Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study

Abstract

Purpose To compare the safety and efficacy of intense pulsed light (IPL) followed by meibomian gland expression (MGX), against monotherapy of MGX. Methods Patients with moderate to severe meibomian gland dysfunction (MGD) were 1:1 randomized to 4 sessions of intense pulse light + MGX at 2-week intervals, or 4 sessions of Sham + MGX at 2-week intervals. Both patients and examiners were blinded to the allocation. Outcome measures, evaluated at the baseline (BL) and at a follow-up (FU) conducted 4 weeks after the last IPL session, included fluorescein tear breakup time (TBUT) as the primary outcome measure, OSDI (Ocular Surface Disease Index) questionnaire, Eye Dryness Score (EDS, a visual analog scale (VAS)-based questionnaire), Meibomian gland score (MGS, a score of meibum expressibility and quality in 15 glands on the lower eyelid), daily use of artificial tears, and daily use of warm compresses. In addition, during each treatment session, the number of expressible glands was counted in both eyelids, the predominant quality of meibum was estimated in both eyelids, and the level of pain/discomfort due to MGX and IPL was recorded. Results TBUT increased from 3.8±0.2 (μ±standard error of mean (SEM)) to 4.5±0.3 seconds in the control arm, and from 4.0±0.2 to 6.0±0.3 in the study arm. The difference between arms was statistically significant (P < .01). Other signs/symptoms which improved in both arms but were greater in the study arm included MGS (P < .001), EDS (P < .01), the number of expressible glands in the lower eyelids (P < .0001) and upper eyelid (P < .0001), the predominant meibum quality in the lower eyelid (P < .0001) and upper eyelid (P < .0001), and the level of pain due to MGX (P < .0001). Outcome measures which improved in both arms with no significant differences between the two were OSDI (P = .9984), and the daily use of artificial tears (P = .8216). Meibography, daily use of warm compresses, and severity of skin rosacea did not show statistically significant changes in either arm. No serious adverse events were observed. There was a slight tendency for more adverse events in the control group (P = 0.06). Conclusions The results of this study suggest that, in patients with moderate to severe symptoms, combination therapy of intense pulse light (IPL) and meibomian gland expression (MGX) could be a safe and useful approach for improving signs of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Future studies are needed to elucidate if and how such improvements can be generalized to different severity levels of MGD.

Pulsed Light Therapy in the Management of Dry Eye Disease: Current Perspectives

“…The only adverse reactions were light pain (1 patient) and moderate bacterial conjunctivitis (1 patient), with no statistically significant differences between groups. 18 …”

“…The only adverse reactions were light pain (1 patient) and moderate bacterial conjunctivitis (1 patient), with no statistically significant differences between groups. 18 Arita and collaborators found no significant differences regarding intraocular pressure, visual acuity, lens opacity, and fundoscopy examination before and 32 weeks following treatment with IPL technology. 17 Similarly, no adverse events were reported by Yan Shi et.…”

“…No differences were also found regarding the daily use of artificial tears. 18 Piyacomn et al reported improvement in TBUT and reduction of meibum quality and expressibility scores after the initial session, which persisted at 6-month follow-up. 19 A systematic review with meta-analysis by Sambhi et al showed an important increase in TBUT albeit with a nonsignificant increase in Schirmer's test and SPEED score at subsequent post-treatment evaluations in the IPL+MGX group.…”

Different Number of Sessions of Intense Pulsed Light and Meibomian Gland Expression Combination Therapy for Meibomian Gland Dysfunction

“…Although the overall subjective relief was accomplished in patients who had a total of three or more sessions in this study, our results do not show the optimal number of treatment sessions of IPL and MGX combination therapies. Recently, Toyos et al [ 50 ] proposed four sessions of IPL and MGX combination therapy at 2-week interval in a randomized controlled study in MGD patients with moderate to severe symptoms. In this regard, the establishment of the optical protocol according to the IPL machine and to the severity of MGD will be one of the interesting candidate research topics.…”

Update on Dry Eye Disease Treatment: Evidence From Randomized Controlled Trials

“…Nevertheless, masking treatment renders RCTs for lid treatments additionally challenging compared with eye drops. [109][110][111][112][113][114][115][116][117][118][119][120] Vectored Thermal Pulsation Three RCTs evaluating outcomes of a single, 12-min, vectored thermal pulsation (VTP) treatment using LipiFlow device (Tear-Science, Morrisville, NC) versus warm compresses 102,103 or oral doxycycline therapy 101 reported significantly better improvement of symptoms of MGD at 3-month follow-up.…”