Lactoferrin Promotes Healthy Healing after Cataract Surgery

At least 3 million Americans undergo cataract surgery every year.¹ While for the most part, this is a simple surgery with a very high (98%) success rate and very few (0.5%) severe complications,¹ the procedure does result in “dry eye” (loss of tear film quantity and quality) for most patients.^2-4

While dry eye is not generally considered a “serious” complication by researchers, it can produce symptoms such as pain, irritation, and poor vision even when mild or moderate.

Severe dry eye can damage a person’s eye health and impair their general health, well-being, and quality of life.³ While patients with pre-existing dry eyes often have the condition exacerbated by cataract surgery, dry eye may develop even for those who have never experienced it before.⁵

Supplement for Postoperative Dry Eyes

A recent study illustrates a novel means of overcoming dry eye in the days and weeks following cataract surgery. Ophthalmologists supplemented patients undergoing cataract surgery with lactoferrin, starting on day one after the procedure and continuing for 60 days.⁶ The procedure used was the most common form of cataract surgery, small incision cataract surgery. Half of the patients supplemented with lactoferrin, while the other half received no special medication. All patients continued their normal medications, including the postoperative drops routinely given to all patients.

The primary outcome variable was the tear breakup time, a commonly used measure of the quality of the tear film. Because tears consist of much more than simply water, this test is a measure of tear quality: The longer it takes for the tear film to break up, the higher the quality of the tears in terms of their ability to wet the surface of the eye (the cornea) and keep it lubricated and comfortable.

While the control group showed a steady decline in tear breakup time from the day of surgery to the 60-day mark, the lactoferrin supplemented group, after an initial seven-day decline, demonstrated a steady rise in tear breakup time.⁶ By day 14, the difference was a significant 26.4% increase in the lactoferrin group compared to the controls, and by day 30, the difference between the two groups reached a significant 55.4%. At the end of the study, 60 days after surgery, the lactoferrin group’s tear breakup time exceeded that of the control group by 77%.⁶

This improvement in tear quality was mirrored by a steady rise in tear quantity, as measured by a simple assessment called the Schirmer test, which determines the amount of tear fluid absorbed onto a filter paper strip in a set amount of time. It was not until day 30 that this test showed a significant difference, but on that day, the lactoferrin-supplemented patients were producing 65% more tears than control subjects, and by day 60, the difference was 95% in favor of the lactoferrin group.⁶

Since dry eye is largely a comfort-related measure when mild or moderate, it was important to measure the impact of supplementation on subjective symptoms as well as measures of tear quantity and quality. By the end of the study, 42.8% of control patients still had at least mild symptoms of dry eye using a standard questionnaire, while only 26.6% of supplemented patients did.⁶ And no patient reported any side effects related to the lactoferrin oral supplement.

How Does Lactoferrin Prevent Postoperative Dry Eyes?

 

It is still under investigation as to why patients undergoing cataract surgery should be so prone to developing dry eyes after the procedure, though scientists have several educated guesses.⁶ First, most cataract patients are older, and hence already predisposed to having dry eyes. In addition, the procedure requires distorting the surface of the eye and cutting nerves to the cornea (layer covering the eye), activating the inflammatory response common to all kinds of surgery.⁶

Since inflammation is a common response to injury or irritation to the eyes, it makes sense to look at natural components of tears in search of a soothing, anti-inflammatory molecule that is perfectly designed for addressing ocular inflammation.

Lactoferrin, a protein complex (glycoprotein) naturally present in tears, is known to have anti-inflammatory and antimicrobial properties. It also enhances cell growth for healing, suppresses excessive blood vessel development, and even prevents tumors.⁶ In people with dry eyes for reasons other than surgery, lactoferrin levels are known to be low, and lactoferrin has been used successfully in managing dry eyes in the autoimmune condition called Sjögren’s syndrome.^6,7

Animal studies provide further support for the use of lactoferrin to ameliorate dry eyes, particularly after the kind of controlled destruction produced in cataract surgery. Topical lactoferrin solution accelerated healing of eyes in mice whose corneas had been damaged.⁸ In fact, within 24 hours, the damage to lactoferrin-treated animals was 100% cleared, compared to 65% to 70% in animals treated with saline only or with another protein, albumin. Lactoferrin treatment was also shown to reduce inflammatory cell infiltration and levels of the inflammatory signaling molecule (cytokine) interleukin-1 (IL-1).

 

Other Options for Non-Surgical Induced Dry Eye

For those that experience dry eyes, a proven remedy is the extract of the maqui berry, which is rich in delphinidins, molecules that naturally defend against chemical and light-induced damage to the tear-producing glands in the eyes.^9,10 Studies have shown that those supplementing with 60 mg daily of maqui berry extracts experienced an increase in tear production and a reduction in symptoms of dry eye.¹⁰

The human study described at the beginning of this article shows the importance of addressing the risk of dry eye. People preparing to undergo cataract surgery may consider initiating 350 mg a day of lactoferrin supplementation the day after the procedure and continue taking it for 60 days following the procedure.⁶

Summary

Cataract surgery has a 98% success rate, but it often results in “dry eyes,” the loss of tear film quantity and quality.

A recent study of cataract patients who supplemented immediately after surgery with lactoferrin found that those who took the supplement performed better on a test known as tear breakup time, which is used to measure dry eyes as well as the time it takes for tears to break up in the eye.

By day 30, this test showed a significant difference in the lactoferrin-supplemented patients, who produced 65% more tears than control subjects. By the end of two months, the difference was 95% in favor of the lactoferrin group. And no subjects who received lactoferrin reported any side effects.

Lactoferrin is a protein complex naturally present in tears. It is known to have anti-inflammatory and antimicrobial properties, while enhancing cell growth for healing.

Based on current science, patients preparing to undergo cataract surgery should begin supplementing with lactoferrin the day after the procedure and continue with it for 60 days following the operation.

If you have any questions on the scientific content of this article, please call a Life Extension^® Wellness Specialist at 1-866-864-3027.

References

1. Available at: http://www.statisticbrain.com/cataract-statistics. Accessed January 7, 2016.
2. Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009;23(2):65-73.
3. Kasetsuwan N, Satitpitakul V, Changul T, et al. Incidence and pattern of dry eye after cataract surgery. PLoS One. 2013;8(11):e78657.
4. Li XM, Hu L, Hu J, et al. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26(9 Suppl 1):S16-20.
5. Sutu C, Fukuoka H, Afshari NA. Mechanisms and management of dry eye in cataract surgery patients. Curr Opin Ophthalmol. 2015.
6. Devendra J, Singh S. Effect of oral lactoferrin on cataract surgery induced dry eye: a randomised controlled trial. J Clin Diagn Res. 2015;9(10):Nc06-9.
7. Danjo Y, Lee M, Horimoto K, et al. Ocular surface damage and tear lactoferrin in dry eye syndrome. Acta Ophthalmol (Copenh). 1994;72(4):433-7.
8. Pattamatta U, Willcox M, Stapleton F, et al. Bovine lactoferrin promotes corneal wound healing and suppresses IL-1 expression in alkali wounded mouse cornea. Curr Eye Res. 2013;38(11):1110-7.
9. Tanaka J, Kadekaru T, Ogawa K, et al. Maqui berry (Aristotelia chilensis) and the constituent delphinidin glycoside inhibit photoreceptor cell death induced by visible light. Food Chem. 2013;139(1-4):129-37.
10. Hitoe S, Tanaka J, Shimoda H. MaquiBright standardized maqui berry extract significantly increases tear fluid production and ameliorates dry eye-related symptoms in a clinical pilot trial. Panminerva Med. 2014;56(3 Suppl 1):1-6.