July 16, 2016
In a retrospective study of patients with refractory dry eye who had exhausted conventional treatment and elected to receive intense pulsed light and meibomian gland expression (IPL/MGX), 58 percent of patients' symptoms improved from as much as 25 to more than 50 percent after treatment. Study results were published in Cornea in 2016.
Joanne F. Shen, M.D., Ophthalmology chair and director of the dry eye clinic at Mayo Clinic's campus in Phoenix/Scottsdale, Arizona, and a research team studied 35 patients treated with IPL/MGX. The team reviewed demographics, ocular histories, Standard Patient Evaluation of Eye Dryness 2 (SPEED2) symptom survey scores, slit-lamp examinations and meibomian gland evaluations at baseline and at each visit before IPL/MGX treatments. All patients had a minimum of six months of follow-up after the first treatment and typically received one to four treatments spaced four to six weeks apart.
After four IPL/MGX treatments, a paired sample t-test showed a significant (P < 0.0001) decrease in SPEED2:
- 8 patients (23 percent) had a ≥ 50 percent decrease in SPEED2 scores
- 23 patients (66 percent) had a 1 to 49 percent decrease in SPEED2
- 1 patient (3 percent) had no change in SPEED2
- 3 patients (9 percent) had an increase in SPEED2
"The combination of IPL and MGX can significantly improve dry eye symptoms — in this retrospective analysis, in 89 percent of patients — and meibomian gland function, which in this study improved in 77 percent of patients in at least one eye," says Dr. Shen. "The study confirms that IPL treatment for meibomian gland dysfunction can improve dry eye symptoms and is a reasonable option for patients who have not shown improvement with other therapies."
IPL/MGX procedure
At the first treatment, each patient underwent Fitzpatrick skin typing, and the IPL machine was set to appropriate settings — 1D, 2D or 4A. At each treatment, the eyelids were bilaterally closed and sealed shut with disposable eye shields. After generous application of ultrasonic gel to the treated skin, patients received approximately 30 pulses (with slight overlapping applications) from the right preauricular area, across the cheeks and nose to the left preauricular area, treating up to the inferior boundary of the eye shields.
Each treatment was followed by MGX with a cotton tip applicator and digital pressure to empty meibum from bilateral upper and lower eyelids. Patients used preservative-free ketorolac drops twice a day for two days after IPL treatment. Slit-lamp examination was performed before each treatment.
"Patients underwent four monthly examinations and IPL/MGX treatments or until symptoms were resolved to their satisfaction, treatments became intolerable or they were unable to continue the treatment protocol," says Dr. Shen.
After the first IPL/MGX treatment, early-responder patients experienced five to seven days of symptomatic improvement followed by regression until the next treatment. After the second treatment, patients experienced one to two weeks of improvement. Slow responders did not see improvements until after the second or third treatment. After the fourth treatment, most patients had at least three months of sustained improvement.
"Interestingly, 63 percent of this IPL/MGX-responsive group previously failed to respond to LipiFlow thermal pulsation," says Dr. Shen. "However, these therapies are not a permanent fix. Once regression occurs, we recommend a single IPL/MGX treatment that varies between patients. In our patient population, a few patients are in remission, but most will require repeat single treatments every three to six months."
Use of topical and systemic medications usually can be discontinued after IPL/MGX, but the dry eye clinic team prescribes omega-3 fatty acids at 1,200 mg daily for patients after treatment. "My philosophy has shifted over the past five years, from handing out the multiple tear substitutes available to now, instead, focusing on restoring the ocular surface and tear film," says Dr. Shen.
For more information
Vegunta S, et al. Combination therapy of intense pulsed light therapy and meibomian gland expression (IPL/MGX) can improve dry eye symptoms and meibomian gland function in patients with refractory dry eye: A retrospective analysis. Cornea. 2016;35:318.