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Heat, pressure used to treat evaporative dry eye
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Two new technologies that provide tear film analysis and meibomian gland treatment may represent a more targeted strategy for dry eye, according to a specialist.
Dry eye is a chronic, progressive and prevalent disease. Although dry eye has traditionally been associated with aqueous tear deficiency, it is now being more frequently recognized that evaporative dry eye represents the majority of dry eye patients, according to Matteo Piovella, MD, an OSN Europe Edition Board Member.
A recent study showed that as many as 86% of people with dry eye have meibomian gland dysfunction (MGD) and subsequent lipid deficiency of the eye’s natural tear film.
“Obstructed meibomian glands result in decreased lipid secretions, thereby affecting the lipid layer, a critical component of the healthy, stable tear film. An unstable tear film leads to increased tear evaporation and decreased lubricity between the eyelids, resulting in micro-traumas and subsequent ocular surface inflammation,” Piovella said. “Dry eye is a downward spiral, and over time, symptoms, complications and complaints are bound to get worse.”
New treatment
Traditional therapies for dry eye, which include lubricating drops, ointments, gels, warm compresses and moisture goggles, provide short-term relief without addressing the underlying cause.
“We now have a breakthrough treatment for the large number of patients suffering with dry eye. I’m pleased to have this new, safe and effective treatment to offer to those who are frustrated and seeking an alternative to traditional therapies,” Piovella said.
The LipiView Ocular Surface Interferometer and the LipiFlow Thermal Pulsation System (TearScience) are used in combination to evaluate and treat MGD and subsequent dry eye syndrome.
The LipiView analyzes and quantifies the amount of lipid on the tear film surface at the time of measurement.
“The primary goal of the dry eye treatment is to restore the full functionality of meibomian glands, and this is possible by treating the eye with the second device, called LipiFlow,” Piovella said. “This device has two components that must be placed under and over the eyelid to create a pulsating pressure. The device also warms up to a heat of 42.5°C, melting the crystallized secretions that block the eyelid ducts. Pressure and heat squeeze the secretions out of the meibomian glands and increase lipid availability.”
LipiFlow is a 12-minute procedure performed at an eye care practice, which eliminates issues of patient compliance typically associated with the traditionally recommended dry eye treatment.
In the past, dry eye treatment was targeted at supplementing lacrimal gland output with the use of palliative lubricating drops and ointments. It is now understood that the leading cause of dry eye is meibomian gland dysfunction and not lacrimal gland dysfunction; therefore, treatment efforts must be targeted at clearing the meibomian gland obstructions, Piovella said.
Cost limitation
Although dry eye treatment with LipiFlow is a well-established procedure in the United States, it is not yet common in Italy. According to Piovella, cost may be a limitation to widespread use.
“The price of the device is quite high and is further increased because the eye contact parts are disposable and very expensive indeed,” he said.
Piovella personally treated 48 eyes of 24 patients with LipiFlow, obtaining an increase of meibomian lipidic production in 65% of the cases.
“The next step should be going further on with the study to better understand the potential advantages of this innovative treatment. As far as I can say, it allows a better and more accurate diagnosis and an increase in lipid production from 10% up to 70%, with significant improvement of dry eye symptoms. So far, the only limitation appears to be the high cost of the procedure,” he said. – by Timothy Norris