On the opportunity of the ESCRS 2010 (European Society of Cataract & Refractive Surgeons), Laboratoires Théa organized on Sunday, September 5th interactive scientific sessions with experts dedicated to the Meibomian Gland Dysfunction and latent heat technology. Please find hereafter the minutes and the film of the intervention of Doctor JR. Fuller, a consultant Ophthalmic Surgeon and the inventor of Blephasteam®.
Blephasteam®: Eyelid Warming Device, Moist Heat Technology
John Robert Fuller, Consultant Ophthalmic Surgeon, Dorset County Hospital, Dorchester - United Kingdom
A New Eyelid Warming Device, Blephasteam®
Blephasteam® is a unique and innovative device for the treatment of Meibomian Gland Dysfunction (MGD), dry eye, and blepharitis. It was invented by the Fuller brothers and developed in collaboration with Laboratoires Théa.
It was inspired when JR Fuller was sitting in a steam room and he noted that his ocular comfort and tear film were improved and that he had a clearer visual acuity after the session. The advantage of the steam room environment is to transfer heat fast via latent heat at a low and therefore safer temperature. In 2002, the first device prototypes were produced. Laboratoires Théa have transformed this concept from a prototype into Blephasteam® a marketable medical product.
Blephasteam® consists of a device with two eyepieces each with a watertight chamber around the orbit. A removable moistened ring saturates each chamber with humidity, facilitating heat transfer from a moderate and controlled safe heat source.
The advantage of Blephasteam®, apart from its efficacy, is that blinking, necessary to empty the glands and for restoration of the tear film, is preserved. While wearing Blephasteam® (10 minutes, twice a day), the patient continues to have clear vision and can go about his or her usual activities and can even read or watch television.
Blephasteam® studies
The first study1 was presented in the poster session during ARVO Congress in May 2006. Blephasteam® was tested on 20 patients with at least two symptoms of dry eye. Tear evaporation, lipid layer spreadibility and eyelid temperature were measured before and after 10 minutes use of Blephasteam®.
The tear evaporation rate of almost 40 g/m2/h before treatment decreased to 27 g/m2/h (Figure 1). Thus, a statistical significant reduction by 32% was observed following treatment with Blephasteam®.
Figure 1 : Box plot of tear evaporation rate measured
before and immediately after treatment with Blephasteam®
Additionally a significant increase in the incidence of a swell-spread uniform tear film after treatment was observed.
The eyelids were observed to rise from 33.5 to a safe level of 38.7°C. Moreover, this temperature was not reported as uncomfortable by patients.
This study2 showed that treatment with Blephasteam® induced a significant improvement in the tear film lipid layer and spreading in subjects with dry eye syndromes. This was confirmed by a significant reduction in tear evaporation rate.
Temperatures were also measured on a dummy cornea (Figure 2), they were observed to rise from 34°C to a safe level of 42°C. These temperatures allow patients suffering from MGD to meet the melting point of their meibum (Figure 2).
Figure 2 : Blephasteam® temperature curve
Results of another study were presented at TFOS in Sicily in 2007[2]. In this study the visual acuity (VA), Non Invasive tear Break Up Time (NIBUT), lipid layer thickness, pupilometry and aberrations were measured before and immediately after 10 minutes of treatment in 31 patients with dry eye syndrome.
A significant improvement in VA of 0.1 log units was observed following treatment (p=0.029). NITBUT improved significantly from 11.3 to 17.2 sec (p=0.0001). Aberrometry showed a significant reduction in aberrations (p=0.020). Pupil diameter was found to be significantly reduced from 4.42 to 4.14mm (p=0.0001).
Figure 3 : Improvement of NIBUT after Blephasteam® session
This study2 showed that treatment with Blephasteam® improved VA. This was objectively confirmed by a significant reduction in the total eye aberrations. No significant correlation between the improvement in VA and any single parameter was found. The effect is a combination of improved tear film, and a reduced pupil size, reducing peripheral aberrations.
As well as effectively treating MGD this study showed the Blephasteam® improved visual acuity through a number of additive mechanisms.
In conclusion, Blephasteam® is a simple, safe and effective treatment of Meibomian gland dysfunction. It safely delivers controlled heating of the eyelids, facilitating drainage of lipid secretions thus providing an objective improvement of visual acuity, quality of the tear film and ocular comfort.
- Effects of novel eye warming goggles on the tear film. Pearce I, Archer C, Mcwilliams M, Tomlinson A, Fuller R. Poster ARVO May 2006
- Pearce I, Pentland A, Shabbir S, McDonald E, Khameran A, Walsh G, Niall C. Strang N Fuller R. Changes in visual acuity following meibomian heat gland therapy. Abstract TFOSVA 2007.
