FDA study demonstrates benefits of intense pulsed light for dry eye disease
ROME — The FDA study leading to approval of intense pulsed light treatment with OptiLight technology confirmed the good results seen over many years in patients with dry eye who often do not respond to other treatments.
“I started this journey in 2001 when I was treating patients for rosacea, and those patients were getting improvement in their dry eye,” Rolando Toyos, MD, said at the OSN Italy meeting.
Intense pulsed light (IPL) uses a xenon flash lamp to produce light in the 500 nm to 1,000 nm wavelength range, pulsed and filtered to allow specific wavelengths of energy to be released. It treats dry eye due to meibomian gland dysfunction through several mechanisms of action, breaking the cycle of inflammation.
“IPL reduces the inflammatory mediators and closes the abnormal blood vessels that perpetuate inflammation. At the same time, it kills all microorganisms, including the Demodex mites that infect the eyelids. Incidentally, robots mounted with a xenon flash lamp were used in hospital departments to deactivate SARS-CoV-2 from surfaces,” Toyos said.
Meibomian glands are stimulated to work better, and the warmth produced by the treatment facilitates melting and expression of the glands’ secretions, he said.
In the FDA study, one eye was treated with sham and expression and the other eye with IPL and expression. Toyos Clinic and two other U.S. centers were involved.
“We did a triple pulse treatment, and all patients had 50 milliseconds of thermal relaxation time with energy from 10 J to 16 J. There were 43 patients in the sham group and 45 in the IPL group, many of which with severe dry eye, OSDI score 33 and above,” Toyos said.
All patients in the IPL group had significantly improved tear breakup time. In addition, the meiboscore, OSDI score and meibomian gland structure improved.
“We had patients with nonfunctioning glands that improved, and we also found that by treating the lower lid, we made the upper lid better as well. We are changing the morphology of the meibomian gland,” Toyos said.
One important lesson learned from the study was that expression is important. To a lesser extent, expression by itself improved meibomian gland functioning without IPL in the control group.
“IPL treatment without expressing the gland would not work,” Toyos said.
For those interested, training for the use of the OptiLight system (Lumenis) for dry eye disease, aesthetics and rosacea is provided by Toyos at his New York clinic.