A Comparison Of Seven Treatment Options For The Treatment Of Meibomian Gland Dysfunction And Dry Eye Disease: An Algorithm Towards Stabilization And Improved Outcomes In Refractive And Refractive Cataract Surgery

The purpose of the study was to look at current treatment regimens for the treatment of meibomian gland disease (MGD) and dry eye disease (DED) and produce an algorithm for treatment as an initial presentation or prior to refractive or refractive cataract surgery.

This was a retrospective, single center, insignificant risk, single surgeon, single ambulatory surgery center study involving the treatment and evaluation of 1721 eyes of 861 patients treated for meibomian gland and dry eye disease. 

Patient's presented diagnosed with MGD or DED prior to evaluation by KGS. All patients had failed multiple topical and systemic pharmaceutical treatment options. The treatments evaluated were as follows: thermal hygienic (Thermamedx); lid exfoliation (Blephex); lower level light therapy alone or in combination with intense pulsed light therapy (Espansione) or other treatment options; thermal pulsation (Lipiflow); thermal blink energy (Tearcare); and radiofrequency (Tempsure). The subjective outcomes were evaluated with the Ocular Surface Disease Index (OSDI) and objective treatments evaluated lissamine green staining of the conjunctiva; tear break up time; and MGD scores graded [0 (normal) to 4 (inability to express)]

All treatments showed improved outcomes (subjective and objective) and variable compliance based on results. A algorithm chart based on clinical, preoperative and surgical outcomes will be presented showing improved OSDI scores, improved refractive and refractive cataract outcomes, and objective findings in over on average 86% of patients studied who had failed multiple topical and/or systemic pharmaceutical interventions. Statistically significant improvement in lissamine green staining, tear break up times, and meibomian gland expression scoring will be highlighted. Treatments of single regimens versus multiple regimens will also be highlighted for both surgical and non-surgical patients.

MGD and DED are complex diseases with multiple treatment options. Finding the right treatment option to optimize outcomes around surgery and for treatment in individuals with evaporative or mixed mechanism dry eye disease is imperative and most involve compliance and results. The algorithm presented is based on use in a single center with a single surgeon and is useful and cost effective.