Omega-3 Fatty Acid Supplements Ineffective for Dry Eye Disease, Study Shows

Dry eye disease is a common condition, often prompting patients to seek eye evaluations. It is characterized by symptoms such as pain, vision abnormalities, and a general feeling of discomfort. Traditional treatments include artificial tears and FDA-approved medications, but these do not always resolve the problem. Omega-3 fatty acids, often considered a natural remedy, have been studied for their potential benefits in treating dry eye disease. However, previous studies, including the landmark DREAM study, have shown mixed results.

The study, conducted by Joon Young Hyon, MD, PhD, and colleagues from Seoul National University College of Medicine, involved a double-masked, parallel-group design. Researchers recruited 132 patients with dry eye disease associated with meibomian gland dysfunction at seven institutions from September 2020 to January 2023. The mean age of participants was 50.6 years, and 78% were women. The patients were randomly assigned to receive either ω-3 fatty acids or grape-seed oil.

Patients in the ω-3 fatty acid group received four daily doses of 1,680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid. The control group received four daily doses of 3,000 mg of grape-seed oil. Both groups had similar baseline Ocular Surface Disease Index (OSDI) scores (43.5 for ω-3 and 44.1 for grape-seed oil).

Key Findings:

• The change in OSDI from baseline to 6 and 12 weeks was -20.5 and -22.7 in the ω-3 fatty acid group and -15.1 and -18.8 in the grape-seed oil group (P=0.12 and P=0.28, respectively).

• There were no changes in safety or adverse events between the groups.

• Compliance with dietary supplement intake was high in both groups (95.8% and 95.4%, respectively).

• No differences were reported in eye drop use or mean visual acuity between the groups.

Penny A. Asbell, MD, MBA, who was not involved in the study but led the DREAM study, expressed skepticism about the efficacy of ω-3 supplements for dry eye disease. She noted that while patients often prefer over-the-counter supplements, evidence consistently questions their value. Asbell highlighted that dry eye disease is difficult to measure, which complicates the assessment of treatment efficacy.

Ian J. Saldanha, MBBS, MPH, PhD, from Johns Hopkins Bloomberg School of Public Health, commented that the study's findings align with existing evidence. He suggested that higher doses of omega-3 supplements might offer benefits, as indicated by secondary outcomes in the study. However, he noted the need for more research to reach a definitive conclusion.

The study had several limitations, including a short duration, small sample size, and the lack of a placebo control. Additionally, the use of grape-seed oil as a control, which has antioxidant properties, may have influenced the results.

The study concluded that re-esterified triglyceride ω-3 fatty acid supplementation does not improve symptoms of dry eye disease associated with meibomian gland dysfunction. Despite the popularity of omega-3 supplements, their efficacy remains unproven, and further research is needed to explore their potential benefits.

Reference:

Eom, Y., Jun, I., Jeon, H. S., Lim, D. H., Lee, H., Hwang, H. S., Chung, S.-H., Chung, T.-Y., Kim, J. Y., Kim, S. W., Choi, C. Y., Song, J. S., Kim, M. K., Seo, K. Y., & Hyon, J. Y. (2024). Re-esterified triglyceride ω-3 fatty acids in dry eye disease with meibomian gland dysfunction: A randomized clinical trial. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.1482