Letter Regarding: Low-Level Light Therapy Versus Intense Pulse Light for the Treatment of Meibomian Gland Dysfunction

Title Letter to the Editor on Low-Level Light Therapy Versus Intense Pulse Light for the Treatment of Meibomian Gland Dysfunction Authors Antonio Ballesteros-Sánchez*, †, ‡, OD, PhD candidate Beatriz Gargallo-Martínez†,§, OD, PhD María Carmen Sánchez-González*, OD, PhD José-María Sánchez-González*, OD, PhD From the *Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain; †Department of Ophthalmology, Clínica Novovisión, Murcia, Spain; and §Department of Ophthalmology, Optometry, Otorhinolaryngology and Anatomic Pathology, University of Murcia, Murcia, Spain. ‡ Corresponding author Antonio Ballesteros-Sánchez, OD, MSc, PhD Candidate. Reina Mercedes Street. University of Seville, Seville, Spain. Telephone: +34 617 70 05 30. E-mail: [email protected] Financial disclosures/conflicts of interest The authors have no financial/non-financial competing interest Letter to the Editor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 To the Editor: We have read with great interest the article, “Low-Level Light Therapy Versus Intense Pulsed Light for the Treatment of Meibomian Gland Dysfunction: Preliminary Results From a Prospective Randomized Comparative Study” recently published in Cornea.1 Although the study design and methodology are commendable, there are some aspects that warrant consideration for further improvement. Giannaccare et al.1 designed a prospective, randomized, single-blinded, comparative study, which is crucial for minimizing biases and ensuring the validity of the results. However, it would be beneficial for future studies to include a detailed explanation of the randomization procedure and the methods used to ensure blinding.2 Transparent reporting of these aspects enhances the reproducibility of the study and allows readers to assess the robustness of the blinding methods employed. Additionally, the inclusion and exclusion criteria play a crucial role in determining the generalizability of the study findings. While the study by Giannaccare et al.1 provided clear inclusion and exclusion criteria, there may be scope for improvement. For example, considering the impact of some medications such as anxiolytics and antidepressants on dry eye disease (DED).3 Therefore, it may be advisable to report this information and determine how it may influence the study results. In terms of data collection, it would be interesting to use new generation devices for dry eye diagnosis, which perform objective and non-invasive measures that are automatically analyzed.4 This helps to reduce observer bias in some tests such as MGD analysis, leading to more reliable results. Although the results reported by Giannaccare et al.1 are in agreement with different studies included in a recent systematic review on the topic,5 it would have been useful to analyze the outcome measures change between the two procedures to better elucidate the benefits of each treatment. The change could be defined 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 as the increment (Δ) which is the difference between the last visit (LV) and baseline (B) “Δ = LV – B”. In addition, it would also have been interesting to analyze the effects of both procedures on meibomian gland secretion reporting the following variables: (1) meibomian gland yielding secretion score (MGYSS), (2) meibomian gland yielding clear secretion (MGYCS) and (3) meibomian gland yielding liquid secretion (MGYLS).6 In conclusion, the study by Giannaccare et al.1 presents a valuable contribution to the field of alternative treatments for DED owing to meibomian gland dysfunction. By addressing the aforementioned points and further refining the methodology, future studies can strengthen the scientific content and improve the clinical relevance of their findings. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 REFERENCES 1. Giannaccare G, Pellegrini M, Scalzo GC, et al. Low-Level Light Therapy Versus Intense Pulsed Light for the Treatment of Meibomian Gland Dysfunction: Preliminary Results From a Prospective Randomized Comparative Study. Cornea. 2023;42:141-144. doi:10.1097/ICO.0000000000002997. 2. Lim C-Y, In J. Randomization in clinical studies. Korean J Anesthesiol. 2019;72:221-232. doi:10.4097/kja.19049. 3. Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15:511-538. doi:10.1016/J.JTOS.2017.05.004. 4. Ballesteros-Sánchez A, Gargallo-Martínez B, Gutiérrez-Ortega R, et al. Intraobserver repeatability assessment of the S390L Firefly WDR slit lamp in patients with dry eye disease: Objective, automated and non-invasive measures. Eye Contact Lens. 2023;Publish Ah. 5. Ballesteros-Sánchez A, Gargallo-Martínez B, Sánchez-González MC, et al. Intense Pulse Light Combined With Low-Level Light Therapy in Dry Eye Disease: A Systematic Review. Eye Contact Lens. 2023;49:8-13. doi:10.1097/ICL.0000000000000958. 6. Wu Y, Li J, Hu M, et al. Comparison of two intense pulsed light patterns for treating patients with meibomian gland dysfunction. Int Ophthalmol. 2020;40:1695-1705. doi:10.1007/S10792-020-01337-0. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65