@article {314181,
	title = {Omega-3 supplementation combined with anti-vascular endothelial growth factor lowers vitreal levels of vascular endothelial growth factor in wet age-related macular degeneration.},
	journal = {Am J Ophthalmol},
	volume = {158},
	number = {5},
	year = {2014},
	month = {2014 Nov},
	pages = {1071-1078.e1},
	abstract = {PURPOSE: To determine the influence of omega-3 supplementation on vitreous vascular endothelial growth factor A (VEGF-A) levels in patients with exudative age-related macular degeneration (wet AMD) receiving intravitreal anti-VEGF treatment. DESIGN: Prospective, randomized, open-label, single-center, clinical trial, consecutive interventional case series. METHODS: The study included 3 cohorts with wet AMD and a control group with epiretinal membrane or macular hole. Twenty wet AMD patients being treated with anti-VEGF were randomized to daily supplementation of antioxidants, zinc, and carotenoids with omega-3 fatty acids (docosahexaenoic acid and eicosapentaenoic acid; group 1, n\&nbsp;= 10) or without omega-3 fatty acids (group 2, n\&nbsp;= 10). They were compared with an anti-VEGF treatment-na{\"\i}ve wet AMD group (group 3, n\&nbsp;= 10) and an epiretinal membrane or macular hole group (group 4, n\&nbsp;= 10). Primary outcome was vitreal VEGF-A levels (at the time of anti-VEGF injection). Secondary outcomes were plasma VEGF-A and central foveal thickness. Patients with new submacular hemorrhage or any other treatment within 3\&nbsp;months were excluded. Final analyses included 9, 6, 7, and 8 patients in groups 1 through 4, respectively. RESULTS: Patients receiving omega-3s (group 1) had\&nbsp;significantly lower levels of vitreal VEGF-A (141.11 {\textpm} 61.89 pg/mL) when compared with group 2 (626.09 {\textpm} 279.27 pg/mL; P\&nbsp;= .036) and group 3 (735.48 {\textpm} 216.43 pg/mL; P\&nbsp;= .013), but similar levels to group 4 (235.81 {\textpm} 33.99 pg/mL; P\&nbsp;= .215). All groups showed similar values for plasma VEGF-A and central foveal thickness measurements. CONCLUSIONS: This study demonstrated that omega-3 supplementation combined with anti-VEGF treatment is associated with decreased vitreal VEGF-A levels in wet AMD patients.},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2014.07.036},
	author = {Rezende, Flavio A and Lapalme, Eric and Qian, Cynthia X and Smith, Lois E and SanGiovanni, John Paul and Sapieha, Przemyslaw}
}
