Frequently asked questions

Q. How is EyePromise® EZ Tears different than other Omega 3 products?

A. EZ Tears is much more than an Omega 3 supplement. It contains 7 anti-inflammatory ingredients in addition to Omega 3′s, and was designed from the ground-up as a dry eye formula to address dry eye from the inside.

The eight anti-inflammatory ingredients provide EPA/DHA* from fish oil, along with seven natural substances that reduce systemic and ocular surface inflammation.  In initial trials, more than a quarter of patients found relief in less than a week with three-quarters of individuals finding subjective relief within a month.

Vitamin A (as retinyl palmitate, 1000 iu per daily dose) – a fat soluble vitamin essential for corneal surface health, as well as mucosal, conjunctival, meibomiam and lacrimal gland health.  It is needed by genes/cells that express mucin (a polysaacharide) of major importance in one of the three major tear layers.

Vitamin D₃ – (2000 iu per daily dose) – a fat soluble vitamin that is generally deficient in the American diet.  Numerous clinical studies have elucidated the health benefits of vitamin D and many are likely explained by its master affects on immunity and systemic inflammation.

Vitamin E, alpha-tocopheral  (60 iu Mixed tocopherals/tocotrienols  20mg) – fat soluble vitamins and their related compounds are essential for reduction of systemic and ocular inflammation.  These compounds are found in a healthy American diet and also important in stabilizing Omega-3 fatty acids.

Evening Primrose Oil (100mg per daily dose) – contains gamma-linoleic acid (GLA) which has been shown to favorably affect dry eye symptoms, probably by inhibiting conversion of Omega-6 fatty acids to pro-inflammatory molecules.

Turmeric Extract (50mg) – has a number of systemic and ocular anti-inflammatory mechanisms including COX-2 mediated conversion of Omega-6 fatty acids to pro-inflammatory prostaglandins and inhibition of other pro-inflammatory signals on the ocular surface. (interluekins  MMP-9, MAPK, TNF-alpha, p 38, JNK and NF-Kappa B)

Green Tea Extract (50mg containing 95% polyphenols and 40% EGCG) – has both antioxidant and multi-modes of action on anti-inflammatory pathways in systemic and ocular tissues.  An intriguing observation is that EGCG and curcumin are natural inhibitors of MMP-9, a central mediator of ocular surface pro-inflammatory cytokines, a major contributor of dry eye.

Omega-3 Fatty Acids (1000mg DHA/EPA) EZ Tears contains a new source from fish oil that has been purified and enriched until it contains nearly 70% (by weight) of the two compounds DHA and EPA.  These two compounds have been identified as important compounds responsible for the many beneficial effects of fish oil on human health.  The cold water fish are caught in pristine waters off the coast of Alaska.  Throughout the purification and enrichment process the oil is tested for contaminants and is certified below detectible levels.  Both the oil and the EZ Tears softgels are manufactured under the FDA guidelines for current Good Manufacturing Practices. (cGMP’s)  This careful attention to detail, purification, and enrichment allows a high quality dosage of over 1 gram (1000 mg) of DHA/EPA per daily dose.  This allows the consumer to receive the same active ingredients (DHA/EPA) as found in 4-7 mega softgels of fish oil from a retail shelf.  In addition to purity and concentration, special attention is given to stability.  The special sourcing and processing along with the antioxidants in EZ Tears assure a stable (non-rancid) product.

Enteric Coating – after production of the softgels and visual inspection, they go through a secondary coating process to reduce fish odor, minimize aftertaste, and upset stomach common with cheap fish oil capsules. *EPA (Eicosapentaenoic Acid) DHA (Docosahexaenoic Acid)

Q. How often should I take EZ Tears?

A. EZ Tears is a nutritional dietary supplement designed to encourage compliance through a daily dose of 2 moderate-sized softgels to increase tear production and tear quality.  EZ Tears should be taken with a multi-vitamin to stimulate tear production and reduce the inflammatory processes that affect the ocular surface

Q. Why is enteric coating important?

A. Enteric coating allows the softgel to pass through the stomach to the lower intestine where it opens up and takes effect. Non-enteric coated softgels can result in fishy aftertaste, because they often open up in the stomach.                   Q. What is the difference between Ethyl Ester and Triglycerides?

Q. What does EPA/DHA mean and why is it important?

A. EPA/DHA Ratio – With DHA being a major component of the retina and most important precursor of the anti-inflammatories, it is reasonable to assume DHA is the most critical fatty acid.  It is also noteworthy that high DHA content fish oils are more expensive.  EZ Tears contains 1 gram of EPA/DHA (550/450mg) per daily dose in the EE form, and the level of DHA is significantly greater than most fish oils in the market.  It is scientifically arguable that the amount of DHA is more important than the form of fish oil.  It is also noteworthy that the pharmaceutical product Lovaza contains the EE form of fish oil, as does the AREDS-2 study protocol.

Q. What is the source of Omega 3′s in EyePromise products? Is it high quality and safe?

A. There are many considerations when evaluating Omega 3′s. Please read the following information. EyePromise EZ Tears, a dry eye supplement formula, contains 8 natural anti-inflammatory nutrients that favorably affect systemic and ocular surface inflammation.  One of these, and the most prevalent in the EZ Tears formulation, is Omega-3 fish oil.  In this document we shall review 6 key issues to consider related to fish oil (Omega-3’s) in a dry eye supplement.

Bio-availability – Controversy and confusion has been created by suppliers and marketers regarding whether the TG (triglyceride) or EE (Ethyl Ester) form of EPA/DHA is more biologically available.  There are literally dozens of rodent and human volunteer studies with varied conclusions.  This isn’t surprising given the many variables that affect bioavailability or bio-absorption of fish oil.  Studies from the 1990’s and recently from Scandinavia and Germany, suggest the triglyceride form may be slightly more bio-available, however this very slight difference must be weighed against multiple considerations elucidated herein.

EPA/DHA Ratio – With DHA being a major component of the retina and most important precursor of the anti-inflammatories, it is reasonable to assume DHA is the most critical fatty acid.  It is also noteworthy that high DHA content fish oils are more expensive.  EZ Tears contains 1 gram of EPA/DHA (550/450mg) per daily dose in the EE form, and the level of DHA is significantly greater than most fish oils in the market.  It is scientifically arguable that the amount of DHA is more important than the form of fish oil.  It is also noteworthy that the pharmaceutical product Lovaza contains the EE form of fish oil, as does the AREDS-2 study protocol.

Concentration, Dose, Size and # of Capsules – Instructing a patient to “take fish oil” without clarification or instruction around total Omega 3 or EPA/DHA content may lead the patient to a retail shelf where they encounter a confusing array of products.  Typical retail shelf fish oil products contain low levels of EPA/DHA, and a low amount of DHA in particular. What appears to be a great “value” may not be a bargain.  These products are usually 30% Omega containing products; therefore, the patient must take 4 to 6 large softgels daily to receive the same EPA/DHA dose in 2 EZ Tears softgels.

EZ Tears contains a 70% EE fish oil form that provides 1 gram (1000 mg’s of EPA/DHA) in 2 capsules per daily dose.  It is known that patient COMPLIANCE decreases when the number and size of softgels increase.   Though optimum daily fish oil/Omega 3 dose determination awaits major intervention studies, many ECP’s recommend 1 to 3 grams of fish oil per day without consideration of the number of softgels or total EPA/DHA consumed.  One epidemiological study, The Women’s Health Initiative Study, found 5 to 6 servings of tuna per week reduced the risk of dry eye syndrome by 93%.  This equates to approximately 500mg of EPA/DHA per day.

Purity – The fish oil in EZ Tears is derived from cold water fish caught in the cold, pristine waters of the Bering Sea off the coast of Alaska.  The starting material is food grade from a sustainable source that is purified, stabilized, and processed in the USA.  Besides quality starting materials and processes, a proprietary purification process and in-depth analysis assures that any heavy metals and toxins are removed to meet or exceed all international quality and safety standards.  The fish oil in EZ Tears conforms to GOED and IFOS standards and purity requirements of the CRN monograph.

Stability– Stability usually refers to the resistance to oxidation and rancidity.  Because of the highly-polyunsaturated nature of Omega-3’s, the compounds must be handled carefully, keeping them oxygen starved.  Once oxidation begins, quality has been adversely affected.  Therefore fish oil must be handled with precision from the moment of harvest.  In addition to fishy odor and upset stomach, rancid fish oil is harmful and pro-inflammatory.  The fish oil in EZ Tears is from a very high quality source, it is handled very carefully, and an important antioxidant system is utilized to create a highly stable formula.  Many fish oils use only vitamin E as an antioxidant.  EZ Tears contains multiple antioxidants and therefore yields a very stable form of high quality Omega-3 oils.

Tolerability – It is very difficult to tolerate unstable fish oil.  Poor raw material, oxidation and foul odor can cause upset stomach, intestinal distress, and burp.  The high purity and stability of EZ Tears helps assure optimal tolerability.  In addition to high quality and stability, using enteric coatings can also improve tolerability.  Though few manufacturers enteric coat their products because of the added cost, EZ Tears softgels are enteric coated to assure tolerability and patient compliance.  Dosage also effects tolerance and more concentrated fish oil forms such as contained in EZ Tears may be better tolerated.

Conclusion– We hope this document has adequately clarified the key considerations in selecting an Omega-3 containing dry eye supplement.  EZ Tears is much more than a high-quality Omega 3 fish oil, as there are 7 additional anti-inflammatory ingredients that help resolve dry eye symptoms quickly “from the inside!”