Re-esterified omega 3 (Omega Eye®) dietary supplements reduce tear film osmolarity in patients with dry eye disease.

Abstract

 

Purpose

 

Dietary supplementation with omega-3 (n-3) polyunsaturated fatty acids (PUFAs) has been found to be beneficial in the treatment of chronic dry eye disease (DED). PUFA bioavailability is increased through the process of re-esterification. In this study, we examined the effect of supplemental re-esterified Omega 3 (RO3) PUFA (Omega Eye®) on patient symptomatology, ocular surface inflammatory markers & tear film osmolarity.

 

Methods

 

Patients with mild to moderate DED were recruited from a tertiary referral ocular surface disease clinic in the United Kingdom, in an open-label, single-group, preliminary feasibility study (n=17). All patients were instructed to take 4 softgels/day of Omega Eye®(2.7g of eicosapentaenoic acid, 1.7g of docosahexaenoic acid & 25μg of D3 Cholecalciferol) for 90 days. Patient-reported outcomes (Ocular Surface Disease Index (OSDI)) were assessed at baseline, 30, 60 & 90 days. Objective outcome measures (Omega 3 index, Schirmer’s test, tear film osmolarity, ocular surface staining scores (Oxford, Van Bijstervald, Ocular Staining Score (OSS)) together with ocular surface impression cytology (OSIC) for CD11c, HLA-DR expression, leukocytes using flow cytometry were evaluated at baseline & at 90 days.

 

Results

 

Seventeen patients (aged 66(27-86) years (median(range); females, 9) reported a significant improvement in the ocular surface discomfort OSDI sub-score from Day 0 (7; 0-12) to Day 90 (4; 0-12)(p=0.02) & borderline improvement in total OSDI score [Day 0 (45.83; 0-72.55); Day 90 (20.83; 0-68.75)(p=0.09)]. An increase in Omega 3 index was seen in 16 patients & this correlated with significant reduction in tear film osmolarity (r = -0.73, p=0.003). There was significant improvement in ocular staining scores (Oxford staining (p=0.005), Van Bijstervald (p=0.003), OSS (p=0.007)) & significant reduction in conjunctival monocytes (p=0.028) from day 0 vs 90 of treatment. Schirmer’s test & expression of HLA-DR & CD11c were not altered.

 

Conclusions

 

This is the first study to show an increase in omega 3 index is associated with a reduction in tear film hyperosmolarity after nutritional supplementation with RO3 PUFA in patients with mild to moderate DED. This is accompanied by improvement in ocular surface discomfort symptoms, ocular surface staining & reduction in intraepithelial monocytes. Randomised control trials are required to further interrogate this effect.