Effect of Oral Re-esterified Omega-3 Nutritional Supplementation on Dry Eyes

Epitropoulos, Alice; Donnenfeld, Eric D.; Shah, Zubin; Holland, Edward J.; Gross, Michael L.; Faulkner, William J.; Matossian, Cynthia; Lane, Stephen S.; Toyos, Melissa; Bucci, Frank A.; Perry, Henry D.

doi:10.1097/ico.0000000000000940

Cited by 93 publications

(119 citation statements)

References 42 publications

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“…For example, of the 375 patients in the DREAM trial who had tear osmolarity measurements, only 24 (6.4%) would have met the following eligibility criteria in a recent study: an osmolarity of at least 312 mOsm per milliliter in at least one eye and mild meibomian-gland dysfunction in both eyes. 20 Other studies included only patients with rosacea 17 or with results on Schirmer’s test of less than 5 mm in 5 minutes. 22 In the DREAM trial, analyses of subgroups that were defined according to these and other criteria did not yield evidence of a benefit from treatment as compared with placebo.…”

Section: Discussionmentioning

confidence: 99%

n−3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease

Asbell²,

et al. 2018

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BACKGROUND Dry eye disease is a common chronic condition that is characterized by ocular discomfort and visual disturbances that decrease quality of life. Many clinicians recommend the use of supplements of n–3 fatty acids (often called omega-3 fatty acids) to relieve symptoms. METHODS In a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n–3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group). The primary outcome was the mean change from baseline in the score on the Ocular Surface Disease Index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity), which was based on the mean of scores obtained at 6 and 12 months. Secondary outcomes included mean changes per eye in the conjunctival staining score (ranging from 0 to 6) and the corneal staining score (ranging from 0 to 15), with higher scores indicating more severe damage to the ocular surface, as well as mean changes in the tear break-up time (seconds between a blink and gaps in the tear film) and the result on Schirmer’s test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs. RESULTS A total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively. The mean change in the OSDI score was not significantly different between the active supplement group and the placebo group (−13.9 points and −12.5 points, respectively; mean difference in change after imputation of missing data, −1.9 points; 95% confidence interval [CI], −5.0 to 1.1; P=0.21). This result was consistent across prespecified subgroups. There were no significant differences between the active supplement group and the placebo group in mean changes from baseline in the conjunctival staining score (mean difference in change, 0.0 points; 95% CI, −0.2 to 0.1), corneal staining score (0.1 point; 95% CI, −0.2 to 0.4), tear break-up time (0.2 seconds; 95% CI, −0.1 to 0.5), and result on Schirmer’s test (0.0 mm; 95% CI, −0.8 to 0.9). At 12 months, the rate of adherence to treatment in the active supplement group was 85.2%, according to the level of n–3 fatty acids in red cells. Rates of adverse events were similar in the two trial groups. CONCLUSIONS Among patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n–3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo. (Funded by the National Eye Institute, National Institutes of Health; DREAM ClinicalTrials.gov number, NCT02128763.)

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Section: Discussionmentioning

confidence: 99%

n−3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease

Asbell²,

et al. 2018

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“…; Epitropoulos et al. ). Omega‐6 administration has been shown to improve ocular surface signs and ocular discomfort symptoms in Sjögren's patients (Aragona et al.…”

Section: Treatments Targeting Ded Inflammationmentioning

confidence: 99%

Clinical impact of inflammation in dry eye disease: proceedings of the ODISSEY group meeting

Baudouin

İrkeç

Messmer

et al. 2017

Acta Ophthalmologica

127

141

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Dry eye disease (DED) is a common, multifactorial ocular condition with major impact on vision and quality of life. It is now well recognized that the pathophysiology of chronic DED can include a cycle of inflammation involving both innate and adaptive immune responses. Recently, in vitro/in vivo models have been used to obtain a better understanding of DED‐related inflammatory processes at molecular/cellular levels although they do not truly reproduce the complex and chronic hallmarks of human DED. In clinical DED research, advanced techniques such as impression cytology, conjunctival biopsy, in vivo confocal microscopy and multiplex tear analyses have allowed an improved assessment of inflammation in DED patients. This was supported by the identification of reliable inflammatory markers including matrix metalloproteinase‐9, human leucocyte antigen‐DR or intercellular adhesion molecule‐1 in tears and impression cytology samples. One of the current therapeutic strategies focuses on breaking the inflammatory cycle perpetuating the ocular surface disease, and preclinical/clinical research has led to the development of promising anti‐inflammatory compounds. For instance, cyclosporine, already approved in the United States, has recently been authorized in Europe to treat DED associated with severe keratitis. In addition, other agents such as corticosteroids, doxycycline and essential fatty acids, through their anti‐inflammatory properties, show encouraging results. We now have a clearer understanding of the inflammatory processes involved in DED, and there is hope that the still emerging preclinical/clinical findings will be translated into new and highly effective therapies for patients in the near future.

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“…Perhaps the most thorough and widely read study on the ef icacy of omega-3's appeared in Cornea, Sept., 2016, and analyzed the effects of a re-esteri ied triglyceride form in 105 patients [21]. This was a multicenter, prospective, interventional, placebo controlled, double masked study [21].…”

mentioning

confidence: 99%

“…This was a multicenter, prospective, interventional, placebo controlled, double masked study [21]. Subjects took 4 soft gels daily containing a total of 1680mg of EPA/560mg of DHA (Dry Eye Omega bene its, Physicians Recommended Nutraceuticals) or a control of 3136mg of linoleic acid daily for 12 weeks [21].…”

mentioning

confidence: 99%

“…Subjects took 4 soft gels daily containing a total of 1680mg of EPA/560mg of DHA (Dry Eye Omega bene its, Physicians Recommended Nutraceuticals) or a control of 3136mg of linoleic acid daily for 12 weeks [21]. The conclusion was a statistically signi icant improvement in each of ive parameters measured: Ocular Surface Disease Index score (patient's symptomatology), tear osmolarity, MMP-9 (an in lammatory marker), omega-3 serum index levels, and tear break up time [21].…”

mentioning

confidence: 99%

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