Relationship Between Omega-3 Fatty Acids and Glaucoma Risk in Patients With Dry Eye Disease: A Multinational Retrospective Cohort Study

Purpose: To evaluate whether omega-3 fatty acid supplementation is linked to a reduced glaucoma risk in individuals with dry eye disease. Methods: This retrospective cohort study included adults with dry eye disease from a multinational database between 2013 and 2023. Individuals who received omega-3 were classified into the omega-3 group, and individuals who never received omega-3 were defined as the control group. The omega-3 and control groups were 1:1 propensity score matched for age, sex, race, smoking status, comorbidities, and corticosteroid use. Incident total glaucoma, ocular hypertension, primary open-angle glaucoma (POAG), normal-tension glaucoma, primary angle-closure glaucoma, and the use of first-line glaucoma medications were observed across a 5-year follow-up period. Results: A total of 14,168 participants with dry eye disease were included in the final analysis. Compared with the control group, individuals who received omega-3 fatty acid prescriptions experienced lower risks of total glaucoma (hazard ratio HR, 0.48; 95% confidence interval CI, 0.42-0.54), ocular hypertension (HR, 0.57; 95% CI, 0.43-0.75), POAG (HR, 0.45; 95% CI, 0.33-0.63), normal-tension glaucoma (HR, 0.41; 95% CI, 0.19-0.88), primary angle-closure glaucoma (HR, 0.45; 95% CI, 0.21-0.94), and the use of first-line glaucoma medications (HR, 0.65; 95% CI, 0.53-0.80). The lower risks of ocular hypertension and POAG associated with omega-3 use remained consistent across those aged 60 years or older, females, Whites, and other demographic categories. Conclusions: Omega-3 fatty acid supplementations may have the potential to decrease glaucoma risk in individuals with dry eye disease. Translational Relevance: Clinically, omega-3 supplementation in patients with dry eye disease may decrease disease burden.