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Changes in Tear Lipid Layer Thickness and Symptoms Following the Use of Artificial Tears with and Without Omega-3 Fatty Acids: A Randomized, Double-Masked, Crossover Study

Authors Fogt JS, Fogt N, King-Smith PE, Liu H, Barr JT

Received 28 October 2019

Accepted for publication 27 November 2019

Published 20 December 2019 Volume 2019:13 Pages 2553—2561


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Jennifer S Fogt,1 Nick Fogt,1 P Ewen King-Smith,1 Haixia Liu,2 Joseph T Barr1

1Ohio State University College of Optometry, Columbus, OH, USA; 2Allergan Plc, Irvine, CA, USA

Correspondence: Jennifer S Fogt
The Ohio State University College of Optometry, 338 West 10th Avenue, Columbus, OH 43210-1280, USA
Tel +1 614-292-0882

Purpose: To determine if an eye drop containing omega-3 fatty acids (Refresh Optive MEGA-3®, Allergan plc, Dublin, Ireland) increases the lipid layer thickness (LLT) of the tear film versus a non-emollient eye drop (Refresh Optive, Allergan plc).
Methods: Patients (≥30 years) with baseline LLT ≤75 nm completed the Current Symptoms Survey (CSS – a visual analog survey of dry eye symptoms), and LLT was measured pre- and post-instillation (15 and 60 mins) of their randomly assigned treatment. After washout, patients were tested with the other treatment. Primary endpoint: change in LLT from baseline. Secondary endpoint: CSS results.
Results: Of 21 patients enrolled, 19 completed the study. With the omega-3–containing eye drop, the mean (standard deviation) LLT increase from baseline at 15 mins was statistically significant in the overall field (8.8 [11.5] nm; P<0.001), and in each individual zone (superior, central, and inferior). At 1 hr, the LLT change from baseline was statistically significant overall (4.4 [9.7] nm; P<0.02) and in the inferior and central zones. With the aqueous eye drop, LLT change from baseline was only significant at 15 mins in the inferior field. The CSS analysis revealed a ≥8.68-unit decrease in mean average dryness score from baseline at 15 and 60 mins post-instillation of the lipid-based treatment (P≤0.03).
Conclusion: The eye drop containing omega-3 fatty acids increased LLT at 15 mins, maintaining it at 1 hr post-instillation. Dryness symptoms also improved and maintained improved levels 1 hr after instillation, indicating that the product may benefit symptomatic patients with evaporative dry eye.

Keywords: dry eye, artificial tears, ophthalmic solution, omega-3 fatty acids, survey, tear lipid layer

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