Intense pulsed light, gland expression improves MGD
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Intense pulsed light therapy and meibomian gland expression improved symptoms in patients with meibomian gland dysfunction, according to a prospective study published in Eye & Contact Lens.
“Improved dry eye symptoms, tear break-up time (TBUT), corneal staining and meibomian gland secretion were observed in meibomian gland dysfunction (MGD) patients after intense pulsed light and meibomian gland expression (IPL/MGX),” Yun Tang, MD, of the department of ophthalmology at Peking University First Hospital in China, and colleagues wrote. “Patients in the early stages of MGD maybe benefited most from IPL/MGX treatment.”
Tang and colleagues reviewed the medical records of 44 patients with MGD who underwent IPL/MGX treatment every 4 weeks for a total of three treatments. In addition to the response to treatment, the researchers analyzed patients’ Standard Patient Evaluation of Eye Dryness (SPEED) score, Ocular Surface Disease Index (OSDI) score, TBUT, corneal fluorescein staining score (CFSS), meiboscore, meibomian gland loss score (MGLS), meibomian glands yielding secretion score (MGYSS), meibomian glands yielding clear secretion (MGYCS) and meibomian glands yielding liquid secretion (MGYLS). The patients ranged in age from 23 to 86 years with a majority (72.7%) being women.
After three treatments of IPL/MGX, patients exhibited significant improvements in TBUT, CFSS, MGYSS, MGYLS and MGYCS. However, their meiboscore and MGLS did not improve. Overall, 65.9% of patients had significantly lower SPEED scores compared with baseline. Moreover, the treatment led to significant decreases in OSDI, with no patients having severe dry eye symptoms, and 47.7% were considered as normal at the end of the study. Analyses revealed that younger age, longer TBUT and better meibomian gland structure prior to the start of treatment correlated with greater improvements after IPL/MGX.
This study’s retrospective design and higher proportion of female patients may have limited the results, the researchers noted.
“As a prospective physical treatment, IPL, with or without MGX, has been compared with other physical therapies, such as warm compress and MGX,” Tang and colleagues wrote. “The results showed that IPL and IPL/MGX are effective not only in improving the meibum grade, meibum quality, lipid layer grade and TBUT, but also in decreasing inflammation around glands and eyelid abnormalities.”
Perspective
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IPL therapy has been a hot topic in the last several years. I personally have used IPL with MGX in my practice for the last 3 years.
Although the Dry Eye Workshop II discusses IPL as a form of therapy for dry eye disease management, there are no clear-cut clinical guidelines.
This retrospective study evaluates how clinical signs, symptoms and meibomian gland secretions are improved with IPL treatments with specific goals of attempting to determine the ideal candidate and the therapeutic window for IPL with MGX.
We know early disease detection and intervention in the earliest stages generally yields better results, and this study confirms this perspective yet again. Younger adults with better TBUT and better meibomian gland structure responded better to IPL with MGX compared with those with more advanced stages of disease. This study should motivate us to treat our patients earlier to provide them with better outcomes.
Their treatment protocol of four IPL treatments once a month, in addition to new IPL studies coming out, has led me to change my own protocol. I personally have always felt that MGX after each IPL session made sense, and I have also combined a series of IPL treatments with other thermal expression therapies (Lipiflow by TearScience, TearCare by Sight Sciences). This study highlights the benefits of IPL with MGX, which supports my clinical protocol.
One shortcoming to this study that must be stated is the relatively small sample size with mostly female participants. Additionally, it is also a retrospective study as opposed to a prospective randomized clinical trial, commonly considered the gold standard when it comes to measuring the effectiveness of a new intervention or treatment.
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