Eyelid Warming Technology for Meibomian Gland Dysfunction
Meibomian gland dysfunction (MGD), an extremely common clinical condition (seen in more than half of some Asian populations), affects the lipid producing meibomian glands in the eyelids. One function of the glandular secretions is to reduce evaporation of the tear film. In MGD the meibomian glands may become blocked for various reasons. The consequential retention and stasis of the secretion increases immune response as well as scarring response. This eventually results in an abnormal tear film and dry eye symptoms.
The current standard treatments include warm moist compresses, regular lid hygiene, oral antibiotics, topical antibiotic ointments and Omega 3 supplementation. Heating for an extended duration is important because it relieves the occlusion of blocked meibomian glands. However, improvised methods of heating are cumbersome and inefficient requiring repeated measures, often leading to lack of compliance. Today, there is a wider range of commercially available devices that help to unblock meibomian glands and relief dry eye symptoms. These devices may improve MGD treatment dramatically, but have not been tested in the warm climate of Singapore, and are not readily available.
The current study aims to test the efficacy of treatment for devices that utilize A) warm moisture (Blephasteam) and B) warmth (EyeGiene) in patients suffering from meibomian gland dysfunction. Patients will be asked to use Blephasteam and EyeGiene for a period of 4 weeks. The study will monitor patients for changes in tear film and lipid composition, as well as changes in the anatomy of meibomian glands. Additionally, dry eye symptoms will be documented in form of questionnaires. If the newer methods of managing MGD are found to be efficacious and safe, these treatment measures can be made available to patients in Singapore.
Meibomian Gland Dysfunction
Device: Hot compresses
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
|Official Title:||Eyelid Warming Technology for Relief of Meibomian Gland Dysfunction in an Asian Population|
- Dry Eye Symptoms [ Time Frame: Week 4 ] [ Designated as safety issue: No ]A VAS will be applied to evaluate dry eye symptoms as described by Schaumberg et al. (Schaumberg 2007)between baseline and week 4. The scores will be recorded separately for frequency and severity of dry eye symptoms.
- Tear film break up time [ Time Frame: Week 4 ] [ Designated as safety issue: No ]After instillation of fluorescein, the participant will be asked to open the eyes, look ahead at the observer's forehead and not blink for as long as possible. The break up time is defined as the time between the lid opening and the first appearance of any dry spot on the cornea. The participant will be requested to close his eyes for few seconds and the procedure will be repeated for the left eye. The tear film break up time will be compared between baseline and week 4.
- Number of plugs [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The number of blocked/plugged meibomian glands will be counted in each eyelid and any improvement in comparison to baseline assessed.
- Yamaguchi Score [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The severity of meibomian gland dysfunction will be assessed at baseline and week 4.
- Corneal Staining [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The corneal staining will be assessed using fluorescein. The cornea will be divided into 5 sectors. The staining will be assessed at baseline and week 4.
- Schirmer's Test [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The tear production will be assessed using Schirmer Test I. Improvements in tear production will be identified in comparison to baseline.
- Meibography [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The meibomian glands will be imaged using infrared photography and their health graded at baseline and week 4.
- Tear meniscus volume [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The tear meniscus (height of the tear film) will be imaged and measured using the Anterior segment optical coherence tomography (AS-OCT). Briefly, the participant will be asked to look at a target in the instrument while blinking normally. The OCT will then scan the ocular surface and images of the upper and lower tear meniscus will be captured. Any changes in tear volume will be assessed with comparison to baseline values.
- Meibomian gland lipids [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The meibum from patients will be collected using a Kimura Platinum spatula and the lipid components will be analysed using mass-spectrometry. Lipid compositions will be compared between baseline and week 4 visits.
- Tear composition [ Time Frame: Week 4 ] [ Designated as safety issue: No ]The Schirmer test strips will be collected and the tears analysed for protein and lipid changes at baseline and after 4 weeks of treatment.
|Study Start Date:||December 2011|
|Study Completion Date:||December 2013|
|Primary Completion Date:||December 2013 (Final data collection date for primary outcome measure)|
Active Comparator: EyeGiene
EyeGiene (Eyedetec Medical Inc., US) is a self-contained, convenient warm compress system for the eyes. The system is composed of a reusable eye mask and one time use warmers that are inserted into the eye mask. The warming units are activated by squeezing just prior use and deliver 40°C heat for up to 5 minutes within 30-60 seconds.
10 minute treatment, twice daily
Other Name: Eyedetec Medical Inc., US
Active Comparator: Blephasteam
Blephasteam (Spectrum Théa, France) is an eyelid warming device that can be conveniently used at home. The goggles provide standardised heat of about 38 degrees to liquefy lipids and also humidify the chambers with mineral water to ensure optimal moisture levels.
10 minute treatment twice daily
Other Name: Spectrum Théa, France
Placebo Comparator: Control- Hot Compress
The participants in this group will be using warm compresses with a hot towel.
Device: Hot compresses
10 minute treatment, twice daily
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01448369
|Singapore National Eye Centre/ Singapore Eye Research Institute|
|Singapore, Singapore, 168751|
|Principal Investigator:||Louis Tong, PhD||Singapore National Eye Centre|