Although things started to quiet down since the release of the Dry Eye Evaluation and Management (DREAM) study, the recent report questioning the health benefits of vitamin supplements hasn’t helped calm patient concerns. Now that I’ve had sufficient time to digest the study and absorb the myriad opinions I’ve heard about it, I wanted to share my thoughts.

First, I have no issue with the study methodology or its data. Many of the authors are friends and among the brightest minds in eye care. That said, my clinical experience varies considerably from the DREAM study’s headlines. My continued use of triglyceride-based omega-3 supplements in a practice that is essentially limited to dry eye and ocular surface disease is constantly validated and reinforced by patient reports and clinical observation. I am a NY cynic by nature, but I have absolutely no doubt that my patients benefit greatly from omega-3 supplementation. While I was at first confused by the study divergence from my experience, it now makes perfect sense.

It is important to understand that the conclusions of the DREAM study, especially those that formed the basis of lay press headlines, were quite different than the study’s actual results. So, while there was no statistical difference between the olive oil control and the active omega-3 arms, both demonstrated clinically significant improvement in both signs and symptoms of study participants.

This reaffirmed my belief that the epidemic of MGD and related dry eye that we’re seeing in our offices is, at least in part, caused by dietary changes that have occurred over the past decades, in addition to the better recognized shift in visual tasking and blink inhibition associated with rampant digital device use.

Still, based on my clinical experience, I would have expected a greater efficacy difference between olive oil and a TG-based omega-3 supplement. Here, I suspect that the actual reason is the subtle differences between different formulations of EPA- and DHA-containing products. The active arm of the DREAM study used a triglyceride-based omega-3 with a 2-to-1 EPA to DHA ratio. I use a 3:1 ratio product, which may account for the differences I am seeing.

Clearly, more work needs to be done to investigate different formulations of nutritional supplements—including head-to-head product comparisons before we fully understand the effect of omega-3s on dry eye. In the interim, if the supplement you are currently using works for your patients, I suggest you stay the course. As I see it, the omega-3 jury is still out.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com