Meibomian gland dysfunction (MGD), which leads to evaporative dry eye disease, is a misery to treat for both the doctor and the patient — countless appointments and continuous complaints followed by rounds of hot compresses, artificial tears and noncompliance.

This cycle that rings true for all who attempt to manage this condition, which is far more prevalent than patients realize. In a study of almost 400 patients who presented for a routine comprehensive eye examination, 39% had MGD, based on the clinical criterion of absent or cloudy meibum upon gland expression. Increasing age was the most significant correlating factor.¹

SENSITIVE, CUSTOMIZABLE VISUALIZATION

Tear Film Innovations’ iLux is a handheld device designed to gently heat and compress the meibomian glands with magnified direct visualization by the eye-care professional.

Heat and compression are controlled by one ergonomic button on the handle of the unit. The device uses LED light to raise the temperature of the eyelid and melt the inspissated meibum.

Sensors in the disposable Smart Tip monitor the eyelid temperature, and the device controls the intensity of the LEDs to maintain the temperature within a safe, therapeutic range between 40-42º C. The single-patient use, sterile Smart Tip has an inner pad that slips behind the eyelid and an outer pad that is pressed against the lid during heating and expression. The integrated LCD screen displays the inner eyelid surface temperature, duration of warming time and amount of compression force in real time.

James Katz, MD, a corneal specialist in Chicago, has used iLux in his practice at least once or twice a day for the last three months. He says what makes this device unique is the incorporated 15X magnifier, which allows for direct visualization of the meibomian gland orifices. He can customize meibomian gland expression for each patient to completely treat each eyelid, compressing until the meibum changes from solid to semi-solid to a clear liquid.

The therapy usually takes about 10 minutes and requires moving the device from one treatment zone to the next, so that two treatments are performed per eyelid. Dr. Katz describes the iLux procedure to his patients as a spa treatment for the eyelids, providing mild heat and massage. His patients agree.

PART OF A MULTI-PRONGED APPROACH TO MGD

Following treatment with the iLux, Dr. Katz recommends patients continue to use eye masks and moist heat compress, omega-3 supplements and artificial tears to maintain their meibomian glands. “No special post-treatment adjunct therapy is required unless the patient has a hordeolum or chalazion, in which case an antibiotic/steroid combination ointment would be prescribed.”

iLux treatments may need to be repeated, depending on the patient’s response and the underlying cause of the MGD.

EXPECT THE NEED TO GROW

According to Dr. Katz, MGD is becoming far more common — particularly in younger patients.

“Excessive computer, tablet and smartphone use results in a lowered blink rate so the meibomian glands are functioning less effectively. Post-menopausal women and glaucoma medication users also suffer from meibomian gland dropout,” he says.

A recent study of 91 healthy volunteers between the ages of 20 and 77 showed that a high ocular surface disease index, a history of hordeolum or chalazion, puffy eyelids upon waking and foreign-body sensations all correlated with meibomian gland dropout.² Older age, hormone replacement therapy, smoking and allergy medication were independent predictors.

“Integrating MGD education, treatment and continued management into the practice can be a practice builder,” Dr. Katz notes.

While Healthcare Common Procedure Coding System Category III code 0207T exists for automated evacuation of the meibomian glands using heat and pressure, treatment with iLux is payable by the patient.³ The system and disposable tips are priced to make the treatment affordable for patients, while still providing valuable revenue for the practice, according to the company; typical patient cost ranges from $300-$500 per treatment.

PARTING PEARLS

The iLux is easy to learn and perform, according to Dr. Katz. Tear Film Innovations provided on-site and remote training resources, and Dr. Katz now delegates the task to his staff, once he has removed the first layer of blocked meibum at the slit lamp.

Critically, the device’s manual control of heat, pressure and duration allows for individualized targeted therapy.

“Visualization, however, is the key to success,” he says, “because you know you’ve reached the endpoint when the meibum runs clear.” OM

REFERENCES

1. Hom MM, Martinson JR, Knapp LL, Paugh JR. Prevalence of meibomian gland dysfunction. Optom Vis Sci. 1990;67:710-712.
2. Machalinska A, Zakrzewska A, Safranow K, Wiszniewska, Machalinska B. Risk Factors and Symptoms of Meibomian Gland Loss in a Healthy Population. J Ophthalmol. 2016;2016:7526120. Epub 2016 Nov 14.
3. Rumpakis, J. Coding for meibomian gland expression. https://www.optometricmanagement.com/newsletters/ocular-surface-news/january-8,-2015 . Accessed June 10, 2018.