Clinical Ophthalmology (Jun 2019)
Combined low level light therapy and intense pulsed light therapy for the treatment of meibomian gland dysfunction
Abstract
Karl Stonecipher,1 Thomas G Abell,2 Bennett Chotiner,3 Erik Chotiner,3 Rick Potvin41Physicians Protocol, Greensboro, NC, USA; 2Abell Eyes, Lexington, KY, USA; 3Memorial Eye Institute, Harrisburg, PA, USA; 4Science in Vision, Akron, NY, USAPurpose: To evaluate the effects of combined intense pulsed light therapy (IPL) and low-level light therapy (LLLT) on clinical measures of dry eye related to severe meibomian gland disease (MGD) in subjects unresponsive to previous medical management.Patients and Methods: This was a retrospective chart review of patients treated by 4 physicians at 3 centers. All patients were documented treatment failures with traditional pharmaceutical therapy. They all had their MGD evaluated before treatment using a grading scale (0–4), tear breakup time in seconds and the Ocular Surface Disease Index (OSDI) questionnaire. To be included, all patients had to have had a short course of adjunct pharmaceutical or device-related therapy, along with a combined IPL/LLLT treatment. As well, a second MGD evaluation with the same three measures had to have been conducted 1–3 months post treatment.Results: A total of 460 eyes of 230 patients were identified for inclusion in the data set. Mean OSDI scores were significantly lower after treatment; 70.4% of patients had pretreatment OSDI scores indicative of dry eye; this dropped to 29.1% of patients after treatment. A 1-step or greater reduction in MGD grading was observed in 70% of eyes, with 28% of eyes having a 2-step or greater reduction. Tear breakup time was ≤6 seconds in 86.7% of eyes pretreatment, dropping to 33.9% of eyes after treatment. There were no ocular or facial adverse events or side effects related to the combined light treatment.Conclusion: The use of combined IPL/LLLT for the treatment of severe MGD appears to be beneficial in patients who have failed topical and/or systemic therapy.Keywords: LLLT, low level light therapy, IPL, intense pulsed light, meibomian gland dysfunction, ocular surface disease index
