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LipiFlow more effective than warm compress for dry eye disease
One session of vectored thermal pulsation was more efficacious than a warm compress for treating dry eye disease, according to a study.
The systematic review and meta-analysis consisted of 385 patients from four randomized controlled trials that compared the efficacy of a 12-minute vectored thermal pulsation treatment (LipiFlow, Johnson & Johnson Vision) vs. warm compress treatment. The primary outcome of the study was gland function, and secondary outcomes were tear breakup time, Schirmer test, tear osmolarity, lipid layer thickness, SPEED scores and OSDI scores.
LipiFlow patients experienced significantly greater improvement at 2 to 4 weeks in meibomian gland function, tear breakup time and SPEED scores compared with warm compress patients. There was a significantly greater reduction for LipiFlow patients in OSDI scores at 2 to 4 weeks and 3 months compared with warm compress patients.
No differences were observed between the two cohorts in Oxford staining, Schirmer tests, tear osmolarity or lipid layer thickness.
The study authors said vectored thermal pulsation has several advantages over warm compresses, “such as less time consumption (single 12-minute course) and longer treatment effects.” One trial in the study showed evidence that vectored thermal pulsation had an effect on evaporative dry eye and meibomian gland dysfunction at 1 year. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Meibomian gland dysfunction is not only more easily diagnosed using recent advances in imaging equipment, it can also be treated with an ever-growing list of procedures. The common thread among the available treatment options is enhancing the malleability of the impacted meibum to help extract it from the glands, allowing more olive oil-like lipid to squirt onto the tear surface with each blink. Dry eye disease has a global prevalence with MGD as one of its main causes. This meta-analysis done by Pang and colleagues in Taipei, Taiwan, compared the efficacy of vectored thermal pulsation treatment (VTPT) with a warm compress treatment (WCT). The primary outcome was gland function; tear breakup time, Schirmer test, tear osmolarity, lipid layer thickness, and responses to the SPEED and OSDI questionnaires were secondary endpoints.
WCT poses some challenges in that it must be done daily for a few minutes by the patient, creating the potential for nonadherence to recommended therapy. With WCT, it is also difficult to achieve the therapeutic range of temperature and to get the appropriate level of heat to the inner lid without overheating the cornea or the eyelids. Most importantly, WCT does not provide gland evacuation, which is critical for MGD treatment, whereas VTPT delivers heat to the inner and outer eyelid while removing meibum from the glands.
In this study with 385 patients, significantly greater improvement in meibomian gland function as well as in tear breakup time and responses to the SPEED questionnaire were observed in the VTPT group compared with the WTC group. Moreover, a significantly greater reduction in OSDI scores was observed in the VTPT group compared with the WTC group. In conclusion, a single 12-minute VTPT was more efficacious than traditional WCT in treating MGD.