Abstract: Critiquing a compress
This was an interesting study. I’ve been enjoying seeing, in recent years, more studies looking at specific warm compress devices.
This study was about the EyeBag, a popular product from the UK. But I think it’s also fairly representative of a lot of warm compress products. Patients used it twice a day for ten minutes. Patients saw some improvements to symptoms, though not all that consistent. But the clinical signs of MGD did not improve.
This was a very small study, and the abstract doesn’t say anything about how they selected the patients. It doesn’t look to me like a study we can generalize about in any way. But it’s a reminder to me of a frequent concern I have about people either overdoing compresses (too hot, too frequent, too long) or just in general continually doing them without actual evidence of whether they’re improving things.
I think that both symptom improvement (do I feel better?) and clinical improvement (are my test scores better?) are, singly and jointly, legitimate reasons for continuing a treatment. But we ought to have confidence that what we’re doing helps and matters if we’re going to continue it perpetually. The common trap for dry eye patients is that they don’t stop anything because even though they don’t know if it’s helping, they’re afraid they’ll get worse if they stop.
Documenting symptoms properly, with OSDI if we have nothing better, can help prevent this.
J Optom. 2018 Oct 16. pii: S1888-4296(18)30081-5. doi: 10.1016/j.optom.2018.07.002. [Epub ahead of print]
Ngo W, Srinivasan S, Jones L.
To determine the effectiveness of the MGDRx EyeBag in managing meibomian gland dysfunction.
This was a prospective, randomized, controlled, observer-masked, bilateral eye study that enrolled 29 participants. Participants were randomized into either the EyeBag group or the control group. The EyeBag group used the EyeBag 10minutes 2x/day, and the control group remained on their own dry eye treatment regimen (if applicable). All participants were observed at baseline, 2 weeks (2wk) and 4 weeks (4wk). At 4wk, participants in the EyeBag group were asked to stop using the EyeBag. All participants were seen again at 8 weeks (8wk). Primary outcomes were the Ocular Surface Disease Index (OSDI), Current Symptoms Questionnaire (CSQ), meibomian gland score (MG score), and non-invasive tear breakup time (NIBUT).
Twenty-five participants completed the study (mean age 38±15 years, 7 male). There was a significant change in OSDI over time for the EyeBag group (mean[lower 95% CI, upper 95% CI], baseline: 39.1[31.1,47.0], 2wk: 26.8[19.7,33.9], 4wk: 26.6[16.5,36.7], 8wk: 27.7[18.4,37.0]; p=0.01), but not in the control group (p=0.22), but no significant difference between groups at all time points (all p>0.27). Symptoms immediately improved after conducting the EyeBag based on at-home CSQ scores (Δ=-5.0 points, p<0.01), but not in the control group. For both groups, there was no significant change (p-value EyeBag,p-value control) in MG score (0.21,0.17) and NIBUT (0.49,0.06) over time.
The EyeBag may relieve symptoms of dry eye, but the effect on meibomian gland function and tear stability when used for only 4 weeks was undetectable.