Handheld thermal pulsation promise for MGD

Following the release of three-month interim findings¹, the Ocular Surface Laboratory (OSL) team has now completed the full six-month analysis of a trial comparing handheld thermal pulsation therapy with traditional warm compress treatment for meibomian gland dysfunction (MGD)².

The investigator-masked, randomised controlled trial involved 77 participants with MGD and dry eye disease (DED). A single treatment using the Alcon Systane iLux device (not currently commercially available in New Zealand) was compared to daily warm compress therapy and followed up monthly for six months. Both groups showed significant improvements in symptoms and clinical signs over the study period.

The key difference emerged in expressed meibum quality, where the thermal pulsation group demonstrated sustained improvements from month three onwards – an outcome not observed in the warm compress group. This suggests thermal pulsation has the potential to provide a more targeted treatment effect, by safely delivering heat directly to the meibomian glands from the inner conjunctival surface of the eyelid, combined with simultaneous clinician-guided manual expression using a single disposable tip.

Treatment satisfaction was higher in the thermal pulsation group than in the warm compress group and a greater proportion of the participants no longer met the dry eye diagnostic criteria by the study’s conclusion. Symptom improvement, assessed with the Standard Patient Evaluation of Eye Dryness validated questionnaire, was apparent earlier in the iLux group, with benefits noticeable from one month after the study initiation, compared to two months in the warm compress group.

Participants who continued to meet the dry eye diagnostic criteria at month three were offered retreatment. The study showed this subgroup did not appear to benefit from retreatment within six months, suggesting a possible need to consider a different management plan rather than offering repeated treatment.

The warm compress group maintained surprisingly good compliance throughout, averaging about 70%. In routine practice, achieving adherence to daily home-based therapies is typically more challenging. The thermal pulsation approach offers a one-off in-office treatment, with the potential to become relatively widely accessible in clinical practice due to its small size, although no New Zealand launch date has been announced at the time of writing.

This study provides evidence that both handheld thermal pulsation and compliant daily warm compress therapy can effectively manage MGD. Thermal pulsation shows additional benefit in the speed of symptom resolution, in meibum quality improvement and in perceived treatment convenience.

References

Craig JP, Shon C, Zhuang D, Muntz A, Xue AL, Wang MTM. Systane iLux thermal pulsation versus standard of care for MGD management. Invest Ophthalmol Vis Sci 2023; 64: 4003.
Jennings CJ, Zhuang D, Muntz A, Wang MTM, Craig JP. Clinican-guided thermal pulsation vs standard of care; a prospective randomised, investigator-masked 6-month trial. WCO-Omega 2023 conference poster presentation.

Catherine Jennings is a final year PhD candidate, supervised by Prof Jennifer Craig, Dr Kalika Bandamwar and Prof Alex Müntz, researching novel blepharitis management strategies with the OSL. She is a therapeutically qualified optometrist working in private practice and as a professional teaching fellow at the University of Auckland.