Re-esterfied omega-3 fatty acids effective for dry eye

San Diego-Oral consumption of re-esterfied omega-3 fatty acids (1680 mg EPA and 560 mg DHA) once daily for 12 weeks is “an effective treatment for dry eye disease,” said Eric D. Donnenfeld, MD.

"Oral omega-3 supplementation is one of the foundations for the management of meibomian gland dysfunction and dry eye symptoms," said Dr. Donnenfeld, Ophthalmic Consultants of Long Island, New York. 

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Dry eye is the leading cause of meibomian gland dysfunction, and oral nutrition is considered a primary therapy, he said.

Dr. Donnenfeld presented data from a study that assessed the effect of oral re-esterified omega-3 fatty acids on tear osmolarity, MMP-9, ocular surface disease Index (OSDI), tear break-up time (TBUT), Schirmer's score, corneal staining, and omega index.

“Looking at osmolarity has become the lynchpin for dry eye,” he said.

By week 6, there were already statistically significant differences between the treated eyes and the placebo group, and by week 12 even more so in all study parameters, Dr. Donnenfeld said.

With MMP-9, “there was a large trend change from baseline in the omega-3 treated group,” he said.

TBUT changes were statistically significant by week 12, he said, and OSDI symptoms were reduced by 17 points in the omega-3 group versus 5 in the placebo group by week 12.

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The omega index measures omega levels in the plasma. At baseline all patients were in the 4s, but by week 12, those in the omega-3 group had improved to 7.19. The goal is to have a level around 8, he said.

“That’s when the magic happens, when you really start getting the benefit of omega-3s,” he said.

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Specifically, mean tear osmolarity improved from 326.0 mOsm/L at baseline to 317.7 mOsm/L at week 12 in the placebo group and from 326.2 mOsm/L to 306.9 mOsm/L in the omega-3 group (and this was statistically significant beginning at week 6, Dr. Donnenfeld said).

Likewise, the OSDI improved from 27.1 to 22.0 in the placebo group from baseline to week 12, and from 31.4 to 15.5 in the omega-3 group from baseline to week 12, reaching statistical significance by week 12. TBUT improved from 4.61 to 5.81 seconds in the placebo group and from 4.78 to 8.25 seconds in the omega-3 group.

Dr. Donnenfeld added there is a difference between triglycerides that have been re-esterfied and ethyl esterides. This study did not evaluate the difference between the types of omega-3 fatty acids, but used one company’s re-esterized triglycerides.

Four companies currently sell re-esterized triglycerides, but not all patients can afford the name brand. During the question-and-answer session, Dr. Donnenfeld suggested physicians recommend 2 to 3 times the recommended dose for the non-name-brand versions.

"The advantage of using a re-esterified triglyceride omega-3 fatty acid is that the omega-3 maintains its natural triglyceride structure which can be easily metabolized and absorbed,” Dr. Donnenfeld said. “Greater bioavailability translates into greater physiological value.”

Although specific data were not presented, Dr. Donnenfeld said fluorescein-staining scores were also improved.

Also, “internists think there may be bleeding differences in groups that are using supplementation, but I have not found that,” he said.