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

Abstract

Objective: To compare the efficacies of a single thermodynamic treatment system (LipiFlow®) and warm compresses used for 3 months in patients with a moderate severity of meibomian gland dysfunction (MGD). Methods: This prospective, randomized, controlled clinical study enrolled 28 patients (22 females, 6 males; mean age, 53.9 ± 14.8 years) diagnosed as having moderate MGD by plugging at the meibomian gland orifices between one-third and two-thirds of lid margins and at least one of the following: a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score of 6-12; a lipid layer thickness (LLT) score of 40-70 Interferometric Color Units; upper eyelid meiboscore of 1-2; and 3-6 expressible meibomian glands (EMGs) in the lower eyelid. Both eyes of each patient were randomized into study and control eyes. Study eyes were treated with a single, 12-minute LipiFlow® system, while control eyes received 5-minute warm compresses twice daily for 3 months. The dry eye symptoms, the number of EMGs, and LLTs were evaluated. Results: There were no significant differences in the dry eye symptoms, number of EMGs, and LLTs for both groups at baseline and at each follow-up. However, the total SPEED scores for the LipiFlow® group reduced significantly from baseline at each follow-up until 6 months. As to the warm compress group, the total SPEED scores reduced significantly from baseline at each follow-up until 3 months. Conclusion: The single LipiFlow® treatment and twice-daily warm compresses relieved the dry eye symptoms of patients with a moderate severity of MGD compared with their baseline symptoms, despite no statistical differences in the dry eye symptoms, number of EMGs, and LLTs of both treatments.

In-office thermal systems for the treatment of dry eye disease

“…Open-label, prospective split-face any time-point during the 6-month study. 8 Taken together, all in-office thermal treatment options improved symptoms and meibomian gland function in patients with DED.…”

“…17 Similarly, meibomian gland function, assessed as either meibomian gland fluid quality or number of expressible glands, improved in all but one study ( Table 2 ). 8 Booranapong and coworkers followed 28 patients with moderate MGD and found no significant improvement in glandular expression at 27 4 w LipiFlow Open-label RCT 15 3 mo LipiFlow prototype…”

“…13 , 37 Furthermore, one study used a split face study design and and found no significant difference between the two treatments at any time. 8 One article compared LipiFlow to three different at-home eyelid-warming treatments. 36 Compared to hot towels, Eye-Giene (Eyedetec Medical Inc., Danville, CA) and Blephasteam (Théa Pharmaceuticals, Newcastle-under-Lyme, UK), only LipiFlow significantly reduced tear evaporation rates.…”

“…Most study populations were subjects with moderate-to-severe DED. 2 , 3 , 6-8 , 12-16 , 18-22 , 27 , 35-38 One trial included participants with inflammatory MGD, 8 while four studies did not specify severity in the inclusion criteria 17 , 26 , 31 , 32 (Supplemental Table 2).…”

Vectored Thermal Pulsation as a Treatment for Meibomian Gland Dysfunction: A Review Spanning 15 Years

“…Twelve of the 15 RCTs evaluated the effectiveness of a single 12-min LipiFlow treatment in 628 patients (1164 eyes) with MGD [14,[22][23][24][25][26][27][28][29][30][31][32]. In addition, a single 12-min Lipi-Flow treatment was evaluated when combined with warm compress and eyelid compression (one study treating 25 patients, 25 eyes) [33] or blinking exercises (two studies treating 44 patients, 88 eyes) [34,35].…”