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I JANUARY/FEBRUARY 2020 | EYEWORLD | 51 The drawback with the re-esterification process for a more absorbable product is the additional cost. If patients can afford the more expensive brands, they should use them, the physicians said. If that's not possible, they should still take a closer look at how the omega-3 they select is processed. Dr. Sheppard has patients who use omega-3 nutraceuticals from some multilevel marketing companies that appear to be better quality than less expensive generic versions. "At least they're taking some- thing that's supposedly pharmaceutical-grade as well as mercury-free," he said. Dosing, side effects As for dosing, Henry Perry, MD, finds that less is more. Less frequent dosing can help address budget concerns, so patients uncomfortable with a higher price can still buy a high-quality product but not use it as often. Less frequent dosing also helps with patient adherence. "You can take as few as two pills three times a week, and that still gives a benefit for dry eye, skin, joints, and the entire body," he said. In more severe patients, Dr. Perry will recommend two pills twice a day, every day. For patients who eat three or more fish meals a week, Dr. Perry recommends twice-a-week supplementation dosing. It may take a couple of months for patients to see the benefits of omega-3 fatty acids, Dr. Sheppard said. Finding the right dosing balance is import- ant because patients may have to take supple- ments indefinitely. Side effects of omega-3 fatty acid supple- mentation include a fishy taste, nausea, upset stomach, and loose stools. These effects are more common with omega-3 in the ethyl ester form vs. the re-esterified form, Dr. Epitropou- los said. If someone has a rare, severe allergy to About the doctors Alice Epitropoulos, MD Clinical assistant professor The Ohio State University Wexner Medical Center Columbus, Ohio Cynthia Matossian, MD Medical director and founder Matossian Eye Associates Doylestown, Pennsylvania Hopewell, New Jersey Henry Perry, MD Senior founding partner Ophthalmic Consultants of Long Island Rockville Centre, New York John Sheppard, MD Virginia Eye Consultants Norfolk, Virginia continued on page 52