Consider intense pulsed light therapy for midday fogging in scleral lens wearers
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Intense pulsed light has been proven to be an effective treatment in meibomian gland dysfunction and ocular rosacea, specifically for patients with moderate to severe disease.
This procedure yields significant improvement in dry eye signs and symptoms, and for scleral lens wearers, the improvement in tear quality (Whang WJ, et al) and reduction in inflammation (Choi M, et al) reduces midday fogging, a common frustration for these patients.
Midday fogging is an unwelcome nuisance for any scleral lens wearer or fitter. It occurs when various forms of particulate matter build up on the anterior surface or within the tear reservoir of a scleral lens. This can cause vision to become hazy or cloudy after a few hours of lens wear, often resulting in the need for removal, cleaning and reapplication of lenses.
Depending on the etiology, debris that causes midday fogging can present in different forms: white and fluffy, diluted and milky, or refractile and yellow. According to the SCOPE study, midday fogging occurs in approximately 26% of scleral lens wearers (Schornack MM, et al). Causes include improper lens alignment, excessive vault, ocular allergies and meibomian gland dysfunction (MGD).
MGD, a common cause of midday fogging, can cause excessive or reduced secretion of meibum, resulting in poor wettability of the scleral lens. It also causes inflammation in the glands, altering the quality of the lipid secretion that results in ocular inflammation (Rao SK, et al). In studies looking at midday fogging, it appears that inflammation plays a role in many of the causative factors (Walker MK, et al; Postnikoff CK, et al).
Until recently, the treatment for midday fogging caused by MGD was standard lid hygiene, including daily warm compresses and lid scrubs. However, with the implementation of newer technologies like thermal pulsation and IPL for MGD, eye care providers now have more tools in our toolbox.
IPL leads to an improvement in meibum viscosity and increases in oil flow score and tear breakup time (Giannaccare G, et al), with its anti-inflammatory effect confirmed by a significant decrease in inflammatory markers and improvement in tear protein and lipid content (Choi M, et al; Liu R, et al).
Further studies are needed to investigate the efficacy of IPL’s effect in improving midday fogging; however, clinically it can be a great addition to treatment options.
References:
- Choi M, et al. Sci Rep. 2019;doi:10.1038/s41598-019-44000-0.
- Giannaccare G, et al. Clin Optom (Auckl). 2019;doi:10.2147/OPTO.S217639.
- Liu R, et al. Am J Ophthalmol. 2017;doi:10.1016/j.ajo.2017.08.021.
- Postnikoff CK, et al. Invest Ophthalmol Vis Sci. 2019;doi:10.1167/iovs.18-24664.
- Rao SK, et al. Int J Ophthalmol. 2022;doi:10.18240/ijo.2022.05.20.
- Schornack MM, et al. Cont Lens Anterior Eye. 2020;doi:10.1016/j.clae.2020.03.005.
- Walker MK, et al. Cont Lens Anterior Eye. 2020;doi:10.1016/j.clae.2020.02.017.
- Whang WJ, et al. BMC Ophthalmol. 2023;doi:10.1186/s12886-023-02939-9.
For more information:
Stacy Zubkousky, OD, FAAO, FSLS, is an assistant professor and resident education coordinator at Nova Southeastern University College of Optometry in Florida.
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