Comparison of a single-dose vectored thermal pulsation procedure with a 3-month course of daily oral doxycycline for moderate-to-severe meibomian gland dysfunction

Abstract

PurposeThe aim of this study was to compare the efficacy of a single bilateral 12-minute vectored thermal pulsation (VTP) procedure versus daily oral doxycycline for 3 months for moderate-to-severe meibomian gland dysfunction (MGD).MethodsThis prospective, randomized, parallel-group, single-masked study included 28 subjects who received either a single-dose VTP or 3 months of doxycycline treatment. At baseline and 3 months post treatment, all subjects were evaluated for the following: dry eye symptoms with a standard dry eye questionnaire (the Standard Patient Evaluation for Eye Dryness [SPEED]), meibomian gland (MG) function by counting the number of glands yielding liquid secretion with the MG evaluator (MGE), tear breakup time (TBUT) and corneal and conjunctival staining.ResultsIn the VTP group, at 3 months, there was a significant improvement in MG function (4.00±1.47 to 7.73±5.53), SPEED score (11.00±3.30 to 5.42±2.15), TBUT (6.26±2.01 to 8.44±1.81), corneal staining (0.38±0.50 to 0.12±0.33) and conjunctival staining (1.69±1.93 to 0.62±0.85). In the doxycycline group, there was a significant improvement in MG function (4.63±1.41 to 10.63±5.91), SPEED score (13.42±4.17 to 9.42±5.47) and conjunctival staining (2.38±1.88 to 1.13±1.51), but the improvement in TBUT (6.90±2.56 to 7.59±2.03) and corneal staining (0.21±0.41 to 0.13±0.34) was not statistically significant (p=0.262 and p=0.414, respectively). At 3 months, SPEED score was significantly better in the VTP group (p<0.05); other parameters were comparable between the two groups.ConclusionA single 12-minute bilateral VTP procedure was significantly more effective than the 3-month daily course of oral doxycycline at improving the dry eye symptoms secondary to MGD. A single 12-minute VTP treatment was at least as effective as a dose of doxycycline for 3 months, in improving MG function and all measured signs of MGD. Given the minimal risk profile of the single VTP procedure over long-term doxycycline use, a single VTP presents a favorable alternative to long-term antibiotic use.

Comparison of an Automated Thermodynamic Treatment System (LipiFlow) and Warm Compresses for the Treatment of Moderate Severity of Meibomian Gland Dysfunction

“…When they stopped the warm compresses, their symptoms reappeared. Many studies [9][10][11][12][13][14][15][16][17][18][19] have reported that a single LipiFlow® treatment had a statistically significant greater reduction in dry eye symptoms than warm compresses at 1 month until 1 year post-treatment. In contrast to those findings, the results of the present study were the same as those of other reports 16,25 that did not demonstrate a statistically significant difference in the dry eye symptoms between the single LipiFlow® treatment and the twice-daily warm compresses, nor in the number of EMGs and LLTs, despite a tendency to improve those three parameters in the patients receiving the LipiFlow® treatment.…”

“…The inclusion criteria were patients at least 18 years of age who had a moderate severity of MG obstruction, defined in this study as follows: the presence of plugging at the MG orifices between onethird and two-thirds of total lid margin area and at least one of the following: (1) a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score of 6-12 15,20-21 ; (2) a lipid layer thickness (LLT) score of 40-70 ICU (Interferometric Color Units), measured by using a LipiView® interferometer (TearScience Inc., Morrisville, NC, USA) 22 ; (3) an upper eyelid meiboscore of 1-2, obtained by using a Meibography® (Oculus, Wetzlar, Germany), using the grading scales developed by Arita et al 23 ; and (4) 3-6 expressible MGs (EMGs) in the lower eyelid. 15,21 The exclusion criteria were patients with systemic diseases resulting in dry eyes (such as systemic lupus erythematosus, rheumatoid arthritis, and allergic diseases); patients who had eyelid abnormalities, previous ocular surgery, or trauma; and patients who used systemic medications affecting dry eyes (for instance, antihistamines, tetracycline derivatives, isotretinoin, and topical cyclosporine A) or steroids in the preceding month.…”

Non‐pharmaceutical treatment options for meibomian gland dysfunction

“…75 A single VTP session was shown to be at least as effective at improving subjective symptoms as was either application of a warm compress daily for two weeks 64 or twice daily for three months [67][68][69] or oral administration of doxycyclin twice daily for three months. 72 Prospective, randomised, controlled studies have also found that a single VTP therapy improved the MGS to a Figure 3. Intense pulsed light therapy is administered with an M22 system (Lumenis) to a 38-year-old woman with moderate meibomian gland dysfunction greater extent compared with a warm compress 64,68 and was more effective at reducing the conjunctival tear evaporation rate than was EyeGiene, Blephasteam, or a warm towel.…”

“…The device applies direct heat (42.5 C) to the palpebral conjunctiva of the upper and lower eyelids directly over the meibomian glands in order to soften meibum, while simultaneously applying pulsatile pressure to the outer eyelids with an inflatable air bladder that compresses the glands. 63,64 Case studies 63,65,66 as well as controlled 18,64,[67][68][69][70][71][72] and non-controlled [73][74][75][76][77] trials have shown that a single 12-minute VTP therapy can improve meibomian gland function, ocular surface staining, and tear film break-up time as well as relieve ocular symptoms (Table 3). Such improvement in meibomian gland function and dry eye symptoms achieved with a single VTP therapy session can be sustained for one to three years.…”

“…Such improvement in meibomian gland function and dry eye symptoms achieved with a single VTP therapy session can be sustained for one to three years. 68,74,77 The improvement in meibomian gland function induced by VTP therapy has been evaluated on the basis of the number of meibomian glands yielding liquid secretion (MGYLS) in the lower eyelid 63,[66][67][68][69][70]72,[75][76][77] or the meibomian gland secretion (MGS) score, 64,65,68,71,[73][74][75]77 which represents both the number of secreting meibomian glands and the quality of the secreted material as determined with a meibomian gland evaluator (MGE, Johnson & Johnson Vision). Some prospective trials have found that the lipid layer thickness of the tear film as determined with a LipiView interferometer (Johnson & Johnson Vision) did not change significantly at an average of 52 days or greater than three months after a single VTP therapy.…”