Custom Print Megnetic Levator Prosthesis Pilot Comparison

Study the device feasibility of non-surgical treatment for blepharoptosis (inability to open the eyelid) consisting of a biocompatible magnetic element adhered to the upper eyelid and a second magnet above the eye on a custom 3D-printed eyeglasses frame with a dial to provide adjustable magnetic force to open the eye while still allowing eye closure.

Study Overview

• Status: Completed
• Conditions: Blepharoptosis
• Intervention / Treatment: Device: The cMLP device

Detailed Description

Extensive description of the study protocol is provided in the Research Strategy (R), but key components are summarized and justified here. This is a prospective, interventional, single-arm, single-group open label study. Because the primary objective of this study is to perform prototyping in the interest of developing and determining the feasibility of our novel approach, randomization to treatment or control is not necessary or appropriate at this stage. All participants will have ptosis and will be fitted with the experimental custom adjustable force MLP. Determining if the custom MLP is superior to the non-custom MLP is beyond the scope of this phase I SBIR project.

The primary outcome is custom MLP fitting success defined as 8mm interpalpebral fissure size or greater, patient desire to engage in a 20-min trial, and comfort rated greater than 5 out of 10 after the 20 minute trial (all criteria must be met). These criteria may be met at any one visit in the prototyping process. Therefore, one prototype may fail but if subsequent prototypes succeed, the case will be rated as a success. Selection of the criteria was based on a desire to have both objective and subjective metrics. Eye opening of 8mm was selected because it is a functional amount of eye opening found to be useful to patients in prior studies (note that these patients do not have inferior lid malposition). We have used interpalpebral fissure as a primary outcome as opposed to Marginal Reflex Distance (distance from the corneal reflection to upper lid) in order to allow enrollment of bilateral and severe cases, and to provide a common outcome for both eye opening and closing on the blink. Desire to engage in a 20-minute trial was selected as a criteria because it provides some information on the patient's opinion of the device. Comfort greater than 5 out of 10 indicates better than neutral, and was selected as a minimum goal for success (median comfort in our prior study was 8 out of 10).

The statistical analysis method for the primary outcome will be an exact binomial test of one proportion to determine which condition is met for more than half of patients. If the prototype approach is successful for greater than half of patients after 20 minutes of wear there will be a large enough sample for a phase II study to warrant continued development.

Sample Size Calculation for primary outcome: With 10 subjects we will have 80% power to show that the success rate significantly exceeds 50% with a one-sided alpha=0.05 exact binomial test of one proportion when the success rate is 8/10 or greater, meaning 8 would have to succeed to reach significance. With 15 subjects the success rate would need to be 11 to reach significance.

• Study Type: Interventional
• Enrollment (Actual): 16
• Phase: Early Phase 1

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Mass. Eye and Ear

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 5 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Presence of Blepharoptosis for at least one eye, moderate cognitive function or better defined as greater than or equal to 18 out of 30 on a pre-screening of the Mini-Mental State Exam, age 5 or older. Sex - All. Gender Based - All.

Exclusion Criteria:

• Absence of Blepharoptosis. Age less than 5, Severe Cognitive impairment defined as Mini-mental score less than 18, behaviors consistent with delirium (combinations of disorientation, hallucinations, delusions, and incoherent speech), or lethargy. These individuals must be excluded since participation requires competent self-care, reliable responses and cooperation during fitting of the devices. Healthy Volunteers.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Device Feasibility
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: the experimental arm; All subjects, the ptosis group and the normal group receive the same intervention.	Device: The cMLP device; There is only one medical device we are testing, so only one intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resting interpalpebral fissure size	Interpalpebral fissure is defined as the greatest distance between the upper and lower eye lid margins at the insertion point of the lashes. Resting is defined as point where the eyelid is maximally elevated.	after 20 minutes of wear
Patient decision to participate in a 20-min trial with the prototype MLP	This is a binary response measure (1 = yes I would like to participate or 0 = no I would not like to participate.	after 2 minutes of wear
Comfort rating scale	This measure is a 10 point likert-type rating scale used to quantify the comfort of the MLP (1 poor comfort to 10 high comfort).	after 20 minutes of wear

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in the resting interpalpebral fissure size from highest to lowest magnetic force settings	Interpalpebral fissure is defined as the greatest distance between the upper and lower eye lid margins at the insertion point of the lashes. Resting is defined as point where the eyelid is maximally elevated.	after 2 minutes of wear
Interpalpebral fissure size at maximum blink	Interpalpebral fissure is defined as the greatest distance between the upper and lower eye lid margins at the insertion point of the lashes. Maximum blink is the point of smallest interpalpebral fissure (most closing).	after 2 minutes, 20 minutes, and 1-week of wear
Frequency and severity of adverse events	Thresholds for adverse events include eyelid skin erythema greater than grade II on the industry scale, grade II worsening in corneal staining on the NEI industry scale, and a greater than 2-line worsening in visual acuity in the treated eye.	after 20 minutes and 1-week of wear

Collaborators and Investigators

• Sponsor: Skelmet Inc
• Collaborators: Massachusetts Eye and Ear Infirmary
• Investigators: Principal Investigator: Yu Cao, Mr, Skelmet Inc

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): March 31, 2020
• Study Completion (Actual): March 31, 2020

Study Registration Dates

• First Submitted: March 16, 2021
• First Submitted That Met QC Criteria: March 16, 2021
• First Posted (Actual): March 19, 2021

Study Record Updates

• Last Update Posted (Actual): March 19, 2021
• Last Update Submitted That Met QC Criteria: March 16, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Blepharoptosis
• Additional Relevant MeSH Terms: Eye Diseases; Eyelid Diseases; Blepharoptosis
• Other Study ID Numbers: Skelmet

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: We will not be sharing IPD with other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No