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IPL and MGX Versus MGX Alone in the Treatment of Dry Eye Disease Secondary to MGD

Primary Purpose

Dry Eye, Meibomian Gland Dysfunction

Status
Completed
Phase
Not Applicable
Locations
Israel
Study Type
Interventional
Intervention
Intense Pulsed Light (IPL) therapy
Sham therapy
Sponsored by
Lumenis Be Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Dry Eye focused on measuring Intense Pulsed Light, Meibomian Gland Dysfunction, Dry Eye Disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject is able to read, understand and sign an Informed Consent (IC) form
  2. Subject is 18 years or older
  3. Subject has Fitzpatrick skin type I to IV
  4. SPEED questionnaire equal or more than 10
  5. OSDI questionnaire equal or more than 23
  6. In both eyes, at least 5 non-atrophied meibomian glands on the lower eyelid.
  7. In both eyes, Tear break up time equal or less than 7 seconds
  8. In both eyes, MGA (the total meibomian gland score for 15 glands of the lower eyelid) is smaller or equal to 12

Exclusion Criteria:

  1. Contact lens wear within the month prior to screening
  2. Unwilling to discontinue use of contact lenses for the duration of the study
  3. Ocular surgery or eyelid surgery within 6 months prior to screening
  4. Neuro-paralysis in the planned treatment area within 6 months prior to screening
  5. Other uncontrolled eye disorders affecting the ocular surface, for example active allergies
  6. Current use of punctal plugs
  7. Pre-cancerous lesions, skin cancer or pigmented lesions in the planned treatment area
  8. Uncontrolled infections or uncontrolled immunosuppressive diseases
  9. Subjects with ocular infections within 6 months prior to screening
  10. Prior history of cold sores or rashes in the perioral area or in the planned treatment area that could be stimulated by light at a wavelength of 560 nm to 1200 nm (e.g., Herpes simplex 1 & 2, Systemic Lupus erythematosus, porphyria)
  11. Use of photosensitive medication and/or herbs that may cause sensitivity to 560-1200 nm light exposure, such as Isotretinoin, Tetracycline, Doxycycline, or St. John's Wort within 3 months prior to screening
  12. Over exposure to sun within 4 weeks prior to screening, in the judgment of the investigator
  13. Administration of prescription eye drops for dry eye within 7 days prior to screening, excluding artificial tears and glaucoma drops
  14. Radiation therapy to the head or neck within 12 months prior to screening, or planned radiation therapy within 8 weeks after completion of all IPL treatments
  15. Treatment with chemotherapeutic agent within 8 weeks prior to screening, or planned chemotherapy within 8 weeks after completion of all IPL treatments
  16. New topical treatments within the area to be treated, or oral therapies within 3 months prior to screening, except over-the-counter acetaminophen-based analgesics (such as Extra Strength Tylenol®) for pain management after study treatment, new oral omega 3 fatty acid supplements and topical artificial tears
  17. Change in dosage of any systemic medication within 3 months prior to screening
  18. Anticipated relocation or extensive travel outside of the local study area preventing compliance with follow-up over the study period
  19. Legally blind in either or both eyes
  20. History of migraines, seizures or epilepsy
  21. IPL treatment within 12 months prior to screening
  22. Lipiflow treatment, or any other thermal treatment of the eyelids, within 6 months prior to screening
  23. Expression of the meibomian glands within 6 months prior to screening
  24. Any condition revealed during the eligibility screening process whereby the investigator deems the subject inappropriate for this study
  25. Women below the age of menopause (50 years of age)

Sites / Locations

  • Shaare Zedek

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Intense Pulsed Light (IPL) therapy

Sham therapy

Arm Description

Subjects with receive 10-15 intense pulsed light (IPL) pulses on the skin of the malar region (both cheeks, from tragus to tragus including the nose) and up to 3 mm from the lid margin of the lower eyelid. Following the administration of IPL pulses, subjects will undergo meibomian gland expression.

Participants will undergo a sham treatment that will mimic the intense pulsed light (IPL) therapy. The tip of the IPL lightguide will be placed in 10-15 locations on the skin of the malar region (both cheeks, from tragus to tragus including the nose) and up to 3 mm from the lid margin of the lower eyelid, but IPL pulses will not be actually delivered. Following this sham procedure, subjects will undergo meibomian gland expression.

Outcomes

Primary Outcome Measures

Change of baseline TBUT
Change of Tear break up time in the study eye, from baseline to follow-up

Secondary Outcome Measures

Change from baseline MGA
Change of Meibomian gland secretion score, from baseline to follow-up, in both eyes
Change from baseline OSDI
Change of self-assessed symptoms with the OSDI questionnaire, from baseline to follow-up, in both eyes

Full Information

First Posted
August 22, 2017
Last Updated
February 19, 2020
Sponsor
Lumenis Be Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03265652
Brief Title
IPL and MGX Versus MGX Alone in the Treatment of Dry Eye Disease Secondary to MGD
Official Title
Intense Pulsed Light and Meibomian Gland Expression (MGX) Versus MGX Alone in the Treatment of Dry Eye Disease Secondary to Meibomian Gland Dysfunction
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
May 15, 2018 (Actual)
Primary Completion Date
April 18, 2019 (Actual)
Study Completion Date
April 18, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Lumenis Be Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of the current study is to examine the contribution of intense pulsed light (IPL) for relieving signs and symptoms of dry eye due to meibomian gland dysfunction. The effect of IPL will be examined in a study designed as a randomized controlled trial. In the study arm, subjects will undergo 4 treatment sessions, consisting of IPL pulses immediately followed by expression of the meibomian glands. In the control arm, subjects will undergo the same treatments, except that the IPL pulses will be disabled. For each subject, the duration of the study will be 10 weeks, as explained in the detailed description,
Detailed Description
Outcome measures (tear break-up time, tear film osmolarity, meibomian gland assessment, number of meibomian glands yielding liquid secretion in lower eyelid , meibography, self-assessed symptoms and close up photos of the lid margins) will be measured at baseline. All subjects will receive 4 treatments at 2 weeks intervals. In each treatment session, a subject allocated to the study group will be treated with IPL administered in the malar region, from tragus to tragus including the nose, 2-3 mm below the lower eyelids. Immediately following the IPL administration, the meibomian glands will be manually expressed from both eyelids. Subjects in the control arm will receive exactly the same treatment, except that the IPL administration will be sham. A single follow-up will occur at 10 weeks after the baseline (or 4 weeks after the 4th treatment session). At the follow-up, the changes in the outcome measures will be evaluated, and compared between the two arms. For each subject, the duration of the study will be 10 weeks: 1st treatment at baseline; 2nd treatment at 2 weeks after baseline; 3rd treatment at 4 weeks after baseline; 4th treatment at 6 weeks after baseline; and a single follow-up at 10 weeks after baseline). Statistically significant differences between the two arms will support the study hypothesis that IPL treatment itself provides relief to both signs and symptoms of dry eye disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dry Eye, Meibomian Gland Dysfunction
Keywords
Intense Pulsed Light, Meibomian Gland Dysfunction, Dry Eye Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Subjects will be randomized 1:1 to a study arm and a control arm. Subjects in the study arm will be treated with IPL and meibomian gland expression. Subjects in the control arm will be treated with sham and meibomian gland expression.
Masking
Participant
Masking Description
Subjects in the study arm will receive a series of IPL pulses using the M22 IPL handpiece. In subjects of the control arm, the device will be disabled. The subject will feel the lightguide on the skin, will hear clicking sounds, but no light will be actually produced by the M22 device. Since during treatment both eyes of the subject will be fully occluded, no subject will be able to see if the treatment is actual or sham. There is no way to completely mask the subjects, since the IPL generally causes slight redness of the skin, and in some patients is may also cause some discomfort
Allocation
Randomized
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intense Pulsed Light (IPL) therapy
Arm Type
Experimental
Arm Description
Subjects with receive 10-15 intense pulsed light (IPL) pulses on the skin of the malar region (both cheeks, from tragus to tragus including the nose) and up to 3 mm from the lid margin of the lower eyelid. Following the administration of IPL pulses, subjects will undergo meibomian gland expression.
Arm Title
Sham therapy
Arm Type
Placebo Comparator
Arm Description
Participants will undergo a sham treatment that will mimic the intense pulsed light (IPL) therapy. The tip of the IPL lightguide will be placed in 10-15 locations on the skin of the malar region (both cheeks, from tragus to tragus including the nose) and up to 3 mm from the lid margin of the lower eyelid, but IPL pulses will not be actually delivered. Following this sham procedure, subjects will undergo meibomian gland expression.
Intervention Type
Device
Intervention Name(s)
Intense Pulsed Light (IPL) therapy
Intervention Description
Intense pulsed light therapy is a non-invasive and non-laser light treatment that is FDA-approved for various conditions in dermatology. Subjects will receive a total of 4 treatments over the course of the study, at intervals of 2 weeks. Each treatment will include applications on 10-15 IPL pulses in the malar region and close to the lower eyelids, followed by meibomian gland expression. Meibomian gland expression will be implemented by squeezing the meibomian glands with the aid of two Q-tips positioned on either side of the meibomian glands, or with a meibomian gland expressor forceps.
Intervention Type
Device
Intervention Name(s)
Sham therapy
Intervention Description
Subjects will receive a total of 4 treatments over the course of the study, at intervals of 2 weeks. Each treatment will include a sham application of IPL on 10-15 locations in the malar region and close to the lower eyelids, followed by meibomian gland expression. Meibomian gland expression will be implemented by squeezing the meibomian glands with the aid of two Q-tips positioned on either side of the meibomian glands, or with a meibomian gland expressor forceps.
Primary Outcome Measure Information:
Title
Change of baseline TBUT
Description
Change of Tear break up time in the study eye, from baseline to follow-up
Time Frame
10 weeks
Secondary Outcome Measure Information:
Title
Change from baseline MGA
Description
Change of Meibomian gland secretion score, from baseline to follow-up, in both eyes
Time Frame
10 weeks
Title
Change from baseline OSDI
Description
Change of self-assessed symptoms with the OSDI questionnaire, from baseline to follow-up, in both eyes
Time Frame
10 weeks
Other Pre-specified Outcome Measures:
Title
Change from baseline MGYLS
Description
Change of the number of meibomian glands yielding liquid secretion, from baseline to the follow-up
Time Frame
10 weeks
Title
Change from baseline TFO
Description
Change of the tear film osmolarity, from baseline to the follow-up
Time Frame
10 weeks
Title
Change from baseline Meiboscore
Description
Change of the Meiboscore evaluated with meibography, from baseline to the follow-up
Time Frame
10 weeks
Title
Percentage of study eyes with normal TBUT
Description
Percentage of study eyes with TBUT > 10 seconds at the follow-up
Time Frame
10 weeks
Title
Percentage of subjects with normal OSDI
Description
Percentage of subjects with OSDI < 23 at the follow-up
Time Frame
10 weeks
Title
Percentage of subjects with normal MGA
Description
Percentage of eyes with MGA > 12 at the follow-up
Time Frame
10 weeks
Title
Qualitative assessment of eyelid appearance
Description
High resolution photos of the upper and lower eyelids in both eyes
Time Frame
10 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is able to read, understand and sign an Informed Consent (IC) form Subject is 18 years or older Subject has Fitzpatrick skin type I to IV SPEED questionnaire equal or more than 10 OSDI questionnaire equal or more than 23 In both eyes, at least 5 non-atrophied meibomian glands on the lower eyelid. In both eyes, Tear break up time equal or less than 7 seconds In both eyes, MGA (the total meibomian gland score for 15 glands of the lower eyelid) is smaller or equal to 12 Exclusion Criteria: Contact lens wear within the month prior to screening Unwilling to discontinue use of contact lenses for the duration of the study Ocular surgery or eyelid surgery within 6 months prior to screening Neuro-paralysis in the planned treatment area within 6 months prior to screening Other uncontrolled eye disorders affecting the ocular surface, for example active allergies Current use of punctal plugs Pre-cancerous lesions, skin cancer or pigmented lesions in the planned treatment area Uncontrolled infections or uncontrolled immunosuppressive diseases Subjects with ocular infections within 6 months prior to screening Prior history of cold sores or rashes in the perioral area or in the planned treatment area that could be stimulated by light at a wavelength of 560 nm to 1200 nm (e.g., Herpes simplex 1 & 2, Systemic Lupus erythematosus, porphyria) Use of photosensitive medication and/or herbs that may cause sensitivity to 560-1200 nm light exposure, such as Isotretinoin, Tetracycline, Doxycycline, or St. John's Wort within 3 months prior to screening Over exposure to sun within 4 weeks prior to screening, in the judgment of the investigator Administration of prescription eye drops for dry eye within 7 days prior to screening, excluding artificial tears and glaucoma drops Radiation therapy to the head or neck within 12 months prior to screening, or planned radiation therapy within 8 weeks after completion of all IPL treatments Treatment with chemotherapeutic agent within 8 weeks prior to screening, or planned chemotherapy within 8 weeks after completion of all IPL treatments New topical treatments within the area to be treated, or oral therapies within 3 months prior to screening, except over-the-counter acetaminophen-based analgesics (such as Extra Strength Tylenol®) for pain management after study treatment, new oral omega 3 fatty acid supplements and topical artificial tears Change in dosage of any systemic medication within 3 months prior to screening Anticipated relocation or extensive travel outside of the local study area preventing compliance with follow-up over the study period Legally blind in either or both eyes History of migraines, seizures or epilepsy IPL treatment within 12 months prior to screening Lipiflow treatment, or any other thermal treatment of the eyelids, within 6 months prior to screening Expression of the meibomian glands within 6 months prior to screening Any condition revealed during the eligibility screening process whereby the investigator deems the subject inappropriate for this study Women below the age of menopause (50 years of age)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Zadok, MD
Organizational Affiliation
Shaarei Zedek Hospital ( Jerusalem)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Shaare Zedek
City
Jerusalem
Country
Israel

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
At this point it is not yet decided if and how to share IPD with other researchers

Learn more about this trial

IPL and MGX Versus MGX Alone in the Treatment of Dry Eye Disease Secondary to MGD

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