Omega-3 fatty acid supplementation improves dry eye symptoms in patients with glaucoma: results of a prospective multicenter study

Figures & data

Table 1 Composition of Brudypio^® 1.5 g

Composition	Per capsule	Percentage of recommended amount in one capsule	Per three capsules	Percentage of recommended amount in three capsules
Concentrated oil in omega-3 fatty acids (mg)	500		1,500
TG-DHA 70%	350	–	1,050	–
EPA 8.5%	42.5	–	127.5	–
DPA 6%	30	–	90	–
Vitamins
Vitamin A (retinol, μg)	133.3	17	400	50
Vitamin C (ascorbic acid, mg)	26.7	33	80	100
Vitamin E (d-α-tocopherol, mg)	4	33	12	100
Vitamin B1 (thiamine, mg)	0.36	33	1.1	100
Vitamin B2 (riboflavin, mg)	0.46	33	1.4	100
Vitamin B3 (niacin equivalent, mg)	5.33	33	16	100
Vitamin B6 (pyridoxine, mg)	0.46	33	1.4	100
Vitamin B9 (folic acid, μg)	66.7	33	200	100
Vitamin B12 (cobalamin, μg)	0.83	33	2.5	100
Essential trace elements
Zinc (mg)	3.33	33	10	100
Copper (mg)	0.33	33	1	100
Manganese (mg)	0.66	33	2	100
Selenium (μg)	18.3	33	55	100
Other components
Lutein (mg)	3.33	–	10	–
Zeaxanthin (mg)	0.33	–	1	–
Glutathione (mg)	2	–	6	–
Lycopene (mg)	2	–	6	–
Coenzyme Q10 (mg)	2	–	6	–
Anthocyanins (mg)	5	–	15	–
Oleuropein (μg)	67	–	200	–

Note: The dosage tested is three capsules per day, which corresponds to 100% of the recommended daily amounts of the included vitamins and minerals.

Abbreviations: TG-DHA, triglyceride-bound docosahexaenoic acid; EPA, eicosapentaenoic acid; DPA, docosapentaenoic acid.

Table 2 Description of variables at baseline (visit 0) and at 12 weeks in 1,255 patients with glaucoma with dry eye symptoms

Variables	Data
Sex
Men (%)	477 (38.0%)
Women (%)	778 (62.0%)
Age, mean (SD) (years)	63.6 (12.8)
Hypotensive medication, daily eye drops, mean (SD)	1.7 (2.0)
Artificial tears’ users, n (%)	959 (88.3)
Daily eye drops, mean (SD)	3.4 (1.6)
	Baseline(visit 0)	Visit at 12 weeks	P-value
Dry eye symptoms, mean (SD)
Scratchy	1.3 (0.8)	0.6 (0.7)	<0.001
Stinging sensation	1.4 (0.8)	0.7 (0.7)	<0.001
Grittiness	1.6 (0.8)	0.7 (0.7)	<0.001
Painful eyes	0.6 (0.8)	0.3 (0.5)	<0.001
Tired eyes	1.0 (0.9)	0.4 (0.6)	<0.001
Grating sensation	1.1 (0.9)	0.5 (0.6)	<0.001
Blurry vision	0.8 (0.8)	0.3 (0.6)	<0.001
Conjunctival hyperemia, n (%)
None	106 (9.2)	335 (31.6)	<0.001
Mild	561 (48.8)	615 (58.0)
Moderate	385 (33.5)	105 (9.9)
Severe	98 (8.5)	8 (0.6)
Oxford grade, n (%)
Right eye
0	159 (12.9)	458 (38.0)	<0.001
I	466 (37.7)	543 (45.0)
II	383 (31.0)	164 (13.6)
III	173 (14.0)	34 (2.8)
IV	50 (4.1)	5 (0.4)
V	6 (0.5)	1 (0.1)
Left eye
0	153 (12.4)	462 (38.4)	<0.001
I	472 (38.3)	530 (44.0)
II	368 (29.8)	175 (14.6)
III	186 (15.1)	30 (2.5)
IV	46 (3.7)	5 (0.4)
V	10 (0.8)	1 (0.1)
Tear breakup time, median (IQR) (seconds)
Right eye	8 (6–10)	10 (8–12)	<0.001
Left eye	8 (6–10)	10 (8–12)	<0.001
Schirmer test, mean (SD) (mm)
Right eye	9.69 (4.02)	11.0 (3.70)	<0.001
Left eye	9.81 (4.06)	12.1 (18.7)	<0.001
Daily eye drops of artificial tears, mean (SD)	3.45 (1.62)	3.40 (1.56)	0.003
Intraocular pressure, mean (SD) (mmHg)
Right eye	16.4 (2.92)	16.1 (2.70)	<0.001
Left eye	16.5 (2.95)	16.1 (2.60)	<0.001

Abbreviations: SD, standard deviation; IQR, interquartile range.

Figure 1 Changes in Schirmer test scores in the right and left eyes at baseline (visit 0) and at visit at 12 weeks (*P<0.001, Wilcoxon rank sum test).

Figure 2 Changes in tear instability, TBUT, in the right and left eyes at baseline (visit 0) and at visit at 12 weeks (*P<0.001, Wilcoxon test).

Abbreviation: TBUT, tear breakup time.

Table 3 Improvement of dry eye symptoms according to compliance with treatment

Dry eye symptoms	Baseline (visit 0)		Visit at 12 weeks
	Complianta	Noncompliantb	Compliant	Noncompliant
Scratchy	1.3 (0.8)	1.2 (0.8)	0.6 (0.7)	0.6 (0.7)
Stinging sensation	1.5 (0.8)	1.3 (0.8)	0.7 (0.7)	0.7 (0.7)
Grittiness	1.6 (0.8)	1.4 (0.8)	0.7 (0.2)	0.8 (0.7)
Painful eyes	0.7 (0.9)	0.6 (0.8)	0.3 (0.5)	0.3 (0.5)
Tired eyes	1.0 (0.9)	1.0 (0.9)	0.4 (0.6)	0.5 (0.6)
Grating sensation	1.2 (0.9)	1.0 (0.8)	0.4 (0.6)	0.5 (0.6)
Blurry vision	0.8 (0.9)	0.7 (0.8)	0.3 (0.6)	0.3 (0.5)
			Difference 12 weeks vs baseline
			Compliant	Noncompliant	P-value
Scratchy			−0.7 (0.7)	−0.6 (0.7)	<0.001
Stinging sensation			−0.8 (0.7)	−0.7 (0.7)	<0.001
Grittiness			−0.9 (0.8)	−0.7 (0.7)	<0.001
Painful eyes			−0.4 (0.7)	−0.3 (0.6)	0.060
Tired eyes			−0.6 (0.8)	−0.5 (0.7)	0.120
Grating sensation			−0.7 (0.8)	−0.5 (0.7)	<0.001
Blurry vision			−0.5 (0.7)	−0.4 (0.6)	0.015

Notes: Data as mean (standard deviation). Compliant (781, 62.2%) and noncompliant (474, 37.8%) are self-reported data.

a Compliant: always took the three capsules every day.

b Noncompliant: some/much forgetfulness.

Table 4 Improvement of dry eye symptoms according to the degree of conjunctival hyperemia in the subgroup of compliant patientsa

Dry eye symptoms	Baseline (visit 0)		Visit at 12 weeks
	None/mild	Moderate/severe	None/mild	Moderate/severe
Scratchy	1.2 (0.7)	1.7 (0.8)	0.5 (0.6)	0.8 (0.8)
Stinging sensation	1.2 (0.7)	1.9 (0.8)	0.5 (0.6)	0.9 (0.7)
Grittiness	1.3 (0.8)	2.1 (0.7)	0.6 (0.7)	0.9 (0.7)
Painful eyes	0.4 (0.7)	1.0 (0.9)	0.1 (0.4)	0.4 (0.6)
Tired eyes	0.7 (0.8)	1.4 (0.9)	0.3 (0.6)	0.6 (0.7)
Grating sensation	0.9 (0.8)	1.6 (0.9)	0.3 (0.5)	0.6 (0.7)
Blurry vision	0.5 (0.7)	1.1 (0.9)	0.9 (0.5)	0.4 (0.6)
			Difference 12 weeks vs baseline
			None/mild	Moderate/severe	P-value
Scratchy			−0.6 (0.7)	−0.9 (0.7)	<0.001
Stinging sensation			−0.7 (0.7)	−1.0 (0.8)	<0.001
Grittiness			−0.7 (0.7)	−1.2 (0.8)	<0.001
Painful eyes			−0.2 (0.5)	−0.7 (0.8)	<0.001
Tired eyes			−0.4 (0.6)	−0.8 (0.9)	<0.001
Grating sensation			−0.7 (0.7)	−1.0 (0.8)	<0.001
Blurry vision			−0.3 (0.6)	−0.7 (0.8)	<0.001

Notes: Data as mean (standard deviation).

a Compliant: always took the three capsules every day.