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Patient Preference Test Results
Patient Preference Test
As featured in Optician Magazine January 2015 edition

Figure 1: Proportion of patients selecting each device as their preferred option

Preferences for MGD treatments

Dr Mathew Schneiders and Mr Allon Barsam look at optometrist and patient preferences for a range of microwavable hot compress treatments for meibomium gland dysfunction

Dry eye disease affects up to 70 per cent of the population.1,2 The most common cause of dry eye disease is meibomian gland dysfunction (MGD), which is present in around 85 per cent of patients with dry eye disease.3 Meibomian glands are modified sebaceous glands found within the tarsal plates of the eyelids. These glands produce the lipid layer that coats the tear film. MGD is primarily caused by terminal duct obstruction of the meibomian glands, which results in a poor quantity and/or quality of lipid secretion. Consequently, this may result in instability of the tear film, increased tear evaporation, increased bacteria growth on the lid margin, blurred vision and ocular surface inflammation.2

Treatment of MGD
The principal treatment for MGD is to heat and melt the oil in the glands and then to express the melted secretions from the eyelids. Tear film lipid layer thickness has been shown to increase by 80 per cent, in patients with MGD, after application of a 40°C compress for at least four minutes, and improved by a further 20 per cent after 15 minutes of treatment.4 A number of commercially available products have been launched to facilitate this process. These are primarily variations on microwavable grain-filled masks that are applied to the eyelids for a specified period of time.

Previously there have been publications on the efficacy of these microwavable devices. Bilkhu et al showed that these products can be safe and effective with patients reporting benefits lasting at least six months if aided by occasional retreatment.5 Research from the University of Montreal6 showed assessed efficacy of five commercially available microwavable hot compress devices. These are Bruider Moist Heat compress (Bruider healthcare), MGDRx (The eyebag company), The Eye Doctor (The body doctor), Eye essential mask (Thera pearl) and Tranquileyes goggles (eyeeco). Their research showed that, out of the above, The Eye Doctor device maintained the best optimum efficacy throughout the 10-minute treatment.

Study
Our aim was to explore patients’ opinions and preferences regarding the most commonly available microwavable hot compress devices in the UK. Optometrists in the south east of England were recruited to identify patients with dry eye disease. We provided samples of the MGDRx (The EyeBag Company), The Eye Doctor (The Body Doctor) and Blephamask (Altacor) and the patients were asked: ‘If all three cost the same and were equally effective which would you use?’ Patients were then asked to qualify their answers with the reason for their selection.
Six optometrists agreed to take part and between them 63 dry eye disease patients were asked about their preferences; 41 per cent of participants were male and 59 per cent were female, the average age was 60 years.
The Eye Doctor was selected by 67 per cent of patients as their preferred treatment device (Figure 1). The main reasons offered for selecting The Eye Doctor included the fact that it was the only option that had a strap to keep it in place, it had a hygienic cover that was washable and that it had the best shape.
Seventeen per cent of patients selected the MGDRx. The main reason stated for selecting MGDRx was the soft material and availability. Sixteen per cent selected the Blephamask. The main reason stated for selecting the Blephamask was its larger coverage of the eyes.
We also asked the opticians what their preferred device would be. Four of the six made a clear selection; 75 per cent preferred The Eye Doctor and 25 per cent selected the MGDRx. Their explanations echoed those of the patients.

Conclusion
The Eye Doctor was the preferred device for 67 per cent of patients and four of the optometrists in this study. This study focused on the practical and aesthetic influences that lid hygiene devices have on patient buying behaviour. Further studies combining efficacy, cost, and design would be welcomed. MGD is a chronic and often difficult to treat condition and as more products become available there will be a number of considerations optometrists and practice managers will need to make on what products to stock. The products with features that make it easier for patients to maintain compliance with treatment will excel

References
1 The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul Surf, 2007; Apr;5(2):75-92.
2 Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 2011;52:1930-7.
3 Lemp MA, Crews LA, Bron AJ et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea, 2012; 31, 472–8.
4 Blackie CA, Solomon JD, Greiner JV, et al. Inner eyelid surface temperature as a function of warm compress methodology. Optom Vis Sci, 2008; Aug;85(8):675-683.
5 Bilkhu PS, Naroo SA, Wolffsohn JS. Randomised masked clinical trial of the MGDRx eyebag for the treatment of meibomian gland dysfunction-related evaporative dry eye. Br J Ophthalmol doi:10.1136/bjophthalmol-2014-305220.
6 Lacroix Z, Leger S, Bitton E. Comparison of eyelid warming masks. Poster presented at the British Contact Lens Association (BCLA) Clinical Conference & Exhibition. 6-9 June, 2014. Birmingham, UK. 2014.
Dr Mathew Schneiders and Mr Allon Barsam are researchers for Novus Research, Ophthalmology Department, Luton and Dunstable University Hospital
As featured on www.opticianonline.net 29th January 2015
 
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