Omega-3 fatty acid dietary supplements: To prescribe or not to prescribe for dry eye?

Omega-3 fatty acid supplements—commonly recommended for symptom relief for dry eye disease—may not have the beneficial effects previously thought.

Published online April 13 in The New England Journal of Medicine, the Dry Eye Assessment and Management (DREAM) study looked at the efficacy of Omega-3s on dry eye. In a trial, 535 patients with dry eye disease were divided into two groups. Over a 12-month period, one group received daily doses of "active" fish oil supplements (3,000 mg) and the other a placebo (1 teaspoon of olive oil). Participants continued to take their usual interventions for dry eye.

A majority in both groups showed an improvement of at least 10 points on the Ocular Surface Disease Index (OSDI), but the National Eye Institute-funded study also found differences in their scores were "not statistically significant"—the mean score for the "active" supplement group was -13.9 points versus -12.5 points for the placebo. Sixty-one % of people receiving the omega-3 supplement improved their OSDI score by 61%, compared with 54% of those in the control group.

"In conclusion, among patients who had moderate-to-severe dry eye disease despite the use of other treatments and were randomly assigned to receive either n-3 fatty acid or placebo supplements, symptoms and signs had improved," researchers write. "We found no evidence of a beneficial effect of n-3 fatty acid supplements as compared with placebo supplements among patients with dry eye disease."

The study group represented departments of ophthalmology at Icahn University School of Medicine at Mount Sinai, the University of Pennsylvania, Philadelphia, Case Western Reserve University, University of California, Berkeley, University of Michigan and Minnesota Eye Consultants.

Dry eye disease is one of the most common eye conditions in the U.S. with about 14% of Americans having the condition.

To prescribe or not to prescribe?

Daniel Bintz, O.D., a member of the AOA Health Promotions Committee who practices in Elk City, Oklahoma, has been following stories about the study and scanning the internet for rebuttals. Dr. Bintz recommends and sells a "high-quality" brand of fish oil supplements to his patients.

"I've never told patients that fish oil would improve their dry eyes," Dr. Bintz says. "But I think we all 'hoped' fish oil would improve dry eye symptoms."

Regardless, he says, fish oil is good for his patients' overall health. Studies have shown omega-3 fatty acids can lower blood pressure and the likelihood of a heart attack.

"I tell patients that most of us don't eat enough ocean fish containing omega-3 fish oils, and there are studies that show the benefits of omega-3 oils in our bodies," Dr. Bintz says. "I also tell patients there is a possibility that fish oil supplements may improve their dry eye symptoms, but the improvement may not be noticed because they usually have many other treatments they are using for their dry eye disease at the same time."