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62 | EYEWORLD | OCTOBER 2019 C ORNEA DEVICE FOCUS by Rich Daly EyeWorld Contributing Writer 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 com- pressions because you've got to do it the right way or it doesn't take," Dr. Rowen said. Dr. Sheppard praised the innovation of us- ing 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 & John- son 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 photobio- modulation. This effect has been reported in the [peer-reviewed] literature." 1 Dr. Gupta noted that the different ap- proaches of MGD devices, with iLux and Lipi- Flow 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 some- what 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 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 de- vice 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 ad- dress 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 visu- alization 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 immunomodula- tors, 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 effec- tively manage the multifactorial MGD prob- lem," 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 Potential seen in newer MGD device 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

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