The Dry Eye Zone

Rebecca's Blog

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IPL for stubborn MGD

Recent study highlights IPL for obstructive MGD

This study came out a couple of months ago but I just got to it now… if you haven’t seen it yet, IPL fans and those who are curious about the potential will be pleased to see this study on the results of intense pulsed light therapy followed by meibomian gland expression.

It was the first study of its type - prospective, multi-center.

31 patients, 62 eyes…

…with stubborn, obstructure MGD underwent four to eight treatments consisting of IPL followed by meibomian gland expression every three weeks, at three different sites in Japan.

Most of these patients had at least 3 meibomian gland dropouts in one eyelid. Yes, they had severe MGD.

What’s the goal? And how do you know when you reach it?

Setting aside IPL itself for a moment, one thing I appreciated in this study was this statement of what the goal is:

The goal of MGD therapy is to provide long-term and stable amelioration of the symptoms of this condition by improving the quality of meibum or increasing meibum flow, thereby normalizing the balance between the lipid layer and the aqueous and mucin layers of the tear film and enhancing tear film stability, as well as by reducing inflammation.

To the doctor, the end goal is, we are told, symptom improvement (we patients feel better) as a result of the treatmenent changing the state and behavior of the glands and meibum.

But how does this play out in practice? We need more conversation with doctors about that. They need to communicate more, and we need to listen more (and find more questions to ask). What can we expect, really? How long does it take for a treatment to work its ‘magic’ on the glands, and when do we start feeling better (symptom improvement) in relation to any clinical changes? How can we best keep track so that we’ll know whether we’re improving and what it means? There’s a great deal of confusion out there on these points in MGD-land in general.

To us patients, it seems like it ought to be pretty simple really - do I feel better, or don’t I? But it’s hardly ever that simple in practice.

How do I know whether I’m feeling better (or worse, or the same) specifically because:

  • I had IPL (or Lipiflow, or some other treatment) some weeks ago

  • The cumulative effect of the tea tree lid wipes and rice baggy that I’ve been doing twice daily (before and after that treatment)

  • It’s now March instead of January and 55 degrees instead of 15 so my heat isn’t cranking as much

  • I’m using more Oasis and less Celluvisc this week

  • I’m wearing moisture chambers more (or less)

  • I drank way too much coffee yesterday, or wine last night, or

  • I’m wearing brown socks instead of black today?

Seriously. And doctors ask these questions (and more) too.

But I digress. We were talking about an IPL study.

A little context

I think a lot of you would relate to this sentence, coming after a long list of MGD treatments:

Despite the variety of treatment options available, however, many patients with MGD are refractory to treatment and thus do not experience complete or long-term relief of symptoms.

Results in this IPL study

Lots of good things….

  • SPEED (symptom questionnaire) improved at 4 weeks after final treatment. But I wish they would show us what they looked like along the way, not just after it was all over.

  • Tear break-up times were improved, in fact, non-invasive break-up time more than doubled.

  • Meibum glade, lid margin abnormality and other things improved

Meiboscore and Schirmer did not improve.

In this study, the NIBUT was increased from 3.3 to 7.8 seconds, representing a meaningful clinical improvement, with our previous study having shown that the cutoff value of the NIBUT for dry eye disease as measured by DR-1α is <5 seconds….

Two types of lid margin abnormality—plugging of meibomian gland orifices and vascularity of the lid margin—were evaluated in this study and were found to be significantly improved after IPL-MGX treatment, consistent with the results of previous studies….

Self-reported ocular symptoms covered by the SPEED questionnaire were significantly ameliorated after IPL-MGX treatment in this study, similar to the results of previous studies.

Study conclusion

In conclusion, our results suggest that IPL-MGX therapy is effective for patients with refractory MGD whose severe disease is difficult to manage with other conventional therapies. IPL-MGX thus has the potential to help many patients with MGD and is a promising modality for refractory MGD in particular.

Read complete study

Multicenter Study of Intense Pulsed Light Therapy for Patients With Refractory Meibomian Gland Dysfunction (Arita et al, Cornea, December 2018.)

Check out the references in this study for a nice little library of studies that have been done on IPL for not just MGD but some other types of dry eye.