TFOS lifestyle report: Effects of nutrition on the ocular surface and adnexa

Abstract

This presentation summarizes the findings of the Nutrition Subcommittee of the recent Workshop of the Tear Film & Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease” (www.tearfilm.org). It is now recognized that unhealthy nutrition habits, which include either under and over eating, can impair our daily wellbeing and contribute to the risk of developing several diseases. Nutrients are substances required by the body to perform its basic functions, and must be obtained from our diet. They are broadly classified into three groups: macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals), and water. In the report each element of nutrition and its known impact on the ocular surface is discussed on the basis of scientific evidence. Vitamin deficiencies, such as vitamin A and C, have been consistently associated with ocular surface impairment, but links with other systemic nutritional deficiencies are far less established, and just hypothesized at present. The influence of factors such as age, sex, ethnicity, socioeconomical issues on nutrition, and the modulation of the gut microbiome to improve ocular surface disease are also explored. Certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body, thus leading to deficiencies of micro‐ and macro‐nutrients that are important in maintaining ocular surface health.Among supplements, the omega‐3 and omega‐6 polyunsaturated fatty acids are the most extensively studied dietary supplements in ocular surface disease, with numerous randomized controlled trials, systematic reviews and meta‐analyses, mostly in patients with dry eye disease, and showing low to moderate certainty evidence for a reduction in either symptoms and signs.An overarching issue identified in the report is the relative paucity of high‐quality evidence in explaining the role of nutrition in ocular surface health and disease. Eye doctors are advised to consider the evidence prior to providing nutritional recommendations to patients with respect to treatment for an ocular surface disease.