Comparison Of A Single-Dose Vectored Thermal Pulsation Procedure With A 3-Month Course Of Daily Oral Doxycycline For Moderate-To-Severe Meibomian Gland Dysfunction

Purpose: The aim of this study was to compare the efficacy of a single bilateral 12-minute vectored thermal pulsation (VTP) procedure versus daily oral doxycycline for 3 months for moderate-to-severe meibomian gland dysfunction (MGD).Methods: This prospective, randomized, parallel-group, single-masked study included 28 subjects who received either a single-dose VTP or 3 months of doxycycline treatment. At baseline and 3 months post treatment, all subjects were evaluated for the following: dry eye symptoms with a standard dry eye questionnaire (the Standard Patient Evaluation for Eye Dryness [SPEED]), meibomian gland (MG) function by counting the number of glands yielding liquid secretion with the MG evaluator (MGE), tear breakup time (TBUT) and corneal and conjunctival staining.Results: In the VTP group, at 3 months, there was a significant improvement in MG function (4.00 +/- 1.47 to 7.73 +/- 5.53), SPEED score (11.00 +/- 3.30 to 5.42 +/- 2.15), TBUT (6.26 +/- 2.01 to 8.44 +/- 1.81), corneal staining (0.38 +/- 0.50 to 0.12 +/- 0.33) and conjunctival staining (1.69 +/- 1.93 to 0.62 +/- 0.85). In the doxycycline group, there was a significant improvement in MG function (4.63 +/- 1.41 to 10.63 +/- 5.91), SPEED score (13.42 +/- 4.17 to 9.42 +/- 5.47) and conjunctival staining (2.38 +/- 1.88 to 1.13 +/- 1.51), but the improvement in TBUT (6.90 +/- 2.56 to 7.59 +/- 2.03) and corneal staining (0.21 +/- 0.41 to 0.13 +/- 0.34) was not statistically significant (p=0.262 and p=0.414, respectively). At 3 months, SPEED score was significantly better in the VTP group (p<0.05); other parameters were comparable between the two groups.Conclusion: A single 12-minute bilateral VTP procedure was significantly more effective than the 3-month daily course of oral doxycycline at improving the dry eye symptoms secondary to MGD. A single 12-minute VTP treatment was at least as effective as a dose of doxycycline for 3 months, in improving MG function and all measured signs of MGD. Given the minimal risk profile of the single VTP procedure over long-term doxycycline use, a single VTP presents a favorable alternative to long-term antibiotic use.