Marine omega-3 fatty acid supplements show no benefit in preventing dry eye disease
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Long-term supplementation with marine omega-3 fatty acid has no effect on incident clinically significant dry eye disease or reported severe symptoms of the disease, according to a study.
The VITAL-Dry Eye was an ancillary study of VITAL, a large nationwide trial conducted in the U.S. to assess the potential effects of vitamin D (2,000 IU daily) and omega-3 fatty acids (fish oil, eicosapentaenoic acid and docosahexaenoic acid), 1 mg daily, in the prevention of cancer and cardiovascular disease. VITAL Dry-Eye included 23,523 adults with no signs and symptoms of dry eye disease at baseline. There was a similar number of participants in the treatment and placebo groups.
Primary endpoint of the study was incident clinically diagnosed DED. Secondary endpoint was incident clinically diagnosed DED plus reported severe and persistent DED symptoms. Investigators defined DED as comprehensive of all subtypes (aqueous deficient and evaporative dry eye) and etiologies (contact lens wear, intensive computer use and meibomian gland dysfunction), reflecting the DED population seen in real-world clinical practice.
During a median of 5.3 years of follow-up, 472 participants (2%) were diagnosed DED, but no difference was found between the two groups of active treatment (232 participants, 2%) and placebo (240 participants, 2%). Similarly, an almost equal number of individuals receiving treatment (1,044; 8.9%) and placebo (1,074; 9.1%) had incident DED plus severe DED symptoms.
Based on basic science and clinical studies of short duration and limited sample size, omega-3 fatty acids are frequently recommended in the management of DED for their anti-inflammatory properties. However, investigators of the study said this the first large, randomized clinical trial to assess whether omega-3 fatty acids can prevent the development of DED.
“The results do not support recommending marine [omega]-3 fatty acid supplementation to reduce the incidence of DED,” the authors concluded.
Perspective
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In this study, the patients were monitored for serum essential fatty acid (EFA) levels, controlling for their dietary intake. Neither the high- nor the low-level participants showed decreased or worsened DED or symptom development when they were on a relatively low dose of 1 g per day of the EFA dietary supplement.
The study shows that dry eye potential is relatively unlikely in large populations within an observational cohort for cancer and cardiovascular disease, whether they take low-dose EFA supplements, and regardless of their omega-3 dietary intake.
The strength of this study is its size. The weakness is that dry eye was not an integral part of the anticipated analysis, as systemic conditions dictated the study design. Generally, higher doses of omega-3 fatty acids are used for patients who already have dry eye. To conclude that these patients will not respond to EFA therapy from this study is erroneous, as preventive treatment results can differ vastly from therapeutic interventions. Thus, this data might cause clinicians to recommend higher preventive EFA intake or none for patients who may be at risk for dry eye. These data should not alter current concepts of therapy for existing dry eye.
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Christen WG, at al. JAMA Ophthalmol. 2022.doi:10.1001/jamaophthalmol.2022.1818.
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