Association of systemic omega-3 fatty acids with dry eye signs and symptoms at baseline in the DRy Eye Assessment and Management (DREAM^©) Study

Abstract

Purpose : Omega-3 (ω3) fatty acid supplementation is used to treat systemic inflammatory diseases, but results on ω3’s efficacy as a treatment for dry eye disease (DED), an inflammatory condition, are variable. We evaluated the cross-sectional relationship of systemic ω3 levels [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] with signs and symptoms at baseline in the DRy Eye Assessment and Management (DREAM^©) study, a randomized clinical trial investigating the efficacy and safety of long-term ω3 fatty acid supplementation for DED.

Methods : At baseline, blood samples were collected and analyzed for EPA and DHA (measured as relative percentage by weight among all fatty acids in erythrocytes). Symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI), with higher scores indicating worse symptoms. Signs were also evaluated: conjunctival staining (lissamine green scored 0-6), corneal staining (fluorescein scored 0-15), tear breakup time (TBUT), and Schirmer’s test with anesthesia. The associations of EPA and DHA levels (low, medium, high) with symptoms and signs were evaluated using analysis of variance and tests for linear trend; with the generalized estimating equations approach to accommodate using both eyes of a participant.

Results : Among 520 participants, the mean (SD) was 0.6% (0.4%) for EPA, and 3.9% (1.1%) for DHA, comparable to the mean levels of the general US population. There were no significant associations of EPA or DHA with DED symptoms (Table 1). However, higher EPA+DHA levels were associated with a shorter TBUT (p=0.04); higher EPA levels were associated with more corneal staining (p=0.02) and shorter TBUT (p=0.01), and higher DHA levels were associated with less conjunctival staining (p=0.04) (Table 2).

Conclusions : Previous studies have found varying results on ω3’s effect on the signs and symptoms of DED. Our baseline results suggest that higher systemic levels of ω3 may be associated with shorter TBUT; however the mean difference between the low and high group was only 0.5 sec. More information is needed to conclude that ω3 has an effect on the signs and symptoms of DED. Long-term data on ω3 supplementation in this cohort of well-defined DED patients will be available in the future and may provide useful insights into its effect on clinical signs and symptoms of DED.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.