Intense Pulsed Plus Low-Level Light Therapy in Meibomian Gland Dysfunction

Figures & data

Table 1 Technical Specifications of the IPL and LLL Treatment

Parameters	IPL (Eye-Light^®)	LLL (MY MASK-E^®)
Protective device	Yes	No
Patient position	Reclined in an armchair	Supine position
Type of application	5 painless light shots	One mask
Treatment duration	5 minutes	15 minutes
Anatomic target	Lower lid	Upper and lower lids
Type of laser	High power (short, hot pulses of light)	Low power (long wavelength, red LED light)
Interaction with tissue	Photo-thermal	Photobiomodulation
Energy level delivered	Automatically customized treatments based on the the degree of skin pigmentation (subjectively evaluated with skin Fitzpatrick scale) and the severity of dry eye (determined by ME-CHECK^® Screening).

Abbreviations: IPL, intense pulsed light; LLL, low level light; LED, light emitting diode.

Table 2 Demographic Data (n=62 Eyes/31 Patients)

Gender	38.70% Male/ 61.29% Female
Age	66.94±9.08 [51 to 81]
Systemic Pathology
Diabetes Mellitus	93.55% (29/31)
Systemic arterial hypertension	64.52% (20/31)
Previous ocular surgery
Cataract surgery	17.74% (11/62)
Pars plana vitrectomy	3.23% (2/62)
Anti-angiogenic intravitreous injections	8.06% (5/62)
Eye medications
Lowering ocular hypertension drops	19.35% (12/62)
Artificial eye drops, gels, or ointments	77.42% (48/62)
-Preservative-free	41.94% (26/62)
-Contain preservative	35.48% (22/62)

Table 3 Outcomes Before and After IPL+LLL Treatment (n=62)

Variables	Before IPL+LLL*	2–3 Weeks After IPL+LLL*	P value	6 Months After IPL+LLL*	P value
OSDI score	45.02±21.17	22.35±17.68	<0.001	8.24±9.91	<0.001
Corneal fluorescein staining	51.6	54.84	<0.001	45.2	0.293
NIBUT, sec	10.18±4.55	9.73±3.30	0.751	9.85±2.41	0.792
Blink rate, %	88.77±22.94	98.55±4.42	0.004	63.22±17.04	<0.001
Lipid layer thickness, nm	47.42±23.64	66.37±30.29	<0.001	73.93±27.03	<0.001
Loss area of the MG, %	10.87±15.77	9.11±12.37	0.722	16.71±16.77	0.044
Tear meniscus height, mm	0.33±0.15	0.28±0.16	0.001	0.33±0.26	0.891
Tear osmolarity, mOsm/L	298.08±11.25	306.74±11.81	<0.001	315.49±16.86	<0.001
Schirmer, mm	9.63±5.50	11.26±6.83	0.014	11.36±5.60	0.008

Notes: *values represent “mean±SD”, excepting corneal staining that was represented as percentage. Bold text represents a statistically significant p-value.

Abbreviations: IPL, intense pulsed light; LLL, low level light; OSDI, ocular surface disease index; NIBUT, non-invasive break up time; MG, meibomian glands; SD, standard deviation.

Figure 1 (A) Mean OSDI at 2–3 weeks after IPL and LLL treatment according to presence of gender (p=0.004), previous ocular surgery (p=0.002), lowering ocular hypertension drops (p=0.028) and corneal fluorescein staining (CFS) after treatment (p<0.001). (B) Mean OSDI at 6 months after IPL and LLP treatment according to presence of previous ocular surgery (p=0.021). Gender, lowering ocular hypertension drops and CFS only correlate with OSDI at 2–3 weeks after IPL and LLL treatment.

Abbreviations: IPL, intense pulsed light therapy; LLL, level low light therapy; OSDI, ocular surface disease index; CI, confidence interval.

Table 4 Correlations with OSDI in Different Times

Variables	OSDI Score 2–3 Weeks After IPL+LLL		OSDI Score 6 Months After IPL+LLL
	R	P value	R	P value
Severity of dry eye by OSDI 12*	0.603	<0.001	0.346	0.008
Severity of dry eye by ME-CHECK^®*	0.533	<0.001	0.472	<0.001
Corneal fluorescein stainingꭞ	0.487	<0.001	0.220	0.096
Previous ocular surgery	0.424	0.001	0.302	0.021
Female gender	0.388	0.002	0.202	0.129
Lowering ocular hypertension drops	0.277	0.030	−0.082	0.541
Previous cataract surgery	0.271	0.033	0.198	0.136
Schirmer testꭞ	−0.245	0.055	−0.197	0.138
Blink rateꭞ	−0.216	0.091	−0.154	0.247
Lipid layer thicknessꭞ	0.214	0.094	−0.042	0.756
Degree of skin pigmentation	−0.212	0.097	0.142	0.287
Tear meniscus heightꭞ	−0.152	0.238	−0.125	0.351
Non-invasive break up timeꭞ	0.137	0.292	0.121	0.366
Area loss of the MGꭞ	0.102	0.429	0.037	0.785
Age	0.075	0.564	−0.126	0.345
Tear osmolarityꭞ	−0.070	0.587	−0.005	0.968

Notes: *Before treatment. ꭞAfter treatment. Bold text represents a statistically significant p-value.

Abbreviations: OSDI, ocular surface disease index; IPL, intense pulsed light therapy; LLL, low level light therapy; MG, meibomian glands.

Figure 2 OSDI, lipid layer thickness, Schirmer, osmolarity, loss area of MG, NIBUT and tear meniscus height grade frequencies at before, 2–3 weeks and 6 months after IPL and LLL treatment. OSDI grade: normal (0–12), mild (13–22), moderate (23–32) and severe (33–100). Lipid grade: abnormal (<60), borderline (60–80) and normal (>80). Schirmer grade: abnormal (<5), borderline (5–10) and normal (>10). Loss area of MG grade: abnormal (>60), borderline (40–60) and normal (<40). Osmolarity grade: abnormal (>320), borderline (300–320) and normal (<300). NIBUT grade: abnormal (<5), borderline (5–10) and normal (>10). Tear meniscus height grade: abnormal (<0.22), borderline (>0.44) and normal (0.22–0.44). Green square include variables that improved grade’s frequency: OSDI (p<0.001), lipid layer thickness (p<0.001) and Schirmer (p=0.023). Black square include variables that didn´t change grade’s frequency: loss area of MG (p=0.773), NIBUT (p=0.076) and tear meniscus height (p=0.153). Red square included variables that worsened grade’s frequency: osmolarity (p<0.001).

Abbreviations: NIBUT, non-invasive break up time; MG, meibomius gland; IPL, intense pulsed light therapy; LLL, level low light therapy.