Practitioner recommends new technology for treating MGD

LAS VEGAS – Meibomian gland dysfunction, which results in alteration of the tear film, ocular irritation, clinically apparent inflammation and ocular surface disease, can now be treated in-office with a new high-tech device that will also create a new profit center, according to a speaker here at Vision Expo West.

“There’s a lot going on in meibomian gland dysfunction (MGD); it’s not just about dysfunction,” Jack L. Schaeffer, OD, told attendees. “The acinar cells degenerate and the lumen starts to dilate, causing the meibum to get blocked in the glands.”

He stressed the importance of educating patients on the consequences of untreated MGD.

When expressing the meibomian glands with a fingertip or cotton-tipped applicator, “you want a clear, slightly milky fluid to come out, not anything thick or frothy,” he said. “Show patients photos of what could happen if they remain untreated. They could have a serrated lid. Glands will atrophy and the lid structure will change.”

Therapy has included approaches such as hot compresses, dietary changes, supplementation, antibiotics and anti-inflammatories, Schaeffer said. Recently he has been using the Lipiflow Thermal Pulsation System (Tearscience) to provide his patients with relief from this chronic condition.

The device heats the palpebral surfaces and liquefies the meibomian gland contents, Schaeffer explained, then the bladders on the outside pulsate to express them.

“You need to get the lids to 105 degrees,” he said. “Then we try to get the gland to start working again. It increases blood flow to the tissue. Those glands have been quiet and atrophying for 15 years. This disease starts in the 20s and 30s. If we start treating at age 70, it’s too late.”

Schaeffer says he performs the procedure on both eyes together; the treatment lasts 12 minutes.

He added that the procedure is surprisingly soothing, and he presents it to patients as a “spa for your eye.”

Practitioners concerned with the high price tag for the device should consider purchasing one with other local doctors to share, Schaeffer recommended.

“This is not a big machine,” he said; “it’s not difficult to move around.”

Schaeffer also recommended the Bruder Eye Hydrating Compress and Stye Compress, which he uses and sells in his office.

“I have the patient sit in the office and wear the heat mask for 15 to 20 minutes and express the glands after they’re heated, then I give them the heat pack to take home,” he said.

Schaeffer added that he performs an initial corneal topography to check for keratoconus.

He noted that no reimbursement codes exist for meibomian gland expression.

“It’s an out-of-pocket expense,” he said. “Make sure your patients sign an Advanced Beneficiary Notice.”

Glands should be expressed at least every 2 weeks; every week is best, he said.

Disclosure: Schaeffer is on the advisory board for Tearscience.