Does IPL improve Aqueous Tear Deficiency? (ie, Does IPL improve Schirmer’s Results)

Does IPL improve Schirmer’s? 

Although there have been improvements in the Schirmer’s test results, results were not statistically significant. Larger prospective studies are needed. 


Intense Pulsed Light Therapy with Meibomian Gland
Expression for Dry Eye Disease
Raman-Deep Singh Sambhi, BSc (Hons.), Gagan Deep Singh Sambhi, BSc (Hons.), Rookaya Mather, MD, Monali S. Malvankar-Mehta, PhD

Canadian Journal of Ophthalmology, January 2020
ABSTRACT Objectives: To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye symptoms. Design: Systematic Review followed by a meta-analysis. Participants: Not applicable Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Literature sources included MEDLINE, Embase, Cochrane Library, and meeting abstracts from Canadian Ophthalmological Society, The Association for Research in Vision and Ophthalmology, The American Academy of Ophthalmology, and The European Society for Cataract and Refractive Surgeons. Articles underwent 3 stages of screening before data extraction and meta-analysis. Results: After the initial search, 502 studies were found. Six articles were included for meta-analysis, and data were extracted after 3 stages of screening. Meta-analysis indicated significant increase in tear break-up time (TBUT) post-treatment in the <1-month followup (standardized mean difference [SMD] = 1.29; confidence interval [CI]: 1.10 1.48), up-to-6-month follow-up (SMD = 1.71; CI: 1.46 1.96), and >6-month follow-up (SMD = 2.04; CI: 1.68 2.40) groups. Moreover, meta-analysis suggested a nonsignificant improvement in Standardized Patient Evaluation of Eye Dryness (SPEED) scores after IPL with MGX at the <1-month follow-up (SMD = 1.35; CI: 1.70 to 1.01), up-to-6-month follow-up (SMD = 1.68; CI: 1.93 to 1.43), and >6-month follow-up (SMD = 2.04; CI: 2.40 to 1.68) groups. Meta-analysis also indicated a nonsignificant improvement in Schirmer’s test values at the up-to-2-month follow-up (SMD = 0.27; CI: 0.66 to 0.12), up-to-6-month follow-up (SMD = 0.04; CI: 0.25 to 0.33), and >6-month follow-up (SMD = 0.01; CI: 0.31 to 0.28) groups. Conclusions: The results suggested a significant increase in TBUT and a nonsignificant increase in SPEED and Schirmer’s test values at all follow-up periods post-treatment. Ultimately, IPL with MGX appears to be a promising therapy for MGD.

Multicenter Study of Intense Pulsed Light Therapy for Patients With Refractory Meibomian Gland Dysfunction

Reiko Arita, MD, PhD,*† Takanori Mizoguchi, MD,†‡ Shima Fukuoka, MD,†§ and Naoyuki Morishige, MD, PhD†
Clinical Science, May 2018
Purpose: To evaluate the efficacy of intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) for refractory meibomian gland dysfunction (MGD) in a prospective study conducted at 3 sites in Japan. Methods: Patients with refractory obstructive MGD were enrolled and underwent 4 to 8 IPL-MGX treatment sessions at 3-week intervals. Clinical assessment included the Standard Patient Evaluation of Eye Dryness questionnaire; noninvasive breakup time of the tear film and interferometric fringe pattern as determined by tear interferometry; lid margin abnormalities, fluorescein breakup time of the tear film, corneal and conjunctival fluorescein staining (CFS), and meibum grade as evaluated with a slit-lamp microscope; meibomian gland morphology (meiboscore); and tear production as measured by the Schirmer test without anesthesia. Results: Sixty-two eyes of 31 patients (17 women, 14 men; mean age 6 SD, 47.6 6 16.8 years) were enrolled. The Standard Patient Evaluation of Eye Dryness score (P , 0.001), noninvasive breakup time (P , 0.001), and interferometric fringe pattern (P , 0.001) were significantly improved after therapy, with 74% of eyes showing a change in the interferometric fringe pattern from 1 characteristic of lipid deficiency to the normal condition. Meibum grade, lid margin abnormality scores, fluorescein breakup time, and CFS were also significantly improved (P , 0.001, P , 0.001, P , 0.001, and P = 0.002, respectively) after treatment, whereas the meiboscore and Schirmer test value remained unchanged. Conclusions: IPL-MGX ameliorated symptoms and improved the condition of the tear film in patients with refractory MGD and is therefore a promising treatment option for this disorder.

Intense pulsed light treatment in meibomian gland dysfunction: A concise review
BehzodTashbayev, MazyarYazdani, ReikoArita, FredrikFineide, Tor PaaskeUtheim
The Ocular Surface, October 2020
To review the published literature related to application of intense pulsed light (IPL) for treating meibomian gland dysfunction (MGD).
The literature search included the PubMed database and used the keywords “Intense Pulsed Light and Meibomian Gland Dysfunction”.
IPL is a new instrumental treatment modality for MGD. This treatment modality was originally developed for use in dermatology and was later adopted in ophthalmology for treating MGD. IPL therapy for MGD can improve tear film stability, meibomian gland functionality, as well as subjective feeling of ocular dryness. However, in the reviewed literature, there was great variability in patient selection, evaluation criteria, and treatment protocols and durations.
Numerous studies report that IPL is effective for treating MGD and a safe procedure. There is great potential for further improvements to the procedure, as large comparative studies employing different treatment modalities are lacking.

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