Fish oil capsules have not held up in two eye trials funded by the National Eye Institute (NEI). In AREDS2, adding omega-3s to the eye vitamin formula did not slow progression to late age-related macular degeneration (AMD) after 5 or 10 years. In the DREAM trial, a high daily dose worked no better than an olive oil placebo for moderate to severe dry eye. Eating fish is a separate question: some observational studies link fish to lower AMD risk, but they cannot prove cause and effect.
Many people wonder whether fish oil can help their eyes. The two main omega-3 fatty acids in fish oil are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). NEI has tested them in two randomized trials: one for AMD and one for dry eye.
Omega-3s and macular degeneration: the AREDS2 trial
The AREDS2 trial (JAMA, 2013) enrolled 4,203 people aged 50 to 85 with intermediate AMD, or late AMD in one eye, and followed them for a median of 5 years. It ran from 2006 to 2012. Along with the eye vitamin formula, some participants were randomly assigned to take omega-3s: DHA 350 mg plus EPA 650 mg a day, about 1 gram in total.
Adding omega-3s did not further reduce progression to advanced AMD. The hazard ratio was 0.97. A hazard ratio compares how quickly something happens in two groups, and 1.0 means no difference. NEI's summary on its AREDS and AREDS2 trials page is direct: "Omega-3 fatty acid supplements do not have an effect on cataract or AMD."
Longer follow-up told the same story. AREDS2 Report 28 followed 3,882 participants through the end of 2018, about 10 years in all. For progression to late AMD, omega-3s compared with no omega-3s had a hazard ratio of 1.01 (95% confidence interval 0.93 to 1.09).
The NIH Office of Dietary Supplements (ODS) omega-3 fact sheet agrees. It says EPA and DHA "did not provide any additional benefits after a median follow-up of 5 years." ODS also reports that a Cochrane Review concluded omega-3 supplementation "for up to 5 years in people with AMD does not reduce the risk of progression to advanced AMD or of moderate to severe vision loss."
Why AREDS2 formulas do not include fish oil
The AREDS2 formula NEI lists today contains vitamin C, vitamin E, lutein, zeaxanthin, zinc and copper. Omega-3s were tested in AREDS2 but did not add a benefit, and they are not part of that list. If you see an eye vitamin with fish oil added, that ingredient is not part of the tested AREDS2 formula. Our guide to the AREDS and AREDS2 trials explains both trials in plain language.
What about eating fish?
The findings below come from observational studies, which compare what people already eat with the eye problems they later develop. They can show a link, but people who eat more fish may differ in other ways too, so these studies cannot prove that fish caused the difference.
ODS describes three observational findings:
- In the EUREYE study of 2,275 people aged 65 and older, eating fatty fish at least once a week was linked to "a 53% lower risk of neovascular AMD" (the wet form).
- In a group of 38,022 women, those with the highest DHA plus EPA intake (a median of 330 mg a day) had a 38% lower risk of AMD over about 10 years than those with the lowest intake (a median of 80 mg a day).
- In a group of AREDS participants, those with the highest omega-3 intake were "about 30% less likely" to develop central geographic atrophy and wet AMD.
The eating pattern as a whole has also been studied. An analysis of 7,756 AREDS and AREDS2 participants followed for a median of 10.2 years found that people whose eating most closely matched a Mediterranean pattern had a lower risk of late AMD (hazard ratio 0.78). Fish intake contributed to that link. This was also observational.
NEI includes eating fish in its list of choices that may lower your risk of AMD. The American Academy of Ophthalmology (AAO) likewise notes that fatty fish may lower risk. For more on food and the AREDS2 nutrients, see Can you get AREDS2 nutrients from food?
Keep in mind: the fish findings and the fish oil trials answer different questions. The observational studies looked at people's everyday meals. The AREDS2 trial randomly assigned a specific omega-3 capsule to people who already had intermediate or late AMD, and it found no added benefit.
Omega-3s and dry eye: the DREAM trial
The Dry Eye Assessment and Management (DREAM) study was an NEI-funded, double-blind, randomized, placebo-controlled trial at 27 centers. It enrolled 535 people who had at least a six-month history of moderate to severe dry eye. For 12 months, 349 of them took 3,000 mg of fish-derived omega-3s a day (2,000 mg EPA and 1,000 mg DHA, in five capsules). The other 186 took a placebo of 5 grams of olive oil a day, about a teaspoon. According to NEI's news release, this was the highest omega-3 dose ever tested for dry eye. Everyone could keep using their usual dry eye treatments, including artificial tears and prescription drops.
On a dry eye symptom score, the omega-3 group improved by 13.9 points and the placebo group by 12.5 points. That difference was not statistically significant (P = 0.21). NEI reported that 61% of the omega-3 group and 54% of the placebo group improved by at least 10 points, also not a significant difference.
Eye tests told the same story. There were no significant differences in staining of the eye surface, tear break-up time or the Schirmer tear test. Side effect rates were similar in both groups. In NEI's release, study chair Penny Asbell, MD, said the results "do not support use of omega-3 supplements for patients with moderate to severe dry eye disease."
What happened when people stopped
A DREAM extension study (2020) took people who had used omega-3s for 12 months and randomly assigned 22 to keep taking them and 21 to switch to placebo for another year. The difference in symptom scores was not significant (0.6 points, P = 0.91). People who stopped "did not have significantly worse outcomes compared to those who continued use." This was a small study.
Other evidence on dry eye
ODS describes a VITAL ancillary study of 23,523 adults who took 1,000 mg of omega-3s a day (460 mg EPA and 380 mg DHA) or a placebo for a median of 5.3 years. It found "no significant effects on the incidence of diagnosed dry eye disease or severe disease symptoms." ODS says trial results overall "have had mixed results," and concludes that "the evidence to date shows no consistent relationship between omega-3s and dry eye disease."
NEI's dry eye page lists not getting enough omega-3s (found in fish, walnuts and vegetable oils) as a risk factor. Its list of treatments includes over-the-counter artificial tears, gels and ointments, prescription drops such as cyclosporine (Restasis) or lifitegrast (Xiidra), lifestyle changes, punctal plugs and, less often, eyelid surgery. Omega-3 supplements are not on that treatment list.
| Trial | Who and how many | Daily omega-3 dose | Result |
|---|---|---|---|
| AREDS2 (AMD) | 4,203 people with intermediate AMD, or late AMD in one eye | DHA 350 mg + EPA 650 mg | No effect on progression at 5 years (HR 0.97) or 10 years (HR 1.01) |
| DREAM (dry eye) | 535 people with moderate to severe dry eye | EPA 2,000 mg + DHA 1,000 mg | No better than olive oil placebo after 12 months |
| DREAM extension | 43 people already taking omega-3s | Same as DREAM, or switched to placebo | Stopping did not make symptoms significantly worse |
| VITAL ancillary study | 23,523 adults | EPA 460 mg + DHA 380 mg | No significant effect on new dry eye disease over a median of 5.3 years |
Safety: what to know before taking fish oil
ODS reports that the Institute of Medicine did not set an upper limit for omega-3s. The FDA says supplements providing no more than 5 g a day of EPA and DHA are safe when used as recommended.
ODS also notes:
- Common side effects are usually mild: an unpleasant taste, bad breath, heartburn, nausea, stomach discomfort, diarrhea, headache and smelly sweat.
- High doses (900 mg EPA plus 600 mg DHA a day or more, for several weeks) might reduce immune function, and doses of 2 to 15 g a day might increase bleeding time.
- Heart rhythm: in two large trials, 4 g a day for several years slightly increased the risk of atrial fibrillation in people with, or at high risk of, heart disease.
- Blood thinners: fish oil can have antiplatelet effects at high doses and might prolong clotting times with warfarin. ODS adds that most research shows 3 to 6 g a day does not significantly affect anticoagulant status. Labels for FDA-approved omega-3 drugs say people on anticoagulants should have their INR checked periodically.
If you take a blood thinner or have a heart condition, talk with your doctor before starting fish oil. Our article on AREDS2 and blood thinners covers questions to ask, and Are AREDS2 vitamins safe? covers the rest of the formula.
The bottom line
Omega-3 capsules did not add an AMD benefit in AREDS2 or beat placebo for dry eye in DREAM. For a wider look at food and eye research, see Nutrition and eye health: what the research shows. If you are comparing formulas, our science page lists the doses used in the trials.
Related reading
- The AREDS and AREDS2 trials explained
- 5 vitamins and nutrients that matter for your eyes
- Leafy greens ranked by lutein and zeaxanthin
- Eye health after 50: changes and checkups
- What is AREDS2 and who needs it?
References
- Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-2015. doi:10.1001/jama.2013.4997
- Chew EY, Clemons TE, Agrón E, et al. Long-term outcomes of adding lutein/zeaxanthin and omega-3 fatty acids to the AREDS supplements on age-related macular degeneration progression: AREDS2 report 28. JAMA Ophthalmol. 2022;140(7):692-698. doi:10.1001/jamaophthalmol.2022.1640
- Dry Eye Assessment and Management Study Research Group; Asbell PA, Maguire MG, et al. n-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med. 2018;378(18):1681-1690. doi:10.1056/NEJMoa1709691
- Hussain M, Shtein RM, Pistilli M, et al. 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. Ocul Surf. 2020;18(1):47-55. doi:10.1016/j.jtos.2019.08.002
- Keenan TD, Agrón E, Mares J, et al. Adherence to the Mediterranean diet and progression to late age-related macular degeneration in the Age-Related Eye Disease Studies 1 and 2. Ophthalmology. 2020;127(11):1515-1528. doi:10.1016/j.ophtha.2020.04.030
- NIH Office of Dietary Supplements. Omega-3 Fatty Acids: Fact Sheet for Health Professionals (updated August 22, 2025). ods.od.nih.gov
- National Eye Institute. About AREDS and AREDS2 (updated October 22, 2025). nei.nih.gov
- National Eye Institute. Research news on the DREAM study results (April 13, 2018). nei.nih.gov
- National Eye Institute. Dry eye (updated August 6, 2025). nei.nih.gov
- National Eye Institute. Age-related macular degeneration (updated June 22, 2021). nei.nih.gov
- American Academy of Ophthalmology. Vitamins for AMD (August 19, 2026). aao.org
This article is for general education and is not medical advice. Talk with your eye doctor before starting any supplement, especially if you smoke, take other medicines, or have a health condition. These statements have not been evaluated by the Food and Drug Administration. TruVista products are not intended to diagnose, treat, cure, or prevent any disease.
