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Dry Eye SyndromesNCT04889950

Evaluate the Safety and Effectiveness of The Tixel Fractional System in the Treatment of Meibomian Gland Disfunction

A study testing Tixel C and LipiFlow in people with Dry Eye Syndromes and Dry Eye, run by Novoxel Ltd. at 1 site in Israel.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A Randomized, Masked (Evaluator), Controlled, Prospective Pilot Study of the Effectiveness and Safety of the Tixel®, Versus LipiFlow® in the Treatment of Meibomian Gland Dysfunction. Up to 30 patients (60 eyes) to be randomized in up to 2 clinical sites in Israel and/or Europe. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Tixel C and LipiFlow
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
1 siteIsrael
Study dates
26 Oct 2021to 8 Feb 2023
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years and older of any gender or race.
  • Provision of written informed consent prior to study participation.
  • Willingness and ability to return for all study visits.
  • A positive history of self-reported dry eye symptoms for three months prior to the study using the Ocular Surface Disease Index (OSDI) questionnaire, and a score of ≥ 23 at the baseline visit.
  • Evidence of meibomian gland (MG) obstruction, based on a total Meibomian Gland Score (MGS) of ≤12 in the lower eyelids for each eye. The rater of MGS must not be involved in the study procedure.
  • Tear break-up time (TBUT) <10 seconds. The rater of TBUT must not be involved in the study procedure.
  • Agreement/ability to abstain from dry eye/MGD medications for the time between the treatment visit/s and the final study visit. Ocular lubricants are allowed if no changes are made during the study.
  • Fitzpatrick skin type I-VI

Who cannot join

  • History of ocular surgery including intraocular, oculo-plastic, corneal or refractive surgery within 1 year.
  • Patients with giant papillary conjunctivitis.
  • Patients with punctal plugs or who have had punctal cautery.
  • Ocular injury or trauma, chemical burns, or limbal stem cell deficiency within 3 months of the baseline examination.
  • Active ocular herpes zoster or simplex of eye or eyelid or a history of these within the last 3 months.
  • Patients who are aphakic.
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  • Cicatricial lid margin disease identified via slit lamp examination, including pemphigoid, symblepharon, etc.
  • Active ocular infection (e.g., viral, bacterial, mycobacterial, protozoan, or fungal infection of the cornea, conjunctiva, lacrimal gland, lacrimal sac, or eyelids including a hordeolum or stye).
  • Active ocular inflammation or history of chronic, recurrent ocular inflammation within prior 3 months (e.g. retinitis, macular inflammation, choroiditis, uveitis, iritis, scleritis, episcleritis, keratitis).
  • Ocular surface abnormality that may compromise corneal integrity (e.g., prior chemical burn, recurrent corneal erosion, corneal epithelial defect, Grade 3 corneal fluorescein staining, or map dot fingerprint dystrophy).
  • Lid surface abnormalities (e.g., entropion, ectropion, tumor, edema, blepharospasm, lagophthalmos, severe trichiasis, severe ptosis) that may affect lid function in either eye.
  • Anterior blepharitis (staphylococcal, demodex, or seborrheic grade 3 or 4).
  • Systemic disease conditions that cause dry eye (e.g., Stevens- Johnson syndrome, vitamin A deficiency, rheumatoid arthritis, Wegener's granulomatosis, sarcoidosis, leukemia, Riley-Day syndrome, systemic lupus erythematosus, Sjogren's syndrome).
  • Unwillingness to abstain from systemic medications known to cause dryness for the study duration.
  • Women in child bearing age who are pregnant, nursing, or not utilizing adequate birth control measures.
  • Individuals who have changed the dosing of either systemic or non-dry eye/MGD ophthalmic medication within the past 30 days prior to screening.
  • Individuals who are unable or unwilling to remain on a stable dosing regimen for the duration of the study.
  • Individuals using isotretinoin (Accutane) within 1 year, cyclosporine-A (Restasis) or lifitegrast ophthalmic solution (Xiidra) within 3 months, or any other dry eye or MGD medications (antibiotics, non-steroidal anti-inflammatory drugs, corticosteroids) for at least 2weeks; and to maintain abstinence throughout the duration of the study (ocular lubricants are allowed if no changes are made during the study).
  • Individuals wearing contact lenses at any time during the prior three months and at any point during the study.
  • Current skin cancer, malignant sites and/or advanced premalignant lesions or moles in the treatment area.
  • An impaired immune system condition or use of immunosuppressive medication.
  • Collagen disorders, keloid formation and/or abnormal wound healing.
  • Previous invasive/ablative procedures in the areas to be treated within 3 months prior to initial treatment or plans for such treatment during the course treatment, or before complete healing of such treatments has occurred.
  • Any patient who takes or has taken any oral or topical medications, herbal treatment, food supplements, or vitamins which may cause fragile skin or impaired skin healing during the last 3 months.
  • Any patient who has a history of bleeding coagulopathies.
  • Any patient who has tattoos or permanent makeup in the treated area.
  • Any patient who has burned, blistered, irritated or sensitive skin in any of the areas to be treated.
  • Individuals using another ophthalmic investigational device or agent within 30 days of study participation.
  • Individuals that were treated in either eye with LipiFlow in the last 24 months, or Tixel at any point in the past.
  • Treatment in either eye with IPL in the last year.
  • Expression of the meibomian glands within 6 months prior to screening.
  • Use of at home warm compresses or lid hygiene products while participating in study.

Trial locations and contacts

1 site in 1 country.

Israel1 site
  • Shaare Zedek Medical Center

    Jerusalem, 9103102

Other trials in Israel

About this study

Official title: A Randomized, Masked (Evaluator), Controlled, Prospective Pilot Study of the Effectiveness and Safety of the Tixel Versus Lipiflow in the Treatment of Meibomian Gland Dysfunction.

A Randomized, Masked (Evaluator), Controlled, Prospective Pilot Study of the Effectiveness and Safety of the Tixel®, Versus LipiFlow® in the Treatment of Meibomian Gland Dysfunction. Up to 30 patients (60 eyes) to be randomized in up to 2 clinical sites in Israel and/or Europe. study subject will receive three (3) treatments with Tixel in a monthly interval, and a single treatment for the control group. Follow-up will occur 1 month and 3 months following the last treatment.

Read the detailed description

Up to 30 patients (60 eyes), 15 Per Device at up to 2 study sites in Israel and/or Europe will be recruited to evaluate the safety and effectiveness of the Tixel device in adults with Meibomian Gland Dysfunction (MGD). study subject will receive three (3) treatments with Tixel in a monthly interval, and single treatment for the control group. Follow-up will occur 1 month and 3 months following the last treatment.

Tixel group study visits will be as follow:

Screening: (Must be done up to 7 days prior to initial treatment (Day 0), but can be also done on the same day as baseline testing and initial treatment) Randomization: (Performed after determining that patient is eligible for the study) Treatments - three treatments will be conducted to the study device group. Follow-Up Visits: 4-Weeks (+/-7days) and 12-Weeks (+/-14 days) after last treatment.

Control group visit will be as follow:

Screening: (Must be done up to 7 days prior to initial treatment (Day 0), but can be also done on the same day as baseline testing and initial treatment) Randomization: (Performed after determining that patient is eligible for the study) Treatment- single Follow-Up Visits: 4-Weeks (+/-7days) and 12-Weeks (+/-14 days) after last treatment.

Being tested
Tixel C, LipiFlow
Medical subject headings
Dry Eye Syndromes, Meibomian Gland Dysfunction

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Tixel CDevice

    Tixel C )Novoxel®, Israel) is a thermomechanical system developed for fractional treatment. The system is designed for the treatment of soft tissue by direct conduction of heat, enabling tissue coagulation combined with micro ablation with low thermal damage to the surrounding tissue.

  • LipiFlowDevice

    LipiFlow

Study groups in NCT04889950
Study groupRoleWhat they receive
Tixel GroupExperimentalTixel C Group: Screening and baseline visits, Treatment- 3 treatment sessions, followed by 2 Follow up sessions, 1and 3 months after last treatment visit. Subject will be questioned about Discomfort and Pain Questionnaires (self-assessed) and OSDI questionnaire.
Receives: Device: Tixel C
LipiFlowActive comparatorLipiFlow: Screening and baseline visits, Treatment- 1 single treatment session, followed by 2 Follow up sessions, 1and 3 months after the last treatment visit. Subject will be questioned about Discomfort and Pain Questionnaires (self-assessed) and OSDI questionnaire.
Receives: Device: LipiFlow

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Score and Change From Baseline in Tear Break Up Times (TBUT), as Assessed by a Masked Rater

    Change from baseline to the 4-weeks follow-up exam in Tear Break Up Times (TBUT), as assessed by a masked rater.

    TBUT - Tear Break-Up Time, is a clinical test used to evaluate the stability of the tear film on the surface of the eye. It measures the time it takes for dry spots to appear on the cornea after a blink. A shorter TBUT indicates a more unstable tear film, which can be a sign of dry eye disease or other ocular surface disorders.

    Tear Break-Up Time (TBUT) is typically scored by the time (in seconds). The general interpretation of TBUT scores is as follows:

    Normal TBUT: More than 10 seconds Borderline TBUT: 5 to 10 seconds Abnormal/Low TBUT: Less than 5 seconds

    Measured: Tixel arm: Baseline and 4 weeks after last treatment (8 weeks post baseline). LipiFlow arm: Baseline and 4 weeks after treatment (4 weeks post baseline).

  2. Comparison of the Incidence of Device-related Adverse Events for the Two-treatment Arms.

    Comparison of the incidence of device-related adverse events (e.g., increase in the lid margin such as development of floppy eyelids, entropion or ectropion; and lash integrity) for the two-treatment arms.

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

Secondary outcomes (7)
  1. Score on a Scale and Change From Baseline in Patient Symptoms Using Ocular Surface Disease Index (OSDI).

    Change from baseline in patient symptoms using Ocular Surface Disease Index (OSDI) at 4-weeks and 12-weeks follow-up exam.

    The Ocular Surface Disease Index (OSDI) is a questionnaire designed to assess the severity of dry eye disease.

    OSDI Questionnaire

    The questionnaire consists of 12 questions divided into three subscales:

    Ocular Symptoms Visual Functioning Environmental Triggers

    Scoring System

    The scoring for the OSDI is based on a scale from 0 to 100, where higher scores indicate more severe symptoms. Each question is scored as follows:

    0: None of the time

    1. Some of the time
    2. Half of the time
    3. Most of the time
    4. All of the time

    Interpretation of OSDI Scores

    The OSDI scores are generally interpreted as follows:

    0-12: Normal or no dry eye 13-22: Mild dry eye 23-32: Moderate dry eye 33-100: Severe dry eye

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

  2. Score on a Scale and Change From Baseline in Meibomian Gland Score (MGS), as Assessed by a Masked Rater.

    score on a scale at baseline, 4-weeks and 12-weeks follow-up exam in Meibomian Gland (MGS), as assessed by a masked rater.

    The Meibomian Gland Score (MGS) is a clinical tool used to evaluate the function of the meibomian glands.

    Scoring Criteria

    Each gland is assessed and scored based on the quality of the expressed secretion:

    0: No secretion

    1. Inspissated
    2. Cloudy
    3. Clear liquid

    Interpretation of MGS Minimal MGS score = 0 in each eye (15 glands evaluated in each eye) Maximal MGS score = 45 in each eye (15 glands evaluated in each eye) Low MGS: (below 12) Indicates poor function or obstruction of the meibomian glands, suggesting MGD.

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

  3. Overall Changes From Baseline in Tear Break Up Times (TBUT), as Assessed by a Masked Rater.

    Changes from baseline to the 12-weeks follow-up exam in Tear Break Up Times (TBUT), as assessed by a masked rater.

    BUT - Tear Break-Up Time, is a clinical test used to evaluate the stability of the tear film on the surface of the eye. It measures the time it takes for dry spots to appear on the cornea after a blink. A shorter TBUT indicates a more unstable tear film, which can be a sign of dry eye disease or other ocular surface disorders.

    Tear Break-Up Time (TBUT) is typically scored by the time (in seconds). The general interpretation of TBUT scores is as follows:

    Normal TBUT: More than 10 seconds Borderline TBUT: 5 to 10 seconds Abnormal/Low TBUT: Less than 5 seconds

    Measured: Tixel arm: Baseline and 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline and 12 weeks after treatment (12 weeks post baseline).

  4. Score on a Scale During Treatment Discomfort and Pain Questionnaires (Each Self-assessed by VAS)

    Discomfort and Pain from the treatment (Tixel or LipiFlow) using the questionnaires assessed by the subject. These are visual analogue scale (VAS) questionnaires using a scale from 0-10 to assess eye discomfort and pain. Both questionnaires are to be self-assessed by the patient immediately following treatment.

    Interpetation for the assessment:

    score 0- no discomfort / pain score 5 - moderate discomfort / pain score 10 - worst possible discomfort / pain

    Measured: Tixel arm: 4 weeks (treatment 1- day 0, treatment 2- 2 weeks, treatment 3- 4 weeks). LipiFlow arm: On treatment day - day 0 (only one treatment for this arm)

  5. Corneal Fluorescein Staining Slit Lamp Evaluation Scores and Change From Baseline

    Changes from baseline following treatment for the test and control devices for the following assessments:

    Ocular Surface Staining (to evaluate the integrity of the corneal epithelium by identifying areas of damage or staining)

    Grading scale:

    0 = Normal - No staining

    1. = Mild - Superficial stippling micropunctate staining
    2. = Moderate - Macropunctate staining with some coalescent areas
    3. = Severe - Numerous coalescent macropunctate areas and/or patches

    5 regions (superior, temporal, central, nasal, and inferior) are graded for each eye. total score range from 0 -15.

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

  6. The Mean Changes From Baseline in IOP for All Eyes on the Tixel and Lipiflow Arms

    the IOP values changes from baseline, respectively, for all visits, per treatment arm.

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

  7. Lissamine Green Staining Scores and the Changes From Baseline

    Changes from baseline following treatment for the test and control devices for the following assessments:

    Lissamine staining scores (to assess the health of the conjunctival and corneal epithelium, particularly in dry eye disease, by identifying areas of damaged or dead cells).

    Grading scale:

    0 = Normal - No staining

    1. = Mild - Superficial stippling micropunctate staining
    2. = Moderate - Macropunctate staining with some coalescent areas
    3. = Severe - Numerous coalescent macropunctate areas and/or patches

    6 regions (nasal, superior nasal, inferior nasal, temporal, superior temporal, inferior temporal) are graded for each eye. total score range for each eye is 0-18.

    Measured: Tixel arm: Baseline to 12 weeks after last treatment (16 weeks post baseline). LipiFlow arm: Baseline to 12 weeks after treatment (12 weeks post baseline).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 May 2021
  2. Study start26 Oct 2021
  3. Primary completion4 Jan 2023
  4. Study completion8 Feb 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
A Randomized, Masked (Evaluator), Controlled, Prospective Pilot Study
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04889950
Sponsor's protocol ID
CLN 0798
Status last verified
Nov 2024
First submitted
3 May 2021
Last updated
15 Nov 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Tixel C and LipiFlow in people with Dry Eye Syndromes and Dry Eye, run by Novoxel Ltd. at 1 site in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 32 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 15 Nov 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Score and Change From Baseline in Tear Break Up Times (TBUT), as Assessed by a Masked Rater (time frame: Tixel arm: Baseline and 4 weeks after last treatment (8 weeks post baseline). LipiFlow arm: Baseline and 4 weeks after treatment (4 weeks post baseline).). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Nov 2024.

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