a significant proportion of affected patients.   Dilated eye examinations are needed to detect choroidal nevi, while undilated examinations are not as useful due to the limited field of view.   These detections for choroidal nevi are important because of the severity of the consequences.

“Choroidal nevi are quite frequent in white individuals, with an estimated prevalence between 5% and 8%, but they are estimated to show low rate of malignant transformation, only 1 in 8845 [11]. However, giant choroidal nevi (10 mm or more in diameter) were estimated to transform into melanoma in 18% over 10 years.” – Int J Clin Exp Pathol. 2013; 6(7): 1230–1244.

The importance of dilated eye exams cannot be understated.  It is still the gold standard for evaluating the ocular health of the retina and other structures.  Those patients that do have choroidal nevi or “freckles” in the retina, it is imperative that regular dilated exams are done to check for stability in appearance.  Even though the transformation potential is low, the ramifications can be, in this case, lethal.