The LipiFlow Thermal Pulsation System (TearScience Inc., Morrisville, North Carolina; Figure 1) is a 12-minute treatment for patients with meibomian gland dysfunction (blockage) and evaporative dry eye. For a video demonstration of the procedure, visit eyetube.net/?v=tiwaf.
The LipiFlow treatment is initiated with heat delivered to the inner eyelid surface, close to the location of the meibomian glands, and application of gentle pulsatile pressure to the outer eyelid surface. The treatment facilitates release of blockage from meibomian glands to provide the glands with the opportunity to resume natural production of lipids. According to the company, most patients (76% to 79%) report at least some relief of their dry eye symptoms within 2 to 4 weeks after treatment.
Evaluation of dry eye patients may include assessing the quantity and quality of meibomian gland secretions using the Meibomian Gland Evaluator at the slit lamp, administering a dry eye symptom questionnaire, and imaging the tear film with the LipiView Ocular Surface Interferometer (TearScience Inc.).
A randomized, controlled multicenter clinical trial at nine investigational centers compared application of a single LipiFlow treatment to daily warm compress therapy for the treatment of evaporative dry eye (data on file at TearScience Inc.). A total of 278 eyes (139 patients) were enrolled. The average total meibomian score in patients who received a single LipiFlow treatment improved from 6.3 ±3.5 glands before treatment to 14.3 ±8.7 and 16.7 ±8.7 glands 2 and 4 weeks after treatment, respectively. In patients who received daily warm compresses only for 2 weeks, the mean total meibomian gland score improved from 5.6 ±3.9 glands before therapy to 6.1 ±5.6 glands at 2 weeks. After these patients crossed over to receive a single LipiFlow treatment at 2 weeks, the mean total meibomian gland score improved to 11.7 ±7.3 glands at 4 weeks.
In the study, mean total ocular surface disease index (OSDI) score was lower after LipiFlow treatment than with daily warm compress therapy. Patients in the LipiFlow group improved from a mean OSDI score of 32.0 ±20.0 before treatment to 17.3 ±17.2 and 16.6 ±18.1 at 2 and 4 weeks, respectively. Patients in the daily warm compress group improved from a mean OSDI score of 34.7 ±19.6 before therapy to 26.9 ±18.2 at 2 weeks and further improved after crossover to LipiFlow to 21.0 ±18.3 at 4 weeks.
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