considered 4.5 to 7.3 units for mild-to-moderate dry eye disease and 7.3 to 13.4 for moderate-to-severe dry eye disease. Outcomes were measured between 1 and 12 months. No significant improvement in OSDI scoring was noted for the omega-3 supplementation group compared with placebo (mean difference [MD] -2.5 units; 95% CI, -5.1 to 0.2 units). Another subgroup analysis (N570) of two trials compared omega-3 supplementation added to conventional therapy versus conventional therapy alone after one and three months of treatment. Mean pretreatment OSDI scores were in the moderate to severity range. Conventional therapy consisted of oncedaily eyelid hygiene plus a once-daily lipid emulsion drop in one trial and artificial tears every four hours and betamethasone 0.1% drops every eight hours in the other trial. Statistically significant but borderline clinical symptom improvement was noted in the omega-3 group plus conventional therapy compared with conventional therapy alone (MD -7.2 units; 95% CI, -14.0 to -0.2 units).A 2019 meta-analysis of 17 RCTs (N53,363) measured the efficacy of omega-3 fatty acid supplementation versus placebo in the treatment of dry eye disease of varying severity and etiology. 2 The majority of studies were conducted in India and the United States. The EPA dose ranged between 127.5 and 2,000 mg and DHA dose ranged between 99 and 1,000 mg given daily. Mean follow-up occurred at 1 to 12 months. Because of variable reporting methods, results were pooled and converted into a standardized MD (SMD). After pooling of all 17 trials, reductions in dry eye symptom scoring were strongly, significantly higher in the omega-3 supplementation group compared with placebo (SMD 0.97; 95% CI, 0.55-1.4; I 2 596%).The largest multicenter, double-blind RCT (n5535) to date comparing 3,000 mg of omega-3 supplementation versus placebo included in both reviews above was extended to evaluate effects of discontinuing omega-3 supplements compared with placebo after the study's initial 12-month phase. 3 Patients who completed the initial study's 12-month follow-up visit and who were assigned to the omega-3 treatment arm of the trial were eligible to participate. Of the original participants, 43 participants chose to participate in the extension study. The extension study population was similar to the original RCT with mean age of 58 years old. Patients were then randomized to either receive an additional 12 months of omega-3 supplementation or placebo. No significant difference in OSDI scores was noted between the two groups (MD -0.6 units; 95% CI, -11.0 to 9.5 units) after 12 months.