In this episode of Dry Eye Fireside Chat, Damon Dierker, OD, FAAO, sits down with Ada Noh, OD, about the role of nutritional supplementation in ocular surface disease management, why formulation matters, and how clinicians can help patients develop realistic expectations.
Dr. Noh has built a practice exclusively focusing on ocular surface disease in Little Rock, Arkansas.
Nutrition and ocular surface health fast facts:
- Dr. Noh considers nutritional supplementation a foundational component of ocular surface disease management and incorporates it alongside other therapies based on individual patient needs.
- The 2025 TFOS DEWS III Management and Therapy report recognizes dietary supplementation and lifestyle modifications as components of dry eye disease management while emphasizing individualized treatment approaches based on disease subtype and patient factors.1
- Dr. Noh emphasizes considering formulation, absorption, dosage, and available evidence rather than relying solely on the amount listed on a supplement label.
- Setting realistic expectations is important when initiating nutritional supplementation. Dr. Noh typically advises patients to allow approximately 8 weeks before determining whether supplementation is helping, although some patients report benefits sooner.
- The evidence for omega-3 supplementation remains mixed. The DREAM study found no significant difference between high-dose omega-3 supplementation and olive oil placebo after 12 months in patients with moderate-to-severe dry eye disease.2
- Additional studies evaluating nutritional supplementation have reported potential improvements in symptoms and clinical measures, although differences in formulations, doses, study populations, and outcome measures make direct comparisons challenging.3
- Patient education is central to successful nutritional counseling. Dr. Noh recommends that clinicians understand key concepts about the products they recommend and be able to explain why formulation and consistency matter.
The role of nutrition in managing ocular surface disease
According to Dr. Dierker, the approach to nutrition remains one of the more inconsistently applied components of dry eye management. He notes that patients are often confused about the evidence on whether they should take nutritional supplements, such as fish oil, and if it can improve their symptoms.
Dr. Noh considers nutrition a foundational component of long-term ocular surface management. A key part of Dr. Noh’s approach involves explaining the relationship between systemic health and the ocular surface. Because meibomian glands produce the lipid component of the tear film, she discusses with patients how factors affecting the body’s overall environment may influence meibum quality and ocular surface function.
She believes nutrition can be a valuable component of a broader treatment strategy for many patients. She notes that patients with inflammatory disease may not always have isolated aqueous deficiency and may have mixed disease requiring a broader management approach.
Keep treatment plans manageable
Dr. Noh recommends keeping the initial approach practical, often beginning with one or two nutritional supplements and incorporating other therapies as appropriate.
Patients with dry eye disease often arrive after trying multiple over-the-counter therapies, so it is important to create treatment plans that patients can realistically follow. Introducing several new recommendations at once may make adherence more difficult and make it harder to determine which interventions are contributing to improvement.
Formulation matters in nutritional supplementation
Dr. Noh considers formulation an important factor when recommending nutritional supplementation, noting that not all omega-3 supplements are equivalent. She focuses on re-esterified triglyceride (rTG) formulations and explains to patients that absorption is an important consideration when selecting a supplement.
She also believes formulation should be considered when interpreting clinical studies because differences among products, doses, study populations, and outcome measures may contribute to variability among study findings.
“It’s important to give patients specific recommendations and the formulation matters.”
In addition to omega-3 supplementation, Dr. Noh frequently recommends Blink NutriTears (Bausch + Lomb), an over-the-counter supplement containing lutein, zeaxanthin, and vitamin D3. She views this as complementary to omega-3 therapy because the supplements target different biological pathways.
She cited studies evaluating nutritional supplementation that assessed inflammatory markers such as MMP-9, patient-reported outcomes including OSDI scores, and corneal and conjunctival staining scores.3,4
Combining supplementation with dry eye procedures
For patients preparing for procedures such as intense pulsed light (IPL) or thermal therapies, Dr. Noh typically prioritizes omega-3 supplementation to support meibum quality before treatment. Adjunct supplements may be incorporated later based on patient needs.
Dr. Dierker noted that the evidence surrounding omega-3 supplementation remains mixed and asked Dr. Noh how she interprets the DREAM study findings alongside her clinical experience. Dr. Noh explained that she discusses with patients that omega-3 supplementation may require time before benefits become apparent.
She notes that many people may have inadequate omega-3 intake through diet alone and that supplementation may take approximately 8 weeks before they notice improvement, although some patients report benefits sooner. She also emphasizes that the quality and formulation of omega-3 supplements matter.
Deep dive into the DREAM study and TFOS DEWS III Report
The National Eye Institute-funded DREAM study was a multicenter randomized trial that included 535 patients with moderate-to-severe dry eye disease. Participants received either high-dose omega-3 supplementation or an olive oil placebo. After 12 months, researchers found no statistically significant difference between groups in Ocular Surface Disease Index (OSDI) scores or other clinical measures.2
Additional studies evaluating nutritional supplementation have reported potential improvements in symptoms and clinical measures, although differences in formulations, doses, study populations, and outcome measures make direct comparisons challenging.3
The 2025 TFOS DEWS III Management and Therapy report recognized dietary supplementation and lifestyle modifications as components of dry eye disease management while emphasizing that treatment should be individualized based on disease subtype and patient-specific factors.1
Helping patients understand nutrition
Patient education is central to Dr. Noh’s approach to nutritional supplementation. She emphasizes that setting expectations early can help patients understand why nutritional interventions may require more time than topical therapies before benefits become apparent.
Dr. Noh explains to patients that omega-3 levels may take time to change and that improvement is not always immediate. She typically advises patients to allow approximately 8 weeks before determining whether supplementation is helping, although some patients report benefits sooner.
“Every cell in your body is thirsty for omega-3.”
She also explains to patients that omega-3 supplementation is for their dry eye. Framing supplementation as part of broader health may help patients understand its potential value, particularly when cost becomes a consideration.
Communication and collaboration
When clinicians struggle with nutritional counseling, Dr. Noh believes the challenge is often communication rather than product selection. Many patients associate over-the-counter products with therapies they have already tried without success.
For patients with complex systemic disease or multiple medications, Dr. Noh recommends collaboration with the patient’s broader healthcare team. She may contact the prescribing physician before initiating supplementation to confirm that there are no contraindications.
She also considers timing around surgical procedures and may temporarily pause supplementation when appropriate before restarting therapy after the patient has been cleared.
Getting started
Dr. Noh expects nutrition to become an increasingly recognized component of ocular surface disease. For clinicians who are hesitant to incorporate nutrition into dry eye management, Dr. Noh recommends starting with a simple approach.
“My advice would be to pick up two informative facts to shorten patient education.”
She also recommends involving the entire clinical team in patient education. When staff members understand the rationale behind recommended therapies, conversations with patients can become more consistent and effective.
Key takeaways
- Nutrition can serve as an important component of ocular surface disease management when incorporated alongside other therapies and tailored to individual patient needs.
- Nutritional supplementation should be approached with realistic expectations. Dr. Noh typically advises patients that improvement may take several weeks, with many patients assessing benefit around the 8-week mark.
- Formulation matters when selecting omega-3 supplements. Clinicians should consider factors such as formulation, absorption, dosage, and available evidence when discussing nutritional supplementation with patients.
- The DREAM study did not demonstrate a statistically significant difference between high-dose omega-3 supplementation and olive oil placebo after 12 months in patients with moderate-to-severe dry eye disease.2 However, additional clinical trials and reviews have reported potential improvements in symptoms and clinical measures.3
- The 2025 TFOS DEWS III Management and Therapy report recognizes dietary supplementation and lifestyle modifications as components of dry eye disease management while emphasizing individualized treatment approaches.1
- Patient education is essential for successful nutritional counseling. Explaining differences in formulation, absorption, and expected time to benefit may help improve adherence and set appropriate expectations.
- Collaboration with other healthcare providers is important when patients have complex systemic disease, take multiple medications, or require coordination around surgical procedures.
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This article was written by Sonia Kelley, OD, MS, based on the recorded video from Drs. Damon Dierker and Ada Noh.
