Check the labels: products containing vitamin A can carry a risk of ocular adverse effects and MGD
Andrew Pucker, OD, shared with Optometry 360 findings from a study that assessed the impact of vitamin A from topical agents on ocular conditions like dry eye and meibomian gland dysfunction.
Andrew Pucker, OD:
Hello, I’m Andrew Pucker. I’m the chief development officer at Mintra Health, and today I’m happy to share a paper I recently co-authored titled “Potential Harms of Ocular and Periorbital Topical Vitamin Application: A Systematic Review and Meta-Analysis.” This paper had several co-authors. The first author actually is Kaleb Abbott, OD, and this paper was recently published in Investigative Ophthalmology and Visual Sciences or IOVS.
Why did we do this paper? Well, we know that vitamin A is commonly used in cosmetics, very common additive, and we know that it actually has some benefits. If we think about from the skin perspective, vitamin A is used to treat acne, and it’s also, for example, used to treat aging skin because it can stimulate collagen production. If we think about it from an eye standpoint, vitamin A is important because it can promote corneal wound healing, and it can also promote mucin production, which is important for lubrication on the eye.
We also know from the literature that too much vitamin A is a bad thing and it can promote dry eye disease, so you can have dry eye symptoms, and it may actually cause meibomian gland damage. The vitamin A can cause potentially meibomian gland atrophy. There’s many papers in the literature, but it’s really unclear how vitamin A affects the eye. Like I said, there’s some hints that maybe it is causing dry eye, but we didn’t really know for sure.
We did what was called a systematic review and meta-analysis. This is actually original research because what we did is we went and searched several different outlets and we found roughly 10,000 different articles. A huge amount of research that we went through, and we actually used AI to help us. We hand sorted about 5,000 of the articles, so that’s why we had a huge number of authors on the paper.
It was a lot of work. But from our work, this Cochrane group’s system called the PICO Portal, so they’re one of the main groups that supported our work, but the PICO portal has an AI system that learned from our work and it was able to sort through the remaining roughly 5,000 articles. Something cool they’re doing, but it also helped expedite our process. In the end, we ended up with 89 articles. Most of these articles focused on the face in general, so applying cosmetics to the face, but about 20% of them included something related to the eye specifically, so they specifically named the eye.
If we think about the data overall and do a statistical analysis, we find that using cosmetics with vitamin A in it increases your odds of having pain, dryness, and burning. This is actually very dose-dependent. There’s kind of 2 categories in the paper. We have high-concentration vitamin A and low-concentration vitamin A. High-concentration vitamin A is essentially a prescription maybe from a dermatologist, so you can’t just go get this off the shelf, but there’s also many cosmetics that you can go get from your favorite big box store. If you’re on these high-concentration vitamin As, you’re more likely to have the harms I mentioned, so pain, dryness, burning. But if you’re getting the over-the-counter stuff, it’s not probably as likely to cause these issues. Actually, there wasn’t really a strong association at all.
If we look at the eye-specific articles, it was really hard to sort out that data. There’s some out there, but there really wasn’t enough to come to a strong conclusion. However, based upon the evidence that we have, vitamin A was not more likely to cause eye issues. But really, I think that research is still in its infancy and we need to do more work that specifically looks at the use of vitamin A in the eye from a population standpoint.
Overall, I think that our paper is very useful in that we know that vitamin A can cause some symptoms, but there’s more work to specifically understand how that affects the eye. With that, I thank you and I hope you go read our full article.
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