Adding omega-3 has no effect on dry eye disease

Large-scale trial found omega-3 had no effect on signs or symptoms

Howard Larkin

Posted: Saturday, April 14, 2018

Penny Asbell MD

The results of the Dry Eye Assessment and Management (DREAM) study were simultaneously published in the New England Journal of Medicine and presented by DREAM Research Group Study Chair Penny Asbell MD at the American Society of Cataract and Refractive Surgery Cornea Day 2018 in Washington DC, USA.

Intended to reflect real-world conditions, DREAM followed 535 patients who had DED symptoms for at least six months before the study and were undergoing a range of treatments including artificial tears, cyclosporine drops, warm eyelid soaks and lid scrubs. In addition to continuing existing treatment, 349 received 3000 mg of fish oil daily and 186 received placebo.

While the fish oil group showed significant increases in blood levels of the omega-3 fatty acids, there was no significant difference between the groups in clinical outcomes after three, six and 12 months. Values for mean ocular surface disease index (OSDI), measures of discomfort and pain interference, conjunctival staining, tear-film breakup time and Schirmer’s test scores were all similar. Reduction in use of other DED treatments was also similar between the two groups, as were outcomes for moderate and severe patient subgroups.

Previous evidence for the efficacy of fish oil supplements in relieving DED symptoms was contradictory and weak, Dr Asbell said. Shoe noted that a 2013 American Academy of Ophthalmology Preferred Practice Pattern statement found no evidence favouring efficacy, while a 2017 report from the Tear Film and Ocular Surface Society Dry Eye Workshop (DEWS II) cited mixed results among short-term studies and a lack of high-quality randomised trials.

Nonetheless, faith in omega-3 for treating DED remains strong among patients and ophthalmologists. Indeed, about one third of those taking an instant poll at the ACSRS presentation responded that omega-3 helped all DED patients and more than half said they helped some patient subgroups. Just 10 percent said they were of no use to any patients.

“This National Eye Institute-supported clinical trial shows that oral omega-3 is no better than placebo in relieving signs and symptoms of dry eye disease,” Dr Asbell concluded.