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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| LipiFlow System | Experimental | Treatment with LipiFlow System at randomization in Stage 1 of study |
|
| Warm Compress and Lid Hygiene | Active Comparator | Control group receiving warm compress therapy and lid hygiene at randomization in Stage 1 of study and crossover LipiFlow System treatment in Stage 2 of study |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| LipiFlow System | Device | In-office device treatment for meibomian gland dysfunction by a physician |
|
| Measure | Description | Time Frame |
|---|---|---|
| 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. | Baseline and 3 Months |
| 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. | 12 Months |
| Measure | Description | Time Frame |
|---|---|---|
| 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. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Christy Stevens, O.D. | TearScience, Inc. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| McDonald Eye Associates | Fayetteville | Arkansas | 72703 | United States | ||
| Harvard Eye Associates |
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.
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.
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| ID | Title | Description |
|---|---|---|
| FG000 | 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. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief:
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| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Stage 1: Randomized Design |
|
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| Warm Compress Therapy + Lid Scrub | Device | At-home daily warm compress therapy and lid hygiene |
|
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| Baseline, 3 Months |
| 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. | 12 Months |
| Laguna Hills |
| California |
| 92653 |
| United States |
| Center for Excellence in Eye Care | Miami | Florida | 33176 | United States |
| Chicago Cornea Consultants, Ltd. | Hoffman Estates | Illinois | 60169 | United States |
| Jackson Eye | Lake Villa | Illinois | 50046 | United States |
| Cincinnati Eye Institute - Northern Kentucky | Edgewood | Kentucky | 41017 | United States |
| Charles River Eye Associates | Winchester | Massachusetts | 01890 | United States |
| Associated Eye Care | Stillwater | Minnesota | 55082 | United States |
| Ophthalmology Consultants, Ltd. | St Louis | Missouri | 63131 | United States |
| FG001 | Warm Compress & Lid Hygiene, Then Crossover LipiFlow Treatment | Subjects received twice-daily, standardized warm compress therapy and lid hygiene in both eyes from randomization to 3 months in Stage 1. Then, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief:
|
| Received Initial Treatment (Tx) |
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| COMPLETED |
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| NOT COMPLETED |
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| Stage 2: Observational Design |
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| ID | Title | Description |
|---|---|---|
| BG000 | 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. |
| BG001 | 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. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Region of Enrollment | Number | participants |
| ||||||||||||||||
| Baseline Total Meibomian Gland Score | Mean | Standard Deviation | units on a scale |
| |||||||||||||||
| Baseline Total OSDI Score | Mean | Standard Deviation | units on a scale |
| |||||||||||||||
| Duration of Dry Eye Symptoms | Mean | Standard Deviation | years |
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| Duration of MGD or Dry Eye Diagnosis | Mean | Standard Deviation | years |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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. | 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). | Posted | Mean | 95% Confidence Interval | units on a scale | Baseline and 3 Months |
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| 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. | 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. | Posted | Mean | 95% Confidence Interval | units on a scale | 12 Months |
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| 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. | 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). | Posted | Mean | 95% Confidence Interval | units on a scale | Baseline, 3 Months |
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| 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. | 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. | Posted | Mean | 95% Confidence Interval | units on a scale | 12 Months |
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Adverse events were collected over 1 year.
Device-related adverse events were evaluated by arm/group. Events occurring during Stage 1 were assessed based on relationship to the LipiFlow Treatment or Warm Compress Therapy and Lid Hygiene. Events occurring in Stage 2 were assessed based on relationship to LipiFlow Treatment or Crossover LipiFlow Treatment.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | 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. | 0 | 101 | 6 | 101 | ||
| EG001 | 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. | 0 | 99 | 7 | 99 | ||
| EG002 | Crossover LipiFlow Treatment | After using twice-daily, standardized warm compress therapy and lid hygiene for 3 months, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. | 0 | 94 | 4 | 94 |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anterior Staphylococcal Blepharitis | Eye disorders | Systematic Assessment |
| ||
| Blurry Vision | Eye disorders | Systematic Assessment |
| ||
| Burning Sensation | Eye disorders | Systematic Assessment |
| ||
| Chalazion | Eye disorders | Systematic Assessment |
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| Eye/Eyelid Discomfort/Pain | Eye disorders | Systematic Assessment |
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| Eyelid Edema/Swelling | Eye disorders | Systematic Assessment |
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| Eyelid Erythema/Redness | Eye disorders | Systematic Assessment |
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| Eyelid Irritation | Eye disorders | Systematic Assessment |
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| Eyelid Itching | Eye disorders | Systematic Assessment |
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| Eyelid Dermatitis | Eye disorders | Systematic Assessment |
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| Flashes/Ocular Migraine | Eye disorders | Systematic Assessment |
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| Gritty Sensation | Eye disorders | Systematic Assessment |
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| Hordeolum | Eye disorders | Systematic Assessment |
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| Increase/Worsening of MGD | Eye disorders | Systematic Assessment |
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| Increase/Worsening of Ocular Dryness | Eye disorders | Systematic Assessment |
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| Photophobia/Light Sensitivity | Eye disorders | Systematic Assessment |
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| Tearing | Eye disorders | Systematic Assessment |
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Sponsor can review communications for at least 30 days prior to public release with an extension for up to 45 additional days, if the Sponsor notifies the Investigator that the publication contains patentable material or Proprietary Information other than the study results. Upon Sponsor's written request, Investigator agrees to delete any Proprietary Information.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Study Director | TearScience, Inc. | 919-467-4007 | cstevens@tearscience.com |
| ID | Term |
|---|---|
| D000080343 | Meibomian Gland Dysfunction |
| D015352 | Dry Eye Syndromes |
| ID | Term |
|---|---|
| D005141 | Eyelid Diseases |
| D005128 | Eye Diseases |
| D007766 | Lacrimal Apparatus Diseases |
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| Physician Decision |
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| Male |
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| Not Hispanic or Latino |
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| Unknown or Not Reported |
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| Asian |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
|
| Unknown or Not Reported |
|
| No |
| Superiority or Other |
| Supportive multivariate mixed model was also performed for this outcome controlling for significant demographic and baseline characteristics. | Mixed Models Analysis | 0.0020 | 2-Sided | No | Superiority or Other |
Subjects received a single, 12-minute, in-office LipiFlow treatment of both eyes after randomization in Stage 1. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the Combination Treatment subgroup, subjects received one LipiFlow treatment (at randomization) followed by other MGD or dry eye treatment, as prescribed by the physician. |
| OG002 | Warm Compress/Hygiene Arm: One LipiFlow Treatment Subgroup | After 3 months of using standardized warm compress therapy and lid hygiene, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the One LipiFlow Treatment subgroup, no other MGD or dry eye treatment was prescribed for the study duration. |
| OG003 | Warm Compress/Hygiene Arm: Combination Treatment Subgroup | After 3 months of using standardized warm compress therapy and lid hygiene, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the Combination Treatment subgroup, subjects received one LipiFlow treatment (at crossover) or two LipiFlow treatments followed by other MGD or dry eye treatment, as prescribed by the physician. |
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Subjects received twice-daily, standardized warm compress therapy and lid hygiene in both eyes from randomization to 3-month visit in Stage 1. |
|
|
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| OG001 | LipiFlow Arm: Combination Treatment Subgroup | 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. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the Combination Treatment subgroup, subjects received one LipiFlow treatment (at randomization) followed by other MGD or dry eye treatment, as prescribed by the physician. |
| OG002 | Warm Compress/Hygiene Arm: One LipiFlow Treatment Subgroup | After 3 months of using standardized warm compress therapy and lid hygiene, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the One LipiFlow Treatment subgroup, no other MGD or dry eye treatment was prescribed for the study duration. |
| OG003 | Warm Compress/Hygiene Arm: Combination Treatment Subgroup | After 3 months of using standardized warm compress therapy and lid hygiene, subjects received a single, 12-minute crossover LipiFlow treatment of both eyes. In Stage 2, subjects were entered into subgroups based on the subject's assessment of adequacy of symptom relief. In the Combination Treatment subgroup, subjects received one LipiFlow treatment (at crossover) or two LipiFlow treatments followed by other MGD or dry eye treatment, as prescribed by the physician. |
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