In which patients or for what conditions would you consider recommending re-esterified omega-3s as first-line therapy for treating ocular surface disease?

PointI am a big believer that proper functioning of the lids and meibomian glands is critical for managing ocular surface disease (OSD). When examining an OSD patient, I pay particular attention to the eyelid margin and look at the expressibility and quality of the meibum and the overall tear quality. I find that MGD is present in the majority of dry eye patients; however, it is often overlooked and underemphasized in most treatment protocols. To that end, for all of my OSD patients I have them start warm compresses with lid washes along with re-esterified omega-3s — this is in addition to preservative-free artificial tears and/or lifitegrast or cyclosporine (depending on severity and testing results). It is very common for patients to ignore the recommendation and try an omega formulation that they get from a big box store. They generally opt for the non-esterified version because of cost. However, when looking at the amount of actual bioavailable omega, the re-esterified formulations are more cost-effective. In many of these patients when they do switch to the re-esterified omega-3s, we note an improvement in their symptomatology and quality of their tear film. I generally recommend either the PRN formulation or Nordic Naturals, which are both re-esterified.