Latest / Glaucoma, Vision & Longevity: Supplements & Science / Omega-3 fatty acids after trabeculectomy: Anti-inflammatory ally or bleeding risk?

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Omega-3 fatty acids after trabeculectomy: Anti-inflammatory ally or bleeding risk? · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Omega-3 fatty acids after trabeculectomy, anti-inflammatory ally or bleeding risk.
• 0:05
  SPEAKER_00: Trabeculectomy, a common surgery to lower eye pressure and glaucoma, creates a bleb, a fluid-filled reservoir under the conjunctiva.
• 0:14
  SPEAKER_00: After surgery, patients often face ocular surface inflammation and dry eye because of disrupted tear films and inflammation from wound healing.
• 0:22
  SPEAKER_00: Since omega-3 fatty acids, the anti-inflammatory oils in fish oil, are known to calm inflammation elsewhere in the body, some surgeons and patients wonder: can fish oil supplements help with eye comfort and bleb health after trabeculectomy, or do they pose a bleeding risk?
• 0:38
  SPEAKER_00: We review the evidence.
• 0:40
  SPEAKER_00: Overall, many trials show that the EPA DHA omega-3 oils can reduce inflammation and improve tear quality after eye surgery, but their direct effects on bleb function are unproven.
• 0:51
  SPEAKER_00: On the other hand, omega-3s do make platelets less sticky.
• 0:55
  SPEAKER_00: A theoretical concern for bleeding.
• 0:58
  SPEAKER_00: Fortunately, large analyses indicate routine omega-3 doses have minimal impact on surgical bleeding.
• 1:04
  SPEAKER_00: In practice, moderate omega-3 supplements may help with post-op eye comfort, but clinicians should watch for any extra bleeding in high-risk patients.
• 1:12
  SPEAKER_00: What are omega-3 fatty acids?
• 1:14
  SPEAKER_00: Omega-3 fatty acids, especially icosapentenoic acid, EPA, and docosahexanoic acid, DHA, are healthy polyunsaturated fats found in fatty fish, salmon, mackerel, etc., or supplements.
• 1:28
  SPEAKER_00: They cannot be made by our bodies and must come from diet or pills.
• 1:32
  SPEAKER_00: Omega-3s are famously anti-inflammatory.
• 1:35
  SPEAKER_00: In the body, they compete with the usual inflammatory fats, arachidonic acid, and lead to the production of anti-inflammatory molecules, resolvins and protectins.
• 1:44
  SPEAKER_00: In practical terms, omega-3s can reduce swelling and improve tissue healing in many parts of the body.
• 1:51
  SPEAKER_00: In the eye, inflammation and tear film imbalance underlie dry eye symptoms.
• 1:56
  SPEAKER_00: Omega-3s are thought to improve the oily layer of tears from the eyelid glands and calm surface inflammation.
• 2:03
  SPEAKER_00: Indeed, trials in dry eye patients have shown that omega-3 supplements can lengthen the time between eye blinks before tearing occurs, tear breakup time, and reduce tear osmolarity, less irritating, more stable tears.
• 2:17
  SPEAKER_00: These changes translate to patients feeling less dryness, burning, and scratchiness when it works.
• 2:23
  SPEAKER_00: Note, for severe chronic dry eye, a very large trial, the DREAM study, found 3,000 mg per day of omega-3 did not beat placebo on symptom scores, a result that some experts debate due to study design.
• 2:36
  SPEAKER_00: In summary, omega-3s are generally anti-inflammatory fats that can improve tear film stability and may soothe irritated eyes after surgery.
• 2:46
  SPEAKER_00: This forms the rationale for trying them after trabeculectomy.
• 2:49
  SPEAKER_00: Omega-3 supplements and post-op eye comfort.
• 2:53
  SPEAKER_00: Several randomized trials have tested omega-3 supplements for post-surgical dry eye and inflammation.
• 2:59
  SPEAKER_00: Although no study has looked specifically at trabeculectomy patients, we can apply findings from cataract and refractive surgery cases.
• 3:08
  SPEAKER_00: Cataract surgery.
• 3:09
  SPEAKER_00: In a 2017 trial, patients with new dry eye symptoms after cataract removal were given standard treatment with or without omega-3 capsules, each tablet 180 mg EPA plus 120 mg DHA, taken three times daily.
• 3:25
  SPEAKER_00: After a few weeks, the omega-3 group had significantly greater improvement in symptom scores and tear stability than controls.
• 3:32
  SPEAKER_00: For example, the average eye comfort score fell more in the fish oil group, and tear breakup time improved more on omega-3, P0.05.
• 3:41
  SPEAKER_00: This suggests that adding fish oil to routine therapy reduced postoperative inflammation and improved ocular surface comfort.
• 3:48
  SPEAKER_00: Photorefractive kectomy, pyrotectomy, PRK, another small trial looked at patients undergoing PRK, another eye surgery that can cause dry eye.
• 3:57
  SPEAKER_00: Those who took omega-3 supplements before and after surgery healed quicker and had better vision outcomes and tear stability than those without omega-3.
• 4:06
  SPEAKER_00: This pilot study supports that omega-3 may speed corneal healing after surgery.
• 4:11
  SPEAKER_00: Chronic dry eye non-surgical.
• 4:13
  SPEAKER_00: A trial comparing krill oil versus fish oil vs.
• 4:16
  SPEAKER_00: placebo in people with dry eye, not after surgery, found both omega-3 groups improved objective tear measures.
• 4:23
  SPEAKER_00: After three months, tear osmolarity and tear breakup time were significantly better with krill or fish oil than placebo.
• 4:30
  SPEAKER_00: In that study, the krill oil group, higher EPA ratio, also had a significantly greater drop in symptom scores patient comfort than placebo.
• 4:39
  SPEAKER_00: Meta-analyses of dry eye trials generally conclude omega-3s give small but real benefits on tear film health and symptoms, especially when doses are high and used long term.
• 4:50
  SPEAKER_00: However, not all reviews are uniformly positive.
• 4:54
  SPEAKER_00: A 2023 Cochrane review concluded that omega-3s probably have little to no effect on patient-reported dry eye symptoms compared to placebo, though they may improve some tear test signs.
• 5:06
  SPEAKER_00: Importantly, the Cochrane authors noted that combining omega-3 with standard treatments, like artificial tears, seemed more helpful than omega-3 alone.
• 5:16
  SPEAKER_00: In practice, this suggests fish oil is an add-on therapy.
• 5:19
  SPEAKER_00: It may work best alongside drops, lid hygiene, and other post-op care.
• 5:25
  SPEAKER_00: What does this mean for trabeculectomy?
• 5:27
  SPEAKER_00: Trab patients often stop many glaucoma drops, which can irritate the surface, but still experience dry eye and inflammation from surgery trauma.
• 5:35
  SPEAKER_00: The cataract and PRK trials above imply that omega-3 supplements can make a difference in post-op ocular comfort.
• 5:42
  SPEAKER_00: While we lack a trial in TRAB patients, it is reasonable to extrapolate.
• 5:46
  SPEAKER_00: An omega-3 supplement regimen, e.g., several hundred to a few thousand milligrams of combined EPA DHA per day, might reduce irritation, dryness, and redness after trabeculectomy, improving patient comfort.
• 5:59
  SPEAKER_00: Potential effects on bleb health.
• 6:02
  SPEAKER_00: A key question is whether reduced inflammation from omega-3 translates into better bleb healing.
• 6:08
  SPEAKER_00: The ideal bleb is thin, functioning, and leak-free.
• 6:11
  SPEAKER_00: Too much early inflammation can cause scarring and bleb failure.
• 6:15
  SPEAKER_00: In theory, omega-3's anti-inflammatory action could help keep fibrosis in check.
• 6:20
  SPEAKER_00: To date, there are no direct trials of omega-3 on bleb outcomes.
• 6:24
  SPEAKER_00: However, some clues come from studies of tear biochemistry after trabeculectomy.
• 6:29
  SPEAKER_00: One three-year cohort study measured inflammatory lipid mediators in tears before and after TRAB.
• 6:35
  SPEAKER_00: It found that pro-inflammatory tear lipids, like certain prostaglandins, dropped markedly after surgery in most patients.
• 6:43
  SPEAKER_00: Interestingly, patients who later needed needling of their bleb, a sign of failing bleb with scarring, had higher levels of some inflammatory lipids in their tears than those with healthy blebs.
• 6:55
  SPEAKER_00: This suggests chronic inflammation may underlie some bleb problems.
• 7:00
  SPEAKER_00: By extension, if an intervention like omega-3 could suppress that inflammation, bleb health might benefit.
• 7:06
  SPEAKER_00: However, this is speculative.
• 7:09
  SPEAKER_00: No data show that fish oil actually prevents bleb scarring or reduces needling rates.
• 7:14
  SPEAKER_00: It is also possible that reducing inflammation too much could impair the normal wound closure of the conjunctiva.
• 7:20
  SPEAKER_00: On balance, most experts would say omega-3's potential benefits on wound healing via inflammation control are theoretical in the bleb context.
• 7:29
  SPEAKER_00: We note it as a possible plus, but emphasize the lack of direct evidence.
• 7:34
  SPEAKER_00: Platelet function and bleeding risk.
• 7:36
  SPEAKER_00: Omega-3s and platelets.
• 7:38
  SPEAKER_00: One known effect of EPA DHA is that they make platelets somewhat less likely to clump.
• 7:43
  SPEAKER_00: In very high fish diet populations, like Greenland Inuit, scientists observed prolonged bleeding times and altered platelet fatty acids compared to typical Western diets.
• 7:53
  SPEAKER_00: This antiplatelet effect has raised caution among surgeons that omega-3 supplements could increase surgical bleeding.
• 8:01
  SPEAKER_00: In fact, many guidelines currently advise stopping fish oil before surgery and delaying non-urgent ops for a few days if patients are on fish oil supplements.
• 8:11
  SPEAKER_00: The idea is largely precautionary.
• 8:13
  SPEAKER_00: Fish oil does change cell membranes to be less pro-thrombotic.
• 8:17
  SPEAKER_00: However, whether this translates into real harm is the question.
• 8:22
  SPEAKER_00: Clinical evidence on bleeding risk.
• 8:24
  SPEAKER_00: Recent analyses have been reassuring.
• 8:26
  SPEAKER_00: A 2024 meta-analysis of 11 randomized trials, over 120,000 patients, compared bleeding rates in those taking omega-3 supplements versus controls.
• 8:37
  SPEAKER_00: It found no significant difference in overall bleeding events, including including strokes or gastrointestinal bleeds, between the groups.
• 8:45
  SPEAKER_00: Only very high-dose purified EPA, like icosepent ethyl used for heart disease, showed a slight relative increase in bleeding, 50% higher risk, but this change was tiny in absolute terms, 0.6% more events.
• 8:59
  SPEAKER_00: Likewise, a large perioperative trial, opera, n to one of 1500, tested giving 8 to 10 grams of fish oil before open heart surgery and 2 grams day after.
• 9:10
  SPEAKER_00: The fish oil group did not have more bleeding.
• 9:12
  SPEAKER_00: In fact, they had slightly fewer blood transfusions than placebo.
• 9:16
  SPEAKER_00: The odds of major bleeding were not higher, OR or 0.8 in the fish oil group.
• 9:21
  SPEAKER_00: These findings suggest that at least in major surgery, fish oil at high dose didn't worsen bleeding outcomes.
• 9:28
  SPEAKER_00: Bottom line on bleeding.
• 9:30
  SPEAKER_00: In practical terms, normal omega-3 use, roughly 1 to 3 grams day of fish oil, appears to have negligible effect on surgical bleeding risk.
• 9:39
  SPEAKER_00: The small impairment in platelet function is mostly offset by other compensations in clotting.
• 9:45
  SPEAKER_00: However, caution remains recommended if patients are on multiple blood thinners.
• 9:50
  SPEAKER_00: Managing real-world risk at two weeks post-op.
• 9:53
  SPEAKER_00: By about two weeks after trabeculectomy, the main surgical wound has usually begun healing, but the bleb is still vulnerable.
• 10:00
  SPEAKER_00: Here are practical considerations.
• 10:03
  SPEAKER_00: Anticoagulant patients.
• 10:04
  SPEAKER_00: If a patient must continue systemic anticoagulants or strong antiplatelets, e.g., warfarin, doax, clopidogrel, through surgery, fish oil adds another mild blood-thinning factor.
• 10:16
  SPEAKER_00: Ophthalmologists typically assess systemic bleeding risk versus eye risk.
• 10:20
  SPEAKER_00: Glaucoma surgery is considered high risk for hemorrhage, high hyphema, or suprachoroid risk.
• 10:26
  SPEAKER_00: Many surgeons will hold warfarin P2Y12 inhibitors a few days before surgery if safe, keeping aspirin if needed.
• 10:33
  SPEAKER_00: And resume after careful discussion.
• 10:35
  SPEAKER_00: If anticoagulation truly cannot be paused, recent stent, valve, etc., any additional factor like fish oil is generally avoided until healing is robust.
• 10:45
  SPEAKER_00: In short, stay on fish oil only after consulting both your eye doctor and prescribing physician in these cases.
• 10:52
  SPEAKER_00: Blebs with leaks.
• 10:53
  SPEAKER_00: A leaking bleb means a thin, fragile bleb with an opening.
• 10:57
  SPEAKER_00: Even without fish oil, these blebs risk over drainage and infection.
• 11:01
  SPEAKER_00: Adding any blood thinner in this setting could theoretically worsen leak closure.
• 11:06
  SPEAKER_00: If a bleb leak is detected, most surgeons would focus on sealing it with glue, bandage contact lens, etc., and avoid any supplements that impede clotting until the leak is fixed.
• 11:17
  SPEAKER_00: So we would delay restarting or starting omega-3 in the presence of a bleb leak.
• 11:23
  SPEAKER_00: Routine patients.
• 11:25
  SPEAKER_00: For most patients who are off blood thinners and have an intact bleb, omega-3 supplements could start around one to two weeks after surgery, once the risk of immediate post-op bleeding is lower.
• 11:36
  SPEAKER_00: The idea is to enhance comfort and help control residual inflammation as corticosteroids are tapered.
• 11:42
  SPEAKER_00: Clinicians might try a moderate dose, for example, 1000 mg EPA plus 500 mg DHA daily, and adjust based on response.
• 11:51
  SPEAKER_00: Importantly, fish oil is not a substitute for standard post-op care.
• 11:55
  SPEAKER_00: Patients still need their eye drops, antibiotics, steroids, and proper eye hygiene.
• 12:01
  SPEAKER_00: Monitoring.
• 12:02
  SPEAKER_00: Once started on omega-3, doctors should keep an eye on the surgical outcome.
• 12:06
  SPEAKER_00: They will watch for any unusual bruising in the eye, new conjunctival hemorrhages, or a falling intraocular pressure, which could signal bleeding in the eye or leak.
• 12:16
  SPEAKER_00: On the plus side, improved tear assessment, longer TBUT, less redness would be expected.
• 12:22
  SPEAKER_00: If any bleeding complications appear, supplements would be stopped.
• 12:26
  SPEAKER_00: Dosing, formulation, and quality of fish oil.
• 12:29
  SPEAKER_00: If patients and doctors decide to try omega-3s after trabeculectomy, a few practical points on dosing and product are helpful.
• 12:36
  SPEAKER_00: Dosage.
• 12:37
  SPEAKER_00: Clinical trials on eye health have used a wide range.
• 12:40
  SPEAKER_00: For example, in the cataract dry eye trial, patients took 31000 mg capsules per day, total 3 gram fish oil, containing 540 mg EPA plus 360 mg DHA daily.
• 12:52
  SPEAKER_00: The dry eye Krills fish oil trial provided about 1,500 mg per day of EPA plus DHA.
• 12:58
  SPEAKER_00: In general, supplements providing 1,000-3,000 mg total EPA plus DHA per day are commonly used for ocular inflammation or dry eye.
• 13:07
  SPEAKER_00: More is not necessarily better.
• 13:09
  SPEAKER_00: The meta-analysis noted that higher EPA tended to yield more benefit, but excessive doses and four-green without medical indication should be avoided, as these may tip the bleeding balance.
• 13:20
  SPEAKER_00: Patients should read labels carefully.
• 13:22
  SPEAKER_00: A 1,000 mg fish oil capsule often only contains 300 to 600 mg of EPA DHA combined with the rest inert oil.
• 13:30
  SPEAKER_00: Triglyceride versus ethyl ester form.
• 13:33
  SPEAKER_00: Fish oil comes mostly as natural triglycerides or ethyl ester EE forms.
• 13:38
  SPEAKER_00: Reesterified triglyceride RTG forms mimic natural fish oil, and some evidence suggests they are better absorbed and cause less fishy burp than ethyl ester.
• 13:47
  SPEAKER_00: The Large Dream Trial used EE form and has been criticized that Tg form might have been more effective.
• 13:54
  SPEAKER_00: Therefore, when choosing a supplement, many experts prefer a high-quality reasterified Tg formula or natural fish oil.
• 14:00
  SPEAKER_00: Some pharmaceutical grade fish oils like G.
• 14:03
  SPEAKER_00: L.
• 14:03
  SPEAKER_00: lavaza, vacepa, are EE and highly purified, but OTC triglyceride forms, especially with added antioxidants, are also effective.
• 14:12
  SPEAKER_00: The cheapest oils are often EE, so if budgets allow, look for products labeled Tg or RTG.
• 14:19
  SPEAKER_00: Quality and oxidation.
• 14:20
  SPEAKER_00: Of major concern in supplements is oxidation.
• 14:23
  SPEAKER_00: Omega-3 fats spoil easily when exposed to air, light, or heat.
• 14:27
  SPEAKER_00: A 2015 analysis found that half of fish oil supplements on Canadian shelves exceeded safe limits for peroxide or secondary oxidation products, and even in the US, 27% exceeded peroxide recommendations.
• 14:39
  SPEAKER_00: Oxidized fish oil can smell rancid, bad breath slash fishy burp, and may even be harmful if consumed in large amounts, though human data is limited.
• 14:48
  SPEAKER_00: In any case, oxidized omega-3 is likely less effective.
• 14:52
  SPEAKER_00: To ensure freshness, buy reputable brands that report oxidation values, peroxide value, peanicidine, totox.
• 15:00
  SPEAKER_00: Store bottles tightly closed in a cool place and prefer dark glass or opaque capsules.
• 15:04
  SPEAKER_00: If the oil smells strongly fishy or musty, throw it out.
• 15:08
  SPEAKER_00: Some supplements add vitamin E as an antioxidant.
• 15:11
  SPEAKER_00: This can help slow oxidation.
• 15:13
  SPEAKER_00: Triglyceride versus ethyl ester absorption.
• 15:16
  SPEAKER_00: Although raw absorption differences exist, for moderate doses, 1 to 3 grams per dur, most people will get enough omega-3 from either form.
• 15:24
  SPEAKER_00: If using an ethyl ester product, it is best to take it with a fatty meal to aid breakdown.
• 15:28
  SPEAKER_00: In contrast, natural TG fish oil or algal oil DHA caps are absorbed well with or without food.
• 15:35
  SPEAKER_00: Guidance.
• 15:36
  SPEAKER_00: Who, when, and how to use omega-3.
• 15:38
  SPEAKER_00: Putting it all together, here are general recommendations for patients and doctors considering omega-3 after trabeculectomy.
• 15:46
  SPEAKER_00: Patient selection.
• 15:47
  SPEAKER_00: Beneficial for patients who have significant ocular surface inflammation or dryness after surgery and who are not at high risk of bleeding.
• 15:55
  SPEAKER_00: Typical candidates, patients noticing gritty, red eyes after stopping glaucoma drops, or those whose IOP post-op is under control, but surface irritation is troublesome.
• 16:06
  SPEAKER_00: Less suited, patients who are stable and comfortable with current therapy, or those facing complex coagulopathies.
• 16:13
  SPEAKER_00: Timing.
• 16:14
  SPEAKER_00: Do not start fish oil immediately on surgery day.
• 16:17
  SPEAKER_00: Allow initial conjunctival healing and disappearance of hyphema.
• 16:21
  SPEAKER_00: A good rule is to begin around 1 to 2 weeks post-op once the surgeon is happy with wound closure and bleb formation.
• 16:28
  SPEAKER_00: Initial dosing, a moderate dose, for example, 1000 mg EPA plus 500 mg DHA per day, is a reasonable starting point, often as two fish oil capsules daily.
• 16:39
  SPEAKER_00: Some cases may benefit from up to 2,000 to 3,000 mg total, divided doses, if well tolerated.
• 16:46
  SPEAKER_00: Check the supplement label to confirm EPA-DHA content.
• 16:49
  SPEAKER_00: Form.
• 16:50
  SPEAKER_00: Choose a high-quality fish oil or algal DHA-EPA supplement.
• 16:54
  SPEAKER_00: Look for reasterified triglyceride or TG on the label, or trusted brands, often with third-party testing seals.
• 17:00
  SPEAKER_00: Avoid supplements past expiration or with a rancid odor.
• 17:04
  SPEAKER_00: Krill oil, phospholipid-based, is another option.
• 17:07
  SPEAKER_00: It showed good results in one trial, though generally EPA content per memograms is lower, so pills may be smaller or more frequent.
• 17:16
  SPEAKER_00: Safety checks.
• 17:17
  SPEAKER_00: If you're on anticoagulants, warfarin, doax, clopidogrel, tacagrilor, etc., discuss omega-3 with your doctors first.
• 17:25
  SPEAKER_00: You may need to skip or delay fish oil while those meds are being restarted after surgery.
• 17:30
  SPEAKER_00: If a bleb leak or significant hyphema occurs, hold off on fish oil until the eye is stabilized.
• 17:35
  SPEAKER_00: Watch for eye bruising, subconjunctival hemorrhage, or unexpected lowering of IOP, which could signal bleeding.
• 17:42
  SPEAKER_00: If any bleeding issue arises, stop the supplement and alert your surgeon.
• 17:47
  SPEAKER_00: Monitoring.
• 17:48
  SPEAKER_00: At each follow-up visit, your ophthalmologist should evaluate both the bleb for leaks, vascularity, and the ocular surface, redness, tear film.
• 17:56
  SPEAKER_00: They may inquire if comfort has improved.
• 17:59
  SPEAKER_00: Routine blood tests are not needed for fish oil itself.
• 18:02
  SPEAKER_00: However, if on anticoagulants, INR or other relevant labs should guide overall management.
• 18:09
  SPEAKER_00: Duration.
• 18:10
  SPEAKER_00: Omega-3 therapy is generally safe long term.
• 18:13
  SPEAKER_00: If you find it helps your eyes after surgery, you and your doctor might continue it for a few months or more.
• 18:18
  SPEAKER_00: Some people with chronic dry eye stay on low-dose fish oil indefinitely.
• 18:22
  SPEAKER_00: If no benefit is felt after a few months, it could be stopped or tapered.
• 18:27
  SPEAKER_00: Conclusion.
• 18:28
  SPEAKER_00: In summary, omega-3 fatty acid supplements can be a valuable anti-inflammatory ally for postoperative eye comfort.
• 18:36
  SPEAKER_00: Randomized trials, mainly in cataract and refractive surgeries, show that EPA DHA can improve tear stability and reduce dry eye symptoms.
• 18:45
  SPEAKER_00: It is biologically plausible that they may also help control conjunctival inflammation after trabeculectomy, though direct evidence on bleb survival is lacking.
• 18:54
  SPEAKER_00: On the flip side, omega-3 does mildly affect platelet function, raising theoretical bleeding concerns.
• 19:01
  SPEAKER_00: Reassuringly, modern meta-analyses indicate that typical supplement doses do not significantly increase real-world bleeding risk.
• 19:08
  SPEAKER_00: Still, caution is wise.
• 19:10
  SPEAKER_00: In patients on full anticoagulation or any early bleb leak, fish oil should be postponed.
• 19:16
  SPEAKER_00: Practical advice for patients.
• 19:18
  SPEAKER_00: If your eye doctor and you decide to use fish oil after trabeculectomy, aim for a moderate dose, around 1 to 3 grams of EPA plus DHA per day, starting a couple of weeks post-op.
• 19:29
  SPEAKER_00: Choose a high-quality product, triglyceride form, low oxidation, and keep taking your usual eye drops as prescribed.
• 19:37
  SPEAKER_00: Watch for any increased eye redness or bleeding and inform your doctor.
• 19:41
  SPEAKER_00: Key takeaways Omega-3s can improve post-op dry eye and inflammation, good for comfort, with minimal bleeding risk in routine cases.
• 19:50
  SPEAKER_00: As always, supplements should be part of a comprehensive care plan.
• 19:54
  SPEAKER_00: Talk openly with your surgeon or ophthalmologist.
• 19:56
  SPEAKER_00: They can help select the right patients, timing, and dose, and monitor your outcome.
• 20:01
  SPEAKER_00: In the end, omega-3 may prove a helpful tool in the recovery toolkit, but it should be used wisely.
• 20:08
  SPEAKER_00: All links to sources are available in the text version of this article.
• 20:12
  SPEAKER_00: You can find the full article at visualfieldtest.com.
• 20:16
  SPEAKER_00: Thanks for listening.
• 20:18
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