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Dry eye disease: To omega-3 or not to omega-3

Title of Article: Efficacy of Marine ω-3 Fatty Acid Supplementation vs Placebo in Reducing Incidence of Dry Eye Disease in Healthy US Adults: A Randomized Clinical Trial


Dry eye disease (DED) is a multifactorial disease of the ocular surface commonly treated with topical artificial tears and anti-inflammatory agents. As omega-3s play a role in various anti-inflammatory processes, it has been widely debated whether omega-3 fish oil supplementation should be recommended in DED management. For instance, some studies have shown a short-term reduction in DED signs and symptoms with supplementation, whereas the Dry Eye Assessment and Management (DREAM) study did not reveal a significant clinical benefit when omega-3s were used as an adjunct to DED treatment. To determine the clinical utility of omega-3 supplementation in disease prevention, the present study investigated whether long-term daily omega-3 fish oil supplementation (1g/day) could reduce the incidence of nonspecific DED and severe DED symptoms.

Study Key Points:

This ancillary study included 23,523 healthy participants from the nationwide American Vitamin D and Omega-3 Trial (VITAL) in a randomized controlled trial. The mean (SD) age of the participants was 67.0 (7.0) years and roughly half were female (48.3%). Omega-3 supplementation (1g/day) was taken for a median of 5.3 years (ranging 3.8-6.1 years) with a supplement compliance of more than 80%. For the primary endpoint of the study, there was no significant difference in DED development between the supplement (232/11,757 [2.0%]) and placebo (232/11,757 [2.0%]) groups (HR, 0.97; 95% CI, 0.81-1.16). For the secondary endpoint, there was also no significant difference in the incidence of DED plus severe DED symptoms between the supplement [8.9%] and placebo [9.1%] groups (HR, 0.97; 95% CI, 0.89-1.06).

Conclusions and Relevance:

The results from this trial do not support long-term omega-3 supplementation (1g/day) to reduce the incidence of clinically diagnosed DED or reduce the number of reported severe DED symptoms. These results, along with what has been previously reported in the DREAM study, suggest that omega-3 supplementation is neither efficacious as an adjunct to DED management nor a recommended treatment to reduce the risk of DED.


Christen WG, Cook NR, Manson JE, Buring JE, Lee I-M, Bubes V, et al. Efficacy of marine ω-3 fatty acid supplementation vs placebo in reducing incidence of dry eye disease in healthy US adults: A randomized clinical trial. JAMA Ophthalmol [Internet]. 2022;1204:1–8. Available from:

Date of Article Publication: June 9, 2022

Article Summary by: Brooklyn Rawlyk


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