Intense Pulsed Light With Diquafosol Provides Superior Dry Eye Therapy

Intense pulsed light with diquafosol ophthalmic solution can improve both subjective and objective dry eye disease better than intense pulsed light treatments alone, according to a study reviewing trial results that was published in Ophthalmology and Therapy. While evaporative dry eye and meibomian gland dysfunction are both treatable with intense pulsed light therapy, adding diquafosol, a P2Y2 receptor agonist, can significantly improve several metrics associated with ocular surface help, the researchers report. 

Trial investigators (Management of DE With IPL in Combination With DQS; ClinicalTrials.gov Identifier: NCT05694026) evaluated 132 eyes of 66 patients diagnosed with evaporative dry eye who were randomly assigned to receive treatment with intense pulsed light with diquafosol ophthalmic solution (n=44 eyes; mean age, 32.70±7.64 years; 12 women), intense pulsed light alone (n=44 eyes; mean age, 32.23±7.29 years; 11 women), or a sham treatment (n=44 eyes; mean age, 32.26±6.67 years; 9 women). Patients in the trial received a single drop of 3% diquafosol 6 times daily for 4 weeks, or 2 intense pulsed light therapy sessions with a wavelength spectrum of 500–1200 nm on the cutaneous facial sebaceous glands spaced 2 weeks apart, or both. 

All participants underwent full ocular surface examinations at baseline, day 14, and day 28. The metrics evaluated included noninvasive break-up time (NITBUT), tear-film lipid layer (TFLL), corneal conjunctival staining (CS), meibomian gland quality (MGQ),  meibomian gland expression (MGEx), and ocular surface disease index (OSDI).

The investigators found that patients who received intense pulsed light with diquafosol ophthalmic solution treatments demonstrated superior NITBUT, TFLL, CS, MCQ, MGEx, and OSDI scores compared with both the intense pulsed light therapy alone cohort, and the participants in the sham group. 

From baseline to day 28, NITBUT improved in the intense pulsed light therapy with diquafosol group significantly (from 4.98±0.36 seconds to 12.03 ± 1.27 seconds; P =.001), while only gradual improvement was shown in the intense pulsed light-only group (from 4.60±0.48 seconds at baseline to 10.47±3.48 seconds; P =.001), and no statistical improvement in the sham group. TFLL scores for the groups were also significantly different between the intense pulsed light therapy with diquafosol and intense pulsed light therapy only, and sham groups (2.70±0.59 at baseline to 2.09±0.29 at day 28 vs 2.80±0.48 to 2.27±0.45, respectively). Improvements were similarly superior in the combination group for CS, MCQ, and MGEx.

Subjective OSDI testing also revealed significant differences between the combined, intense pulsed light, and sham groups from baseline (43.57±10.20, 42.97±8.78, and 42.36±7.10, respectively) to day 28 (19.36±7.01, 24.77±4.68, and 42.61±7.49), and, again, researchers noted the most significant improvement in the combined group.

“It was discovered that combination therapy with DQS accelerated the healing of dry eye signs and symptoms,” according to the investigators. “The NITBUT value was considerably greater in the combination group, indicating that topical instillation of DQS promoted the recovery of tear function.”

Although the mechanism of action explaining precisely how intense pulsed light therapy reduces evaporative dry eye is unclear, but the study authors suggest that “The most commonly recognized theory explains thrombosis of aberrant blood vessels by converting light received by hemoglobin into heat, hence decreasing the number of inflammatory mediators in the eyelid and meibomian glands.”

This study was limited by its low sample size and single site data collection.