October 2019

CORNEA

Device Focus
Potential seen in newer MGD device


by Rich Daly EyeWorld Contributing Writer


The iLux uses a single-use tip with an inner pad that slips behind the eyelid and an outer pad that’s pressed against the outer surface of the eyelid during heating and compression.
Source: Preeya Gupta, MD

A relatively recent entry into the increasingly crowded category of devices that aim to treat meibomian gland dysfunction (MGD) is seen by experienced surgeons as providing promising results.
iLux (Alcon) is a handheld device that treats MGD with light-based heat and compression through direct visualization by physicians using a magnifying lens. The device has a single-use tip with an inner pad that slips behind the eyelid and an outer pad that’s pressed against the exterior surface of the eyelid during heating and compression. The tip uses temperature sensors to maintain safe heat levels.
“We are addressing an unmet need because it’s a convenient and aggressive treatment to address meibomian gland disease in all four lids,” said John Sheppard, MD.
Sheri Rowen, MD, who uses the portable device in multiple offices, praised the good visualization it allows.
“I can constantly know what the glands are putting out, so I’ve had a good experience with it,” Dr. Rowen said.
Laura Periman, MD, said the different devices providing in-office treatments for MGD have improved patients’ success with home maintenance strategies.
“As part of an integrated treatment plan that includes foundational therapies such as omega-3 fatty acids, topical immunomodulators, Intense Pulsed Light (IPL) for addressing common contributors to MGD such as rosacea, the thermal expression modalities are welcome additions that can be customized to more effectively manage the multifactorial MGD problem,” Dr. Periman said.

How it stacks up

Preeya Gupta, MD, has used iLux for several months to provide 10-minute treatments for dry eye and MGD.
Positive points include the ability to treat both the upper and lower lids, control the amount of pressure and heat applied, and the direct visualization of the glands, Dr. Gupta said.
Compared to other devices, the iLux is closest to the MiBo Thermoflo (MIBO Medical Group), which also delivers heat, Dr. Rowen said.
“Sometimes you will double up with compressions because you’ve got to do it the right way or it doesn’t take,” Dr. Rowen said.
Dr. Sheppard praised the innovation of using LED therapy, adaptable tips for expression, and temperature sensors. Additionally, he noted that the readily portable device takes up little office space, in contrast to the larger LipiFlow Thermal Pulsation System (Johnson & Johnson Vision), which consists of a console and a single-use sterile device that uses both heat and peristaltic motion to evacuate obstructed meibum.
Dr. Periman added that “the LED therapy has the potential for improving the function of the meibomian gland stem cells via photobiomodulation. This effect has been reported in the [peer-reviewed] literature.”1
Dr. Gupta noted that the different approaches of MGD devices, with iLux and LipiFlow aiming to relieve obstructions and intense pulsed-light devices aiming to shut down the blood vessels.
“I would think that these procedures could be complimentary, and certainly sometimes one procedure works better for certain patients than the other,” Dr. Gupta said.
The downside to iLux is that it is one size fits all, Dr. Sheppard said.
“Both the iLux and the LipiFlow are somewhat adaptable to stretchy smaller fissure eyes; one size fits all doesn’t always work best for the treatments however,” Dr. Sheppard said.
His experience has shown that once a skittish patient is calmed and comfortable, he or she usually does well with the comfortable iLux. However, more anxious patients may not do as well.
Dr. Periman said targeted approaches such as iLux and TearCare (Sight Sciences) may be preferable in cases of excessive lid laxity or significant meibomian gland shortening.
Dr. Gupta said practices treating many aspects of dry eye can find it helpful to incorporate various technologies to provide more systematic relief of MGD while providing complimentary treatments for the ocular surface.

Debridement advantage

Lid margin debridement improves the expression of the glands because it cleans off bacteria and sometimes the blockages of the anterior glands, Dr. Rowen said.
“It helps to make sure that the pores to the glands are open,” Dr. Rowen said.
Dr. Gupta said debridement of the lid with a blunt spatula in the clinic can help, but more research is needed on combining microblepharoexfoliation with the meibomian expression procedure.

Home option?

Views on home use of iLux were split among surgeons using the device.
Both Dr. Gupta and Dr. Rowen viewed patient self-use of the device as unlikely to provide reliable results.
However, Dr. Sheppard said he didn’t see why a perceptive and dexterous family member couldn’t be taught how to use it effectively at home or in the setting of an immobile debilitated symptomatic patient.
“That might provide another opportunity for the manufacturer,” Dr. Sheppard said. “You don’t need excessive understanding to use the iLux.”

About the doctors

John Sheppard, MD
Professor of ophthalmology
Clinical director, Thomas R. Lee Center for Ocular Pharmacology
Eastern Virginia Medical School
Norfolk, Virginia

Sheri Rowen, MD
NVISION Eye Centers
Newport Beach, California

Preeya Gupta, MD
Associate professor of ophthalmology
Duke University Eye Center
Durham, North Carolina

Laura Periman, MD
Director, Dry Eye Services and Clinical Research
Evergreen Eye Center
Seattle

Reference

Hamblin MR. Shining light on the head: Photobiomodulation for brain disorders. BBA Clin. 2016;6:113–124. 

Relevant financial interests

Sheppard: None
Rowen: Alcon, Johnson & Johnson Vision
Gupta: Alcon, Johnson & Johnson Vision
Periman: Allergan, Bruder Healthcare, Eyedetec, Johnson & Johnson Vision, Novartis, ScienceBased Health, Sun

Contact information

Sheppard: jsheppard@vec2020.com
Rowen: srowen10@gmail.com
Gupta: preeyakgupta@gmail.com
Periman: lauraperiman@yahoo.com

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