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Krysta Goslin, Craig Czyz, Alice Epitropoulos; Evaluation of a Single Thermal Pulsation Treatment for Dry Eye and Meibomian Gland Dysfunction and Likelihood of Positive SJO Test. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3050.
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Evaporative dry eye from meibomian gland dysfunction (MGD) is the most common form of dry eye. Thermal pulsations (LipiFlow®, Tearscience, Morrisville, NC) is the only FDA approved treatment for Evaporative Dry Eye. The device uses a single 12-minute thermal pulsation to treat MGD. This study assesses if LipiFlow® improves subjective and objective variables relating to dry eye and MGD and if there is a correlation to Sjögren’s Syndrome.
Retrospective study of patients who received a single LipiFlow treatment between October 2013 and October 2014. Preoperative lipid layer thickness, degree of meibomian gland dropout, symptom SPEED scores (Standard patient of eye dryness [SPEED]), subjective comments, tear breakup time (TBUT), and Meibomian Gland Evaluation Score (MGES) were recorded. Thirty patients were also tested for Sjogren’s syndrome. SPEED Score, TBUT, MGES and subjective comments were also obtained between postoperative weeks 6-8. The Wilcoxon matched-pairs signed rank test was used to compare preoperative and postoperative SPEED scores and MGES and the paired t-test was used for preoperative and postoperative TBUT for patients who underwent Lipiflow treatment. Male and female outcomes were compared with the Mann Whitney test.
One hundred forty-six eyes, of 20 males and 66 females (86 patients) were studied, with an average age of 63.5 years (SD 12.8). There was a statistically significant difference (p<0.05) between preoperative and postoperative SPEED scores, TBUT, and MGES. There was also a difference in postoperative SPEED scores (p=0.0425) when comparing males and females but no preoperative (p=0.123) difference. Of the 30 patients tested for Sjögren’s (Sjö™, NICOX, Inc, Fort Worth, TX), 43% were positive (compared with 26% of the general dry eye population testing positive for Sjögren’s syndrome biomarkers). Eighty-six percent of patients experienced a subjective improvement in symptoms post treatment.
This study demonstrates the effectiveness of a single 12-minute thermal pulsation treatment in patients with dry eye from MGD. The efficacy is evidenced by the improvement in postoperative SPEED scores, TBUT, and MGES. There was a strong correlation between positive Sjö™ tests and MGD, indicating an autoimmune component contributing to symptoms experienced.
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