Long-Term (3 Year) Effects of a Single Thermal Pulsation System Treatment on Meibomian Gland Function and Dry Eye Symptoms

Purpose: The present study examined the long-term (3 years) effects of a single (12 min) thermal pulsation system (TPS) treatment on symptomatic patients with evaporative dry eye disease (DED) secondary to meibomian gland dysfunction (MGD). Methods: In this prospective, cohort, observational, single-center study design, signs (meibomian gland secretion [MGS] scores and tear film breakup time [TBUT]) and symptoms (Ocular Surface Disease Index [OSDI] and Standard Patient Evaluation of Eye Dryness [SPEED] questionnaires) were determined in 20 patients (40 eyes) with MGD and dry eye symptoms at baseline (BL), 1 month, and 3 years post-TPS treatment using LipiFlow. Results: Meibomian gland secretion scores increased from BL (4.5 +/- 0.8) to 1 month (12.0 +/- 1.1, P <= 0.001). Improvement persisted at 3 years (18.4 +/- 1.4) relative to BL (P <= 0.001). Meibomian gland secretion scores in all regions of the lower eyelid were improved over BL at 1 month (nasal [P <= 0.001], central [P <= 0.001], temporal [P <= 0.01]) and 3 years (nasal [P <= 0.001], central [P <= 0.001], temporal [P <= 0.001]). TBUT increased from BL (4.1 +/- 0.4) to 1 month (7.9 +/- 1.4, P <= 0.05) but was not significantly different than BL at 3 years (4.5 +/- 0.6, P>0.05). The OSDI scores decreased from BL (26.0 +/- 4.6) to 1 month (14.7 +/- 4.3, P <= 0.001) but returned to BL levels at 3 years (22.5 +/- 5.4, P>0.05). The SPEED scores decreased from BL (13.4 +/- 1.0) to 1 month (6.5 +/- 1.3, P <= 0.001), and this improvement persisted at 3 years (9.5 +/- 1.6, P <= 0.001). Conclusions: Thermal pulsation may be a uniquely efficacious treatment option for DED secondary to MGD in that a single 12-min procedure is associated with significant improvement in MGS and SPEED scores for up to 3 years.