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Randomized Controlled Trial of Long-term Treatment Effectiveness for Meibomian Gland Dysfunction (MGD) and Dry Eye

Randomized Controlled Trial of Long-term Treatment Effectiveness for Meibomian Gland Dysfunction (MGD) and Dry Eye

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01521507
Enrollment
200
Registered
2012-01-30
Start date
2012-01-31
Completion date
2014-01-31
Last updated
2015-02-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Dry Eye, Meibomian Gland Dysfunction

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

DEVICEWarm Compress Therapy + Lid Scrub

At-home daily warm compress therapy and lid hygiene

Sponsors

TearScience, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Stage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 MonthsBaseline and 3 MonthsTo 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 Months12 MonthsTo 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

MeasureTime frameDescription
Stage 1 Mean Change in Total OSDI Score From Baseline to 3 MonthsBaseline, 3 MonthsDry 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 Months12 MonthsDry 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

ArmCount
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
Total200

Withdrawals & dropouts

PeriodReasonFG000FG001
Stage 1: Randomized DesignDevice did not fit, No Treatment20
Stage 1: Randomized DesignLost to Follow-up02
Stage 1: Randomized DesignWithdrawal by Subject13
Stage 2: Observational DesignDevice did not fit, No Treatment01
Stage 2: Observational DesignPhysician Decision10
Stage 2: Observational DesignWithdrawal by Subject31

Baseline characteristics

CharacteristicLipiFlow TreatmentTotalWarm Compress & Lid Hygiene
Age, Continuous56.3 years
STANDARD_DEVIATION 15.9
56.2 years
STANDARD_DEVIATION 15.3
56.1 years
STANDARD_DEVIATION 14.7
Baseline Total Meibomian Gland Score6.2 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 Score45.6 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 Symptoms6.9 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 Diagnosis5.3 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 Participants14 Participants7 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
94 Participants186 Participants92 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Asian
2 Participants5 Participants3 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
98 Participants194 Participants96 Participants
Region of Enrollment
United States
101 participants200 participants99 participants
Sex: Female, Male
Female
74 Participants142 Participants68 Participants
Sex: Female, Male
Male
27 Participants58 Participants31 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
6 / 1017 / 994 / 94
serious
Total, serious adverse events
0 / 1010 / 990 / 94

Outcome results

Primary

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).

ArmMeasureValue (MEAN)
LipiFlow TreatmentStage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months11.6 units on a scale
Warm Compress & Lid HygieneStage 1 Mean Change in Total Meibomian Gland Score From Baseline to 3 Months4.5 units on a scale
Comparison: The null and alternative hypotheses are H0: µt ≤ µc vs. Ha: µt \> µc, where µt and µc are the mean changes in total meibomian gland scores from Baseline to 3 Months for the LipiFlow (test) and Warm Compress and Lid Hygiene (active control) groups, respectively. For the Stage 1 Primary Outcome, the minimum sample size was 24 subjects per group with a power of 90% and a one-sided alpha of 0.025.p-value: <0.0001z-statistic
Comparison: Supportive multivariate mixed model was also performed for this outcome controlling for significant demographic and baseline characteristics.p-value: 0.002Mixed Models Analysis
Primary

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.

ArmMeasureValue (MEAN)
LipiFlow TreatmentStage 2 Mean Total Meibomian Gland Score at 12 Months17.3 units on a scale
Warm Compress & Lid HygieneStage 2 Mean Total Meibomian Gland Score at 12 Months17.9 units on a scale
Warm Compress/Hygiene Arm: One LipiFlow Treatment SubgroupStage 2 Mean Total Meibomian Gland Score at 12 Months18.4 units on a scale
Warm Compress/Hygiene Arm: Combination Treatment SubgroupStage 2 Mean Total Meibomian Gland Score at 12 Months17.4 units on a scale
Comparison: The null and alternative hypotheses for the Stage 2 Primary Outcome was: H0: µi= µj for all i and j where i≠j versus Ha: µi ≠ µj for at least one i and j, where µi is the mean total meibomian gland score at 12 Months for the ith subgroup. The null hypothesis was tested with a two-sided test at alpha=0.05. Since Stage 2 was an observational design, no minimum sample size was calculated for Stage 2.p-value: 0.9098Mixed Models Analysis
Secondary

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).

ArmMeasureValue (MEAN)
LipiFlow TreatmentStage 1 Mean Change in Total OSDI Score From Baseline to 3 Months-23.4 units on a scale
Warm Compress & Lid HygieneStage 1 Mean Change in Total OSDI Score From Baseline to 3 Months-17.8 units on a scale
Comparison: The null and alternative hypotheses are H0: µt ≤ µc vs. Ha: µt \> µc, where µt and µc are the mean changes in total OSDI scores from Baseline to 3 Months for the LipiFlow (test) and Warm Compress and Lid Hygiene (active control) groups, respectively. For the Stage 1 Secondary Outcome, the minimum sample size was 84 per group with a power of 80% and a one-sided alpha of 0.025.p-value: 0.0068t-test, 2 sided
Comparison: Supportive multivariate mixed model was also performed for this outcome controlling for significant demographic and baseline characteristics.p-value: 0.0419Mixed Models Analysis
Secondary

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.

ArmMeasureValue (MEAN)
LipiFlow TreatmentStage 2 Mean Total OSDI Score at 12 Months21.6 units on a scale
Warm Compress & Lid HygieneStage 2 Mean Total OSDI Score at 12 Months35.8 units on a scale
Warm Compress/Hygiene Arm: One LipiFlow Treatment SubgroupStage 2 Mean Total OSDI Score at 12 Months24.0 units on a scale
Warm Compress/Hygiene Arm: Combination Treatment SubgroupStage 2 Mean Total OSDI Score at 12 Months42.2 units on a scale
Comparison: The null and alternative hypotheses for the Stage 2 Secondary Outcome was: H0: µi= µj for all i and j where i≠j versus Ha: µi ≠ µj for at least one i and j, where µi is the mean total OSDI score at 12 Months for the ith subgroup. The null hypothesis was tested with a two-sided test at alpha=0.05. Since Stage 2 was an observational design, no minimum sample size was calculated for Stage 2.p-value: 0.0237Mixed Models Analysis

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026