Dry Eye, Meibomian Gland Dysfunction
Conditions
Brief summary
The study objective is to evaluate the long-term treatment effectiveness for adult patients with meibomian gland dysfunction (MGD) and evaporative dry eye by: 1) comparing the LipiFlow® System to a standardized daily warm compress and eyelid hygiene control therapy over a duration of 3 Months; and 2) evaluating the LipiFlow® alone and in combination with other MGD and dry eye treatments over a duration of up to 12 Months. This is a post-market, non-significant risk, prospective and multi-center clinical trial divided into two stages. The first stage from enrollment to 3 Months is an open-label, randomized controlled design to compare the effectiveness of a single LipiFlow® System treatment to a standardized daily warm compress and eyelid hygiene Control therapy with Crossover LipiFlow® treatment of the Control subjects at 3 Months. The second stage, occurring between 3 and 12 Months, is an observational design to evaluate the effectiveness of LipiFlow® alone and in combination with other MGD and dry eye treatments over a duration of up to 12 Months. Subjects are entered into the following subgroups based on the subject's self-assessment of the adequacy of symptom relief and protocol-defined criteria for additional treatment. 1. One LipiFlow® Treatment: Subjects who receive only one LipiFlow® treatment. 2. Two LipiFlow® Treatments: Subjects who receive a second LipiFlow® treatment. 3. Combination Treatment: Subjects who receive one or two LipiFlow® treatments followed by other MGD or dry eye treatment, as prescribed by the physician.
Interventions
In-office device treatment for meibomian gland dysfunction by a physician
At-home daily warm compress therapy and lid hygiene
Sponsors
Study design
Eligibility
Inclusion criteria
* At least 18 years old * Tear film assessment that qualifies in both eyes * Evidence of meibomian gland dysfunction and dry eye in both eyes * Willingness to comply with study protocol
Exclusion criteria
* Systemic disease condition or medication that causes dry eye * Use of other treatments for MGD or dry eye * Ocular surgery, trauma, herpes infection, punctal plug insertion or punctal occlusion within past 3 months * Active eye infection * Active eye inflammation or recurrent inflammation within past 3 months * Moderate to severe allergic conjunctivitis * Severe eyelid inflammation * Eyelid abnormality that affects lid function * Ocular surface abnormality that may compromise corneal integrity * Pregnant or nursing women * Participation in another ophthalmic clinical trial within past 30 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months | Baseline and 3 Months | To assess the meibomian glands, the secretion characteristics from 15 gland orifices along the lower eyelid were evaluated under a slit lamp biomicrosope using a handheld instrument, Meibomian Gland Evaluator, to apply gentle standardized pressure to the eyelid margin. Expressed secretion characteristics were graded on a scale of 3 (clear liquid secretion), 2 (cloudy liquid secretion), 1 (inspissated/toothpaste consistency), and 0 (no secretion). Total meibomian gland score was calculated based on the sum of the secretion grades for all 15 glands over a range from 0 to 45 with a higher score reflecting less meibomian gland dysfunction. To be eligible for the study, the Baseline total meibomian gland score must have been 12 or less in each eye. Change = 3 Month score - Baseline Score. |
| Stage 2 Mean Total Meibomian Gland Score at 12 Months | 12 Months | To assess the meibomian glands, the secretion characteristics from 15 gland orifices along the lower eyelid were evaluated under a slit lamp biomicrosope using a handheld instrument, Meibomian Gland Evaluator, to apply gentle standardized pressure to the eyelid margin. Expressed secretion characteristics were graded on a scale of 3 (clear liquid secretion), 2 (cloudy liquid secretion), 1 (inspissated/toothpaste consistency), and 0 (no secretion). Total meibomian gland score was calculated based on the sum of the secretion grades for all 15 glands over a range from 0 to 45 with a higher score reflecting less meibomian gland dysfunction. The total meibomian gland score at 12 Months was compared across subgroups, as defined below. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stage 1 Mean Change in Total OSDI Score From Baseline to 3 Months | Baseline, 3 Months | Dry eye symptoms assessed using the OSDI questionnaire were sensitivity to light, grittiness, pain or soreness, blurred vision and poor vision. The questionnaire evaluated the frequency problems with the eyes limited performance in reading, driving at night, working with a computer or bank machine, and watching television. Also, the frequency that eyes felt uncomfortable was assessed in windy conditions, areas with low humidity, and air-conditioned areas. The frequency scale was 0 (none of the time), 1 (some of the time), 2 (half of the time), 3 (most of the time), and 4 (all of the time). The total OSDI score was calculated as the sum of frequency scores for all symptoms multiplied by 25 and divided by the number of questions answered with a range from 0 to 100. A lower total OSDI score represents less disability from dry eye symptoms. To be eligible for the study, the Baseline total OSDI score must have been 13 points or higher in each eye. Change=3 Months score-Baseline score. |
| Stage 2 Mean Total OSDI Score at 12 Months | 12 Months | Dry eye symptoms assessed using the OSDI questionnaire were sensitivity to light, grittiness, pain or soreness, blurred vision and poor vision. The questionnaire evaluated the frequency problems with the eyes limited performance in reading, driving at night, working with a computer or bank machine, and watching television. Also, the frequency that eyes felt uncomfortable was assessed in windy conditions, areas with low humidity, and air-conditioned areas. Frequency scale was 0 (none of the time), 1 (some of the time), 2 (half of the time), 3 (most of the time), and 4 (all of the time). The total OSDI score was calculated as the sum of frequency scores for all symptoms multiplied by 25 and divided by the number of questions answered with a range from 0 to 100. A lower total OSDI score represents less disability from dry eye symptoms. The total OSDI score at 12 Months was compared across subgroups, as defined below. |
Countries
United States
Participant flow
Recruitment details
Between February 19, 2012 and October 15, 2012, this study enrolled subjects with meibomian gland dysfunction (MGD) and evaporative dry eye from nine ophthalmic practices in the United States.
Pre-assignment details
A total of 274 subjects were consented and 200 subjects were randomized. Of the 74 subjects who were not randomized, 52 subjects did not meet the study eligibility criteria and 22 subjects elected not to participate prior to randomization or had not yet attended the Baseline visit when study enrollment was completed.
Participants by arm
| Arm | Count |
|---|---|
| LipiFlow Treatment Subjects received a single, 12-minute, in-office treatment of both eyes for MGD with the LipiFlow System after randomization in Stage 1 of study. | 101 |
| Warm Compress & Lid Hygiene Subjects received twice-daily, standardized warm compress therapy and lid hygiene in both eyes from randomization to 3-month visit in Stage 1. | 99 |
| Total | 200 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Stage 1: Randomized Design | Device did not fit, No Treatment | 2 | 0 |
| Stage 1: Randomized Design | Lost to Follow-up | 0 | 2 |
| Stage 1: Randomized Design | Withdrawal by Subject | 1 | 3 |
| Stage 2: Observational Design | Device did not fit, No Treatment | 0 | 1 |
| Stage 2: Observational Design | Physician Decision | 1 | 0 |
| Stage 2: Observational Design | Withdrawal by Subject | 3 | 1 |
Baseline characteristics
| Characteristic | LipiFlow Treatment | Total | Warm Compress & Lid Hygiene |
|---|---|---|---|
| Age, Continuous | 56.3 years STANDARD_DEVIATION 15.9 | 56.2 years STANDARD_DEVIATION 15.3 | 56.1 years STANDARD_DEVIATION 14.7 |
| Baseline Total Meibomian Gland Score | 6.2 units on a scale STANDARD_DEVIATION 3.7 | 6.2 units on a scale STANDARD_DEVIATION 3.7 | 6.3 units on a scale STANDARD_DEVIATION 3.7 |
| Baseline Total OSDI Score | 45.6 units on a scale STANDARD_DEVIATION 21.2 | 48.7 units on a scale STANDARD_DEVIATION 22.4 | 51.8 units on a scale STANDARD_DEVIATION 23.1 |
| Duration of Dry Eye Symptoms | 6.9 years STANDARD_DEVIATION 6.8 | 7.8 years STANDARD_DEVIATION 7.3 | 8.7 years STANDARD_DEVIATION 7.7 |
| Duration of MGD or Dry Eye Diagnosis | 5.3 years STANDARD_DEVIATION 6.2 | 5.4 years STANDARD_DEVIATION 6 | 5.5 years STANDARD_DEVIATION 5.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 7 Participants | 14 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 94 Participants | 186 Participants | 92 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 5 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 98 Participants | 194 Participants | 96 Participants |
| Region of Enrollment United States | 101 participants | 200 participants | 99 participants |
| Sex: Female, Male Female | 74 Participants | 142 Participants | 68 Participants |
| Sex: Female, Male Male | 27 Participants | 58 Participants | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 6 / 101 | 7 / 99 | 4 / 94 |
| serious Total, serious adverse events | 0 / 101 | 0 / 99 | 0 / 94 |
Outcome results
Stage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months
To assess the meibomian glands, the secretion characteristics from 15 gland orifices along the lower eyelid were evaluated under a slit lamp biomicrosope using a handheld instrument, Meibomian Gland Evaluator, to apply gentle standardized pressure to the eyelid margin. Expressed secretion characteristics were graded on a scale of 3 (clear liquid secretion), 2 (cloudy liquid secretion), 1 (inspissated/toothpaste consistency), and 0 (no secretion). Total meibomian gland score was calculated based on the sum of the secretion grades for all 15 glands over a range from 0 to 45 with a higher score reflecting less meibomian gland dysfunction. To be eligible for the study, the Baseline total meibomian gland score must have been 12 or less in each eye. Change = 3 Month score - Baseline Score.
Time frame: Baseline and 3 Months
Population: Intent to Treat Population (All Participants who were randomized and received at least partial LipiFlow treatment or used warm compress therapy at least once and had data available at 3 Months).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| LipiFlow Treatment | Stage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months | 11.6 units on a scale |
| Warm Compress & Lid Hygiene | Stage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months | 4.5 units on a scale |
Stage 2 Mean Total Meibomian Gland Score at 12 Months
To assess the meibomian glands, the secretion characteristics from 15 gland orifices along the lower eyelid were evaluated under a slit lamp biomicrosope using a handheld instrument, Meibomian Gland Evaluator, to apply gentle standardized pressure to the eyelid margin. Expressed secretion characteristics were graded on a scale of 3 (clear liquid secretion), 2 (cloudy liquid secretion), 1 (inspissated/toothpaste consistency), and 0 (no secretion). Total meibomian gland score was calculated based on the sum of the secretion grades for all 15 glands over a range from 0 to 45 with a higher score reflecting less meibomian gland dysfunction. The total meibomian gland score at 12 Months was compared across subgroups, as defined below.
Time frame: 12 Months
Population: Intent to Treat Population (All participants who received at least partial LipiFlow or Crossover LipiFlow treatment and had data available at 12 Months). Two LipiFlow treatments subgroup was not analyzed because sample size was too small (n\<5) for meaningful analysis.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| LipiFlow Treatment | Stage 2 Mean Total Meibomian Gland Score at 12 Months | 17.3 units on a scale |
| Warm Compress & Lid Hygiene | Stage 2 Mean Total Meibomian Gland Score at 12 Months | 17.9 units on a scale |
| Warm Compress/Hygiene Arm: One LipiFlow Treatment Subgroup | Stage 2 Mean Total Meibomian Gland Score at 12 Months | 18.4 units on a scale |
| Warm Compress/Hygiene Arm: Combination Treatment Subgroup | Stage 2 Mean Total Meibomian Gland Score at 12 Months | 17.4 units on a scale |
Stage 1 Mean Change in Total OSDI Score From Baseline to 3 Months
Dry eye symptoms assessed using the OSDI questionnaire were sensitivity to light, grittiness, pain or soreness, blurred vision and poor vision. The questionnaire evaluated the frequency problems with the eyes limited performance in reading, driving at night, working with a computer or bank machine, and watching television. Also, the frequency that eyes felt uncomfortable was assessed in windy conditions, areas with low humidity, and air-conditioned areas. The frequency scale was 0 (none of the time), 1 (some of the time), 2 (half of the time), 3 (most of the time), and 4 (all of the time). The total OSDI score was calculated as the sum of frequency scores for all symptoms multiplied by 25 and divided by the number of questions answered with a range from 0 to 100. A lower total OSDI score represents less disability from dry eye symptoms. To be eligible for the study, the Baseline total OSDI score must have been 13 points or higher in each eye. Change=3 Months score-Baseline score.
Time frame: Baseline, 3 Months
Population: Intent to Treat Population (All participants who were randomized and received at least partial device treatment or used warm compress at least once and had data available at 3 Months).
| Arm | Measure | Value (MEAN) |
|---|---|---|
| LipiFlow Treatment | Stage 1 Mean Change in Total OSDI Score From Baseline to 3 Months | -23.4 units on a scale |
| Warm Compress & Lid Hygiene | Stage 1 Mean Change in Total OSDI Score From Baseline to 3 Months | -17.8 units on a scale |
Stage 2 Mean Total OSDI Score at 12 Months
Dry eye symptoms assessed using the OSDI questionnaire were sensitivity to light, grittiness, pain or soreness, blurred vision and poor vision. The questionnaire evaluated the frequency problems with the eyes limited performance in reading, driving at night, working with a computer or bank machine, and watching television. Also, the frequency that eyes felt uncomfortable was assessed in windy conditions, areas with low humidity, and air-conditioned areas. Frequency scale was 0 (none of the time), 1 (some of the time), 2 (half of the time), 3 (most of the time), and 4 (all of the time). The total OSDI score was calculated as the sum of frequency scores for all symptoms multiplied by 25 and divided by the number of questions answered with a range from 0 to 100. A lower total OSDI score represents less disability from dry eye symptoms. The total OSDI score at 12 Months was compared across subgroups, as defined below.
Time frame: 12 Months
Population: Intent to Treat (All participants who received at least a partial LipiFlow treatment or Crossover LipiFlow treatment and had data available at 12 Months). The Two LipiFlow treatments subgroup was not analyzed because the sample size (n\<5) was too small for meaningful analysis.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| LipiFlow Treatment | Stage 2 Mean Total OSDI Score at 12 Months | 21.6 units on a scale |
| Warm Compress & Lid Hygiene | Stage 2 Mean Total OSDI Score at 12 Months | 35.8 units on a scale |
| Warm Compress/Hygiene Arm: One LipiFlow Treatment Subgroup | Stage 2 Mean Total OSDI Score at 12 Months | 24.0 units on a scale |
| Warm Compress/Hygiene Arm: Combination Treatment Subgroup | Stage 2 Mean Total OSDI Score at 12 Months | 42.2 units on a scale |