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Charles G Connor, Dena Andrade, Takeva Hicks, Sarah David, Narges Kasraie, William Miller, Srihari Narayanan; Heated Eye Pad tested for in-office treatment of Meibomian gland dysfunction. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4901. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Meibomian gland dysfunction (MGD) is the most common cause of evaporative dry eye. Though manual warm compresses are the backbone of managing MGD, poor compliance makes an office-based procedure desirable. Digital Heat Inc developed a powered Heated Eye Pad (HEP) designed to warm the Meibomian sebum. The HEP resembles a spectacle frame and delivers 40oC heat to the external eyelids. This study examined efficacy of the HEP for in-office MGD treatment.
Twenty MGD subjects (18 females, 2 males) (average age 28.96 yrs) underwent clinical measures (OSDI, MGD Efron scale, Blepharitis Efron scale, NITBUT, Meibography grade (Pult grading scheme) for each eyelid and InflammaDry MMP-9 expression at baseline and 4 weeks post baseline visit. The HEP treatment was performed for 10 minutes at the baseline visit and for 10 minutes 2 weeks post baseline. Data was analyzed by Student t-test with post hoc test for significance.
All subjects reported instant comfort (in office) after the two treatment sessions. Baseline measures were: OSDI 28.96 +/- 16.13; MGD Efron Grade 2.6+/- 0.58; Blepharitis Efron Grade 2.07 +/- 0.58; NITBUT 7.68 +/- 3.48 seconds; Meibography UL 1.36+/- 0.9 and LL 1.34 +/- 0.78. Ten subjects were MMP-9 positive at baseline. One month post-baseline, the measures were: OSDI 23.63 +/- 18.12, MGD Grade 1.78 +/- 0.71 (p=0.001 improved), Blepharitis Grade 1.6 +/- 0.48 (p=0.004 improved); NITBUT 7.32+/- 3.58secs; Meibography UL 1.44+/- 1.04 and LL 1.41+/- 0.84. Only six subjects were MMP-9 positive at the 4-week visit.
The instantaneous in-office comfort provided by the HEP was most likely a transient feeling of wellness since the OSDI scores did not improve significantly at the 4-week visit. A significant improvement in the appearance of the lid margins (Efron grading) was noted. Interestingly, 40% of the patients who were MMP-9 positive at baseline did not have this inflammatory marker at the 4-week visit. While, the HEP provides some betterment, the results suggest that two in-office HEP treatments may be inadequate to deliver long-term benefits for MGD patients. The device should be considered for a more frequent, home-based use, in order to extract greater benefits for MGD patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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