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CompletedNCT04678115Updated Apr 22, 2025Results posted

Clinical Trial Comparing Two Non-Surgical Treatments for Severe Blepharoptosis

An interventional study of Magnetic Levator Prosthesis (MLP) and Kinesiotape Frontalis Sling (KTFS) in Blepharoptosis, Ptosis, Eyelid and Myasthenia Gravis, sponsored by Massachusetts Eye and Ear Infirmary. Completed at 1 site in United States. Open to participants aged 5 Years and older. Per ClinicalTrials.gov, last updated 2025-04-22.

Sponsored by Massachusetts Eye and Ear Infirmary · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
16
Allocation
Randomized
Ages
5 Years and older
Sex
All
01

Study summary

This clinical trial will evaluate two non-surgical devices designed to improve eye lid opening for patients with severe Blepharoptosis (incomplete opening of the eyelids).

Read the detailed description

Two non-surgical devices for patients with Blepharoptosis will be evaluated. The Magnetic Levator Prosthesis (MLP), is an external device that makes use of a newer class of permanent magnets (made of alloys of neodymium (Nd), iron (Fe) and boron (B)) to restore eyelid movement. The Kinesiotape Frontalis Sling (KTFS), involves the use of tape to help facilitate levator muscle contraction to open the eyelid. Video recordings of spontaneous and volitional blinks will be used to evaluate the effects of each device on eyelid reanimation.

The clinical trial will employ a crossover design in which participants will try each device at home in counterbalanced order with a washout period between. In each period of the crossover, participants will receive training (during study visits at Massachusetts Eye and Ear) in how to apply the device and will then try the device at home for one week with daily follow up by video calls. At the end of the one-week period of home use there will be a study visit at Massachusetts Eye and Ear when the device will be returned and additional video recordings of eye blinks will be made.

At the end of the crossover period, participants will be asked to complete a questionnaire comparing the two devices and to select their preferred device.

02

Conditions studied

  • Blepharoptosis
  • Ptosis, Eyelid
  • Myasthenia Gravis
  • Stroke
  • Traumatic Brain Injury
  • Chronic Progressive External Ophthalmoplegia
03

Who can participate

Ages eligible
5 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Presence of ptosis for at least one eye which occludes the visual axis in the resting position (without frontalis drive, lifting with forehead muscles)
  • 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 (MMSE)

Exclusion criteria

Exclusion Criteria:

  • Absence of ptosis which occludes the visual axis
  • Presence of a corneal ulcer of any size
  • Age less than 5 years
  • Severe Cognitive impairment defined as MMSE score less than 18, behaviors consistent with delirium (combinations of disorientation, hallucinations, delusions, and incoherent speech), or lethargy.
  • Presence of corneal hypoaesthesia;
  • Orbicularis weakness on the side of the ptosis
  • Mechanical ptosis, including ptosis due to orbital or lid tumor, cicatricial processes affecting the movements of the upper lid, and enophthalmos.
  • Previous ptosis surgery less than 3 months prior to Visit 1.
  • Lid position affected by lid or conjunctival scarring.
  • History of herpes keratitis.
  • Periocular neurotoxin (eg, Botox, Xeomin, Dysport, Myobloc) injections on the side of the ptosis within 3 months prior to Visit 1 and during the study.
  • History of hyperthyroidism or thyroid eye disease (ie, exophthalmos, upper eyelid retraction, diplopia secondary to extraocular muscle involvement). Hypothyroidism that is controlled on medication is allowed
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
16 participants (actual)

Study arms

  • Experimental
    MLP first, KTFS second

    Participants in this arm will receive the MLP in the first period of the crossover and the KTFS in the second period.

    Device: Magnetic Levator Prosthesis (MLP) · Device: Kinesiotape Frontalis Sling (KTFS)

  • Experimental
    KTFS first, MLP second

    Participants in this arm will receive the KTFS in the first period of the crossover and the MLP in the second period.

    Device: Magnetic Levator Prosthesis (MLP) · Device: Kinesiotape Frontalis Sling (KTFS)

Interventions

  • DeviceMagnetic Levator Prosthesis (MLP)

    Neodymium magnet embedded in a glasses frame and a polymer embedded (PDMS) micro-magnet array fitted externally to the upper lid with IV 3000 securement film. The IV 3000 is FDA approved for extended wear on the skin.

  • DeviceKinesiotape Frontalis Sling (KTFS)

    Kineso Tape is FDA registered as a 510K exempt class 1 device, typically used by physical and occupational therapist to support muscular healing and movement. It is sometimes used on the face in cases of facial palsy or on the eye lid to support the lid in cases of severe blepharoptosis. In such cases it may be attached near the lid margin above the lashes extending up to the forehead skin overlying the frontalis muscle. Alternatively it may be a very short piece attached only along the lid skin. The tape is easily removed.

05

What researchers measure

Primary outcomes

  1. Interpalpebral Fissure (IPF) During Spontaneous Blink

    The primary outcome was objective measurement of the IPF midpoint height during maximum closing in five spontaneous blinks, captured with a Nikon mirrorless SLR video recording system (Z7II; Nikon USA, Melville, NY, USA), with a visible light source mounted just above the lens, measured manually with ImageJ (National Institutes of Health, Bethesda, MD, USA). Spontaneous blinks are normally incomplete, a behavior that is dependent upon age, gender, task, and environmental demands. Maximum closing was defined as the three points at the base of the blink. Participants were instructed to look at the camera lens and try to relax and behave normally. Recording was stopped after 1 minute or after five spontaneous blinks, whichever came first. Recording always occurred in the same windowless clinical research room with consistent lighting, temperature, humidity, and air flow. The IPF midpoint height during maximum closing in five spontaneous blinks is averaged and reported below.

    Time frame: 2 weeks

Secondary outcomes

  1. Interpalpebral Fissure During Resting Open

    Resting open IPF was the median between blink-event IPF, measured automatically by a deep learning model for eyelid landmark detection. the IPF midpoint height during resting open was averaged and reported below.

    Time frame: 2 weeks

  2. Proportion of Non-closure During Volitional Blinks

    At the end of recording, participants were instructed to close their eyes completely and open completely three times, representing volitional blink trials. These were evaluated manually with ImageJ. Blinks were classified by a human rater as having complete closure, or not, and then the proportion of non-closure blinks across all subjects was calculated for each condition and reported below.

    Time frame: 2 weeks

  3. Proportion of Subjects Selecting Each Device

    Proportion of subjects selecting either the MLP, the KTFS or neither

    Time frame: 6 weeks

06

Results

Posted Apr 22, 2025

Participant flow

Data for this study were collected at Massachusetts Eye and Ear, Boston, MA. Subjects were recruited by flyer and by referral from other ophthalmology clinics, or neurology clinics.

Participant flow — Overall Study
MilestoneMLP First, KTFS SecondKTFS First, MLP Second
Started97
Completed87
Not completed10
Withdrew: Lost to follow-up10

Outcome measures

PrimaryInterpalpebral Fissure (IPF) During Spontaneous Blink

The primary outcome was objective measurement of the IPF midpoint height during maximum closing in five spontaneous blinks, captured with a Nikon mirrorless SLR video recording system (Z7II; Nikon USA, Melville, NY, USA), with a visible light source mounted just above the lens, measured manually with ImageJ (National Institutes of Health, Bethesda, MD, USA). Spontaneous blinks are normally incomplete, a behavior that is dependent upon age, gender, task, and environmental demands. Maximum closing was defined as the three points at the base of the blink. Participants were instructed to look at the camera lens and try to relax and behave normally. Recording was stopped after 1 minute or after five spontaneous blinks, whichever came first. Recording always occurred in the same windowless clinical research room with consistent lighting, temperature, humidity, and air flow. The IPF midpoint height during maximum closing in five spontaneous blinks is averaged and reported below.

Time frame:
2 weeks
Reported as:
Mean · millimeters
Interpalpebral Fissure (IPF) During Spontaneous Blink
millimetersMagnetic Levator Prosthesis (MLP)Kinesiotape Frontalis Sling (KTFS)Baseline (Sham)
Interpalpebral Fissure (IPF) During Spontaneous Blink2.4 (1.5 to 3.7)4.1 (2.6 to 6.5)1.1 (0.7 to 1.8)
Statistical analysis
  • Magnetic Levator Prosthesis (MLP) vs Kinesiotape Frontalis Sling (KTFS) · Mixed Models Analysis · p = <0.001 (a priori threshold for statistical significance was p\<0.05)
SecondaryInterpalpebral Fissure During Resting Open

Resting open IPF was the median between blink-event IPF, measured automatically by a deep learning model for eyelid landmark detection. the IPF midpoint height during resting open was averaged and reported below.

Time frame:
2 weeks
Reported as:
Mean · millimeters
Interpalpebral Fissure During Resting Open
millimetersMagnetic Levator Prosthesis (MLP)KTFSBaseline (Sham)
Interpalpebral Fissure During Resting Open6.8 (5.2 to 8.4)7.0 (5.4 to 8.6)3.9 (2.3 to 5.5)
Statistical analysis
  • Magnetic Levator Prosthesis (MLP) vs KTFS vs Baseline (Sham) · Mixed Models Analysis · p = 0.001
SecondaryProportion of Non-closure During Volitional Blinks

At the end of recording, participants were instructed to close their eyes completely and open completely three times, representing volitional blink trials. These were evaluated manually with ImageJ. Blinks were classified by a human rater as having complete closure, or not, and then the proportion of non-closure blinks across all subjects was calculated for each condition and reported below.

Time frame:
2 weeks
Reported as:
Number · Proportion of Non-closure Blinks
Proportion of Non-closure During Volitional Blinks
Proportion of Non-closure BlinksMagnetic Levator Prosthesis (MLP)KTFSBaseline (Sham)
Proportion of Non-closure During Volitional Blinks0.0670.3560.022
Statistical analysis
  • Magnetic Levator Prosthesis (MLP) vs KTFS vs Baseline (Sham) · test of proportionality · p = 0.001
SecondaryProportion of Subjects Selecting Each Device

Proportion of subjects selecting either the MLP, the KTFS or neither

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Proportion of Subjects Selecting Each Device
ParticipantsPreferred Magnetic Levator Prosthesis (MLP)Preferred Kinesiotape Frontalis Sling (KTFS)Preferred Neither Treatment
Proportion of Subjects Selecting Each Device762

Adverse events

Collected over 8 weeks. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Magnetic Levator Prosthesis (MLP)0/15 (0%)0/15 (0%)0/15 (0%)
Kinesiotape Frontalis Sling (KTFS)0/15 (0%)0/15 (0%)3/15 (20%)
Baseline (Sham)0/15 (0%)0/15 (0%)0/15 (0%)
Most frequent other events
Most frequent other events
EventMagnetic Levator Prosthesis (MLP)Kinesiotape Frontalis Sling (KTFS)Baseline (Sham)
Increase in skin erythema scale >3 pointsEye disorders0/152/150/15
Increase in conjunctival staining >2 pointsEye disorders0/151/150/15

Baseline characteristics

The subject that was lost to follow up did not contribute any data to the analysis. No data was collected at their first study visit and so we felt it was best not to report as part of the baseline demographics.

Age, Continuous
Age, Continuous(years)Participants
Median61 (55 to 65)
Sex: Female, Male
Sex: Female, Male(Participants)Participants
Female6
Male9
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Participants
American Indian or Alaska Native0
Asian0
Native Hawaiian or Other Pacific Islander0
Black or African American0
White15
More than one race0
Unknown or Not Reported0
Region of Enrollment
Region of Enrollment(Participants)Participants
United States15
Baseline Interpalpebral Fissure
Baseline Interpalpebral Fissure(millimeters)Participants
Mean3.89 ± 2.36
07

Study locations

1 site
  • Massachusetts Eye and Ear
    Boston, Massachusetts 02114, United States
08

References and documents

Publications

  • Houston KE, Tomasi M, Yoon M, Paschalis EI. A Prototype External Magnetic Eyelid Device for Blepharoptosis. Transl Vis Sci Technol. 2014 Dec 17;3(6):9. doi: 10.1167/tvst.3.6.9. eCollection 2014 Oct. PubMed 25674358 ↗
  • Houston KE, Tomasi M, Amaral C, Finch N, Yoon MK, Lee H, Paschalis EI. The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy. Transl Vis Sci Technol. 2018 Jan 19;7(1):7. doi: 10.1167/tvst.7.1.7. eCollection 2018 Jan. PubMed 29367892 ↗
  • Houston KE, Paschalis EI. Feasibility of Magnetic Levator Prosthesis Frame Customization Using Craniofacial Scans and 3-D Printing. Transl Vis Sci Technol. 2022 Oct 3;11(10):34. doi: 10.1167/tvst.11.10.34. PubMed 36269183 ↗
  • Kurukuti NM, Nadeau M, Paschalis EI, Houston KE. An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Re-Animation in Severe Blepharoptosis: Design and Proof-of-Concept. Transl Vis Sci Technol. 2023 Aug 1;12(8):11. doi: 10.1167/tvst.12.8.11. PubMed 37566397 ↗
  • Tirandazi P, Nadeau M, Woods RL, Paschalis EI, Houston KE. An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Reanimation in Severe Blepharoptosis II: Randomized Evaluation of Angular Translation. Transl Vis Sci Technol. 2023 Dec 1;12(12):1. doi: 10.1167/tvst.12.12.1. PubMed 38038607 ↗
  • Cheatham SW, Baker RT, Abdenour TE. Kinesiology Tape: A Descriptive Survey of Healthcare Professionals in the United States. Int J Sports Phys Ther. 2021 Jun 1;16(3):778-796. doi: 10.26603/001c.22136. PubMed 34123530 ↗
  • Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995 Oct;21(4):221-32. No abstract available. PubMed 8565190 ↗
  • Houston KE, Pundlik S, Shivshanker P, Bowers AR, LaRosa S, Robinson M, Chodosh J, Brandes L, Lee P, Paschalis EI. A Single-Center Sham and Active-Controlled Double-Blind Randomized Crossover Trial of the Magnetic Levator Prosthesis for Severe Blepharoptosis. Transl Vis Sci Technol. 2025 Feb 3;14(2):15. doi: 10.1167/tvst.14.2.15. PubMed 39932468 ↗

Study documents

  • Protocol and statistical analysis plan · May 30, 2024

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No — Upon written request to Massachusetts Eye and Ear data may be provided

09

Registry details

Key details

Study ID
NCT04678115
Lead sponsor
Massachusetts Eye and Ear Infirmary
Collaborators
National Eye Institute (NEI)
Responsible party
Kevin Houston (Assistant Professor, Massachusetts Eye and Ear Infirmary) — Principal investigator
First posted
Dec 21, 2020
Start date
Jun 1, 2021
Primary completion
Dec 31, 2024
Completion
Dec 31, 2024
Results posted
Apr 22, 2025
Last update
Apr 22, 2025

Study contacts

Kevin Houston, OD MSc
principal investigator · Massachusetts Eye and Ear

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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