Combined Intense Pulsed Light and Low-Level Light Therapy for the Treatment of Dry Eye: A Retrospective Before–After Study with One-Year Follow-Up

Abstract

Purpose

To assess the effectiveness of a combination of intense pulsed light and low-level light therapy (IPL/LLLT) for the treatment of dry eye.

Study Design

Retrospective before-after single-center clinical study.

Materials and Methods

Patients diagnosed with dry eye, refractory to conventional treatment, underwent four sessions of combined IPL/LLLT over 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, non-invasive breakup time (NIBUT), tear film osmolarity and meniscus height were measured 6 months before intervention, at baseline, post-intervention (3 months), 9 and 15 months.

Results

NIBUT, osmolarity and meniscus height significantly worsened during the 6 months before treatment, whereas symptoms did not change. OSDI scores significantly improved at post-intervention (MD = −44.0, 95% CI −38.1, −50.0), and then increased again until the at last follow-up, but still significantly different from baseline (MD = −30.0, 95% CI −23.4, −36.8). The three clinical signs showed a similar pattern, with one-year improvements of 3.6 seconds for the NIBUT (95% CI 3.1, 4.2, p <0.001), 28 mOsm/L for osmolarity (95% CI 23.6, 32.4, p <0.001) and 0.03 mm for meniscus height (95% CI 0.02, 0.04, p <0.001). No adverse effects were observed.

Conclusion

IPL/LLLT is safe and produces an important reduction in symptoms and signs of dry eye disease, still relevant one year after the end of treatment in a sample with high symptoms’ severity. Therefore, it represents a promising treatment option for patients who do not improve with conventional treatment. Randomized trials are needed to determine the added benefit provided by LLLT.

Keywords:

• dry eye
• meibomian gland dysfunction
• intense pulsed light
• low-level light therapy
• retrospective study

Abbreviations

ANOVA, analysis of variance; DED, dry eye disease; IPL, intense pulsed light; LED, light-emitting diodes; LLLT, low-level light therapy; MGD, Meibomian Gland Dysfunction; MD, mean difference; NIBUT, Non-invasive Breakup Time; OSDI, Ocular Surface Disease Index; SPEED, Standardized Patient Evaluation of Eye Dryness; TFOS-DEWS, Tear Film and Ocular Surface Society; TBUT, Tear film Breakup Time.

Acknowledgments

We thank Francisco García, Sílvia Rodriguez and Yurena Rodríguez for their work attending to patients and applying the evaluated treatment.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval for the version to be published; have agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Disclosure

MA Pérez-Silguero declares that Topcon Corporation (Tokyo, Japan), distributor of the Eye-light^® device, paid his travel and hotel costs for two national congresses organized by the Spanish Society of Ophthalmology (Granada, 26th-29th September 2018 and Madrid, 25th-28th September 2019), in which he directed two symposiums about dry eye. The remaining authors have no conflicts of interest.

Additional information

Funding

This study has not received any kind of funding.