Key Takeaways

  • In a randomized clinical trial of 132 patients, re-esterified triglyceride omega-3 supplementation was not superior to grape-seed oil in improving dry eye symptoms associated with MGD
  • Both treatment groups experienced clinically meaningful improvements in Ocular Surface Disease Index scores over 12 weeks
  • Omega-3 supplementation was well tolerated, with high treatment adherence and no supplement-related adverse events reported

Re-esterified triglyceride (rTG) omega-3 fatty acid supplementation did not provide a significant benefit over grape-seed oil in improving symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD), according to findings from a randomized clinical trial published in JAMA Ophthalmology.1

The multicenter, double-masked study enrolled 132 adults with DED and MGD across seven institutions in Korea between September 2020 and January 2023. Participants were randomly assigned to receive either daily rTG omega-3 supplementation containing 1,680 mg of eicosapentaenoic acid (EPA) and 560 mg of docosahexaenoic acid (DHA), or 3,000 mg of grape-seed oil as a control.

The primary endpoint was change in the Ocular Surface Disease Index (OSDI) score at 6 and 12 weeks. Investigators found that although symptoms improved in both groups, the differences between treatments were not statistically significant.

At baseline, mean OSDI scores were 43.5 in the omega-3 group and 44.1 in the grape-seed oil group. After 12 weeks, OSDI scores improved by 22.7 points in the omega-3 arm and 18.8 points in the control arm, a between-group difference that did not reach statistical significance (P=.28). Similarly, the 6-week difference was not significant (P=.12).

A total of 115 participants completed the 12-week follow-up, with compliance exceeding 95% in both treatment groups. Investigators also reported no significant changes in visual acuity or IOP and no supplement-related adverse events, suggesting both interventions were well tolerated.

The findings add to an ongoing debate regarding the role of omega-3 supplementation in dry eye management. Previous studies and meta-analyses have reported mixed results, with some suggesting symptom improvement while others—including the large Dry Eye Assessment and Management (DREAM) trial—found no meaningful benefit. The authors noted that differences in omega-3 formulation, dosage, and study design have contributed to inconsistent findings across the literature.

Although the rTG formulation has been proposed to offer greater bioavailability than other omega-3 preparations, the current trial did not demonstrate superiority over the antioxidant control for the study's primary endpoint. The investigators cautioned that fewer than 60 participants in each group completed follow-up, and they emphasized that any favorable trends observed in secondary outcomes should be considered hypothesis-generating rather than definitive.

The authors concluded that their results do not support routine use of rTG omega-3 supplementation solely to improve symptoms of DED associated with MGD, while noting that larger studies may be warranted to further evaluate potential effects on other clinical measures.

Reference

1. Eom Y, Jun I, Jeon HS, et al. Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial. JAMA Ophthalmol. 2024;142(7):617-624. doi:10.1001/jamaophthalmol.2024.1482.