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Srihari Narayanan, Narges Kasraie, Mellinda Stewart, Noah Kasraie, Austin Barr, Charles G Connor, William L Miller; Lid margin debridement improves contact lens discomfort caused by Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6368. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Contact lens discomfort (CLD) reduces CL tolerance and CL wear time. Meibomian Gland Dysfunction (MGD) often leads to CLD. We have shown (ARVO 2015, 2017) that lid margin debridement-scaling improves MGD signs and symptoms and decreases MMP-9. The purpose of this clinical trial was to study improvement in CLD associated with MGD by comparing treatments between BlephEx microblepharoexfoliation and manual (golf spud) lid margin debridement.
Sixty CLD patients with MGD were randomly assigned to BlephEx (N=31; 9 men; 27.2+/-6.7yrs) or Manual (N=29; 7 men; 28.9+/-7.5yrs) treatment groups. Patients reported number of hours of CL wear and number of rewetting eyedrops per day prior to treatment and at 1-month post treatment. The CLDEQ-8 questionnaire, Meibography grading, Inflammadry MMP-9 testing, Non-invasive tear break-up time (NITBUT) tests were done prior to and 1-month post-treatment. Data was analyzed by paired samples t-test.
Both groups significantly (p<0.0001) increased CL wear time post-treatment (Baseline 4.4+/-3.3 hrs; BlephEx 8.48+/-3.86; Manual 8.17+/-4.49); Significantly reduced number of rewetting drops per day (Baseline 1.36+/-2.5 drops; BlephEx 0.35+/-0.97 p=0.03; Manual 0.05+/-0.19 p=0.008); Significantly reduced (p<0.0001) CLDEQ-8 scores (Baseline 23.05+/-5.62; BlephEx 13.87+/-6.06; Manual 13.31+/-6.42). At baseline 42 patients were MMP-9 positive (21 each group), whereas 13 (BlephEx) and 15 (Manual) were positive post-treatment. Meibography grades improved significantly (p=0.036) post-treatment only in the left eyes of the manual group, though all patients showed a trend towards improvement. NITBUT did not improve in either group.
Results show significant betterment in CLD symptoms, doubling of CL wear time and decreased usage of rewetting drops in both treatment groups. Some patients became MMP-9 negative post-treatment in both groups. Meibography grades trended to betterment. Our results suggest that lid margin debridement-scaling is a viable tool for improving CLD in patients with MGD. The practitioner can choose their preferred method of treatment as both groups in our study improved almost equally with respect to the outcome measures.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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