Evaluation of the DREAM study on n-3 fatty acid supplementation for dry eye

N–3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease published in the May 2018 issue of the New England Journal of Medicine supposedly proved that using n-3 (aka omega-3) fatty acids are no better than a placebo in treating dry eye disease.

Among patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n–3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo.

The big problem with this is the placebo that they used. They could have just used glycerin or some inert compound. No. They used olive oil which is really high in oleic acid. Oleic acid also happens to be very good for its anti-inflammatory properties.

That’s like saying that Aleve is no good for headaches because it is not better than Advil.
I thought The Dry Eye Assessment and Management (DREAM) Extension Study – A Randomized Clinical Trial of Withdrawal of Supplementation With Omega-3 Fatty Acid in Patients With Dry Eye Disease study published in the January 2020 issue of The Ocular Surface would give more clarity.

Patients were randomly assigned, in a 1:1 ratio, to receive either active or placebo supplements. The active supplements contained a total dose of 2000 mg of eicosapentaenoic acid (EPA) and 1000 mg docosahexaenoic acid (DHA) and the placebo supplements contained a total dose of 5000 mg of refined olive oil.


How about completely discontinuing the supplement? I want to know how good n-3s are versus not doing anything or compared to any of the myriad of other dry eye drugs and treatments out there. This didn’t really tell me much other than I can recommend patients increase olive oil in their diet and that might help, too.