Comparison of Efficacy and Convenience of Warm Compresses and Eyelid Hygiene to Thermal Pulsation Treatment for Meibomian Gland Dysfunction
Purpose
To evaluate the efficacy, convenience and cost of long term use of twice daily warm compresses and eyelid hygiene as compared to a single, in-office thermal pulsation treatment (LipiFlow System), which applies simultaneous heat and pressure to the eyelids, in patients with meibomian gland dysfunction (MGD) and dry eye.
Methods
In a prospective, multicenter, open-label, randomized clinical trial, 99 subjects (197 eyes) received a single 12-min thermal pulsation treatment and 98 subjects (196 eyes) received twice daily warm compresses (EyeGiene System) and eyelid hygiene (OCuSOFT Lid Scrub) for 3 mo. Subjects had MGD based on meibomian gland (MG) secretions and dry eye symptoms based on OSDI questionnaire. Changes in MG secretions and dry eye symptoms scores from baseline-3 mo. were compared between groups (n=196 and 188 eyes). Compliance with use and cost of treatment were evaluated. Subjects receiving single thermal pulsation treatment were followed to 12 mo. (n=188 eyes).
Results
Thermal pulsation group had significantly greater mean improvement than compress and hygiene group from baseline to 3 mo. in MG secretions (6.2 ±3.7 to 17.8 ±10.6 vs. 6.3 ±3.6 to 10.8 ±8.0; p<0.0001) and dry eye symptoms (45.6 ±21.1 to 21.6 ±19.8 vs. 51.8 ±23.1 to 33.5 ±25.5; p=0.0068). Over 3 mo., 15% of subjects used compresses and hygiene <7 times/week despite 14/week instructions. Costs of compresses and hygiene for twice-daily use over 1 year vs. thermal pulsation treatment were similar. Thermal pulsation group had sustained mean efficacy at 12 mo. in MG secretions (17.3±9.1) and dry eye symptoms (21.6±21.3).
Conclusion
Compared to twice daily warm compresses and eyelid hygiene over 3 months, a single thermal pulsation treatment is significantly more effective in improving MG secretions and dry eye symptoms, shows sustained efficacy over one year at a similar cost, and is more convenient without the need for daily patient compliance.