ABSTRACT
SIGNIFICANCE: Meibomian gland dysfunction (MGD) can produce a myriad of symptoms. The effective treatment of MGD can reduce the burden of this condition. Although several studies have indicated that TearCare (Sight Sciences, Menlo Park, CA) is an effective treatment for MGD, no studies currently provide information regarding the duration of efficacy. PURPOSE: The purpose of this analysis was to determine the duration of efficacy of symptom relief and improvement of signs (as measured by gland function) for a treatment consisting of controlled heating of the meibomian glands using SmartLids (Sight Sciences) combined with manual expression of the liquefied meibum by a physician. METHODS: This study involved retrospective analysis of data gathered from a single-center ophthalmology/optometry practice. Symptoms were assessed using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, and the signs were assessed using the meibomian gland expression (MGE) scores before and at several time points (8 weeks, 6 months, 12 months, and 18 months). Further analysis evaluating the efficacy in subgroups based on age, race, and sex was performed. RESULTS: There were 78 patients included in this study. The mean baseline SPEED score decreased from 14 to 7.9 at 8 weeks. The mean SPEED scores at 6 and 12 months were maintained at 7.7 and 7.9, respectively, and at 18 months went to 8.9. At baseline, the mean MGE was 4.9 in the right eye and 4.8 in the left eye. In both eyes, the mean MGE increased to 9.0 in both eyes at 8 weeks. At 6 months, the mean MGE score was maintained at 8.6 in the right and 8.2 in the left and remained consistent at 12 months with 7.8 in the right and 7.8 in the left. At 18 months, the MGE score went to 6.8 in the right eye and 7.0 in the left eye. CONCLUSIONS: A single TearCare treatment effectively reduced both the symptoms and signs of MGD and maintained its effects for 12 months.
Subject(s)
Dry Eye Syndromes , Meibomian Gland Dysfunction , Humans , Meibomian Gland Dysfunction/diagnosis , Retrospective Studies , Hot Temperature , Meibomian Glands , Treatment Outcome , Dry Eye Syndromes/diagnosis , Tears/metabolismABSTRACT
PURPOSE: To test the hypothesis that wheelchair users experience more discomfort when holding their necks in extended and/or rotated positions than when in their self-selected most comfortable positions (MCPs). METHODS: We studied 20 wheelchair users, first determining their MCPs with the eyes closed. Then, subjects assumed and maintained (for 5 min each) four neck positions in random order: level (L) and elevated (E), both straight ahead of the subject (S) and with the neck rotated (R). We measured neck extension angles (from digital photographs) and neck discomfort (using visual analogue scales [VAS], in %). RESULTS: The mean neck-extension angles were MCP - 2.6 degrees, LS 9.5 degrees, LR 8.1 degrees, ES 23.9 degrees and ER 25.4 degrees (ANOVA p < 0.0001). The mean VAS neck discomfort scores were LS 5.7%, LR 17.4%, ES 24.0% and ER 34.1% (ANOVA p < 0.0001). CONCLUSIONS: Sustained extension and rotation of the neck, alone or in combination, increase the neck discomfort of wheelchair users. The MCP for most wheelchair users is straight ahead with the neck slightly flexed, about 11 degrees and 27 degrees more flexed, respectively, than when looking at an average-height sitting or standing person. These findings have implications for wheelchair design, the behaviour of clinicians and wheelchair users, and the built environment.
