The Use of TECAR Therapy on Meibomitis Disease and Optical Nerve Flow
, Giuseppe Acri 4,* and Alessandro Meduri 4
Round 1
Reviewer 1 Report
Each new technique developed in order to improve the ocular care is always a good way to get life quality. Furthermore, your manuscript has been carefully written and it is really easy to read it. Congratulations! I have many recommendations for you:
_Lines 47-49: would it be possible to complete this introduction considering pulsed light therapy?
_Probably, table 1 could be not necessary, and its information could be included in line 83. "In the present study, 15 patients (8 male (72.62 ± 7.25) and 7 female (xxx)) were enrolled...
_You have to write "tear film break-up time (TBUT)" only once. After it, write (TBUT). Look at lines: 90,146, 152...
_Do not repeat "ANGIO TC SCAN (OCTA)". After line 94) write OCTA. Look at line: 160 ...
_Figure 1: It is really difficult to see what you are explaining in lines 119-120.
_Under Table 2, you must add what TBUT and OCTA mean.
_Was the same subject considered in figure 2 and 3? It must be indicated
_Line 198: This is shown in table 2. Please, do not repeat.
_Probably, it could be better if you improve figure 4 resolution. In addition, you should explain what "A.U", "T0", "G1T1”... meaning
_In your discussion I have missed a comparison among TECAR and other techniques such as pulsed light.
_On the other hand, it could be necessary to study the adverse effects of TECAR or at least discuss them.
_What your take about TBUT results? (Lines: 247-248) In table 3, it is shown p-values<0.05 in all cases. Is it a good method to diagnostic? Furthermore, in table 2: G1 T1vsT2 p-value>0.05, and G2 T1vsT2 p-value >0.05... What could be a good reason for all these TBUT results?
_Are all your references JCR manuscripts? Review them, please.
Author Response
First of all, we thank the Reviewer for his/her generally positive comment. As can be seen in the following, we reviewed the manuscript taking seriously into account all his/her questions and comments. All the performed changes were made using the “Track Changes” function.
Reviewer 1
- _Lines 47-49: would it be possible to complete this introduction considering pulsed light therapy?
We added IPL therapy
_Probably, table 1 could be not necessary, and its information could be included in line 83. "In the present study, 15 patients (8 male (72.62 ± 7.25) and 7 female (xxx)) were enrolled...
We have deleted table 1 and we included the data in the text
_You have to write "tear film break-up time (TBUT)" only once. After it, write (TBUT). Look at lines: 90,146, 152...
We modified it
_Do not repeat "ANGIO TC SCAN (OCTA)". After line 94) write OCTA. Look at line: 160 ...
We modified it
_Figure 1: It is really difficult to see what you are explaining in lines 119-120.
We modified Figure 1
_Under Table 2, you must add what TBUT and OCTA mean.
Under Table 2 we TBUT and OCTA description, and related references, are present.
_Was the same subject considered in figure 2 and 3? It must be indicated
In this paper we have used the best figures at our disposal. The subjects considered in figures 2 and 3 are different. We have explained it in the figure captions.
_Line 198: This is shown in table 2. Please, do not repeat.
We have delated line 198
_Probably, it could be better if you improve figure 4 resolution. In addition, you should explain what "A.U", "T0", "G1T1”... meaning
In the caption we explained the used abbreviations
_In your discussion I have missed a comparison among TECAR and other techniques such as pulsed light.
In the discussion section we have not added the comparison between TECAR and IPL, but, in our opinion, the we added that the combination of the two techniques could be an ideal therapy for eye disorders.
_On the other hand, it could be necessary to study the adverse effects of TECAR or at least discuss them.
We added the adverse effects of TECAR
_What your take about TBUT results? (Lines: 247-248) In table 3, it is shown p-values<0.05 in all cases. Is it a good method to diagnostic? Furthermore, in table 2: G1 T1vsT2 p-value>0.05, and G2 T1vsT2 p-value >0.05... What could be a good reason for all these TBUT results?
TBUT results showed positive effects on disease. We think that it is a good therapeutic method because it is possible to note statistically significant results compared to placebo.
For TBUT, both T1 and T2 sessions for both Group 1 and Group 2 presented significant different distribution with respect to the T0 dataset; in particular, already after T1 session a marked improvement can be seen.
Are all your references JCR manuscripts? Review them, please
We revised the references
Author Response File: 
Author Response.pdf
Reviewer 2 Report
In this article, TECAR therapy was used to treat meibomitis disease and the therapeutic effects were evaluated from multiple aspects, and the results showed that this treatment has some potential on meibomitis disease. There are still some comments that have to be addressed.
1. Introduction
Page 2 line 66-67. One of the aims of this study mentioned in the text was to assess whether TECAR treatment could improve subjective symptoms of patients, however nothing was written about the patients' subjective symptom assessment in both the methods and results sections. If a relevant evaluation is not performed, then the purpose of the study needs to be modified.
2. Introduction
Page 2 line 70-72. It is sufficient to have a description of the statistical analysis in the methods section. It does not need to be stated in the introduction section.
3. Materials and Methods
Page 2 line 91. What are the reasons why lacrimal meniscus height needs to be greater than 0.20 mm in the inclusion criteria?
4. Materials and Methods
Page 3 line 103. Whether all letters of "group " need to be capitalized before and after should be uniform.
5. Materials and Methods
Page 3 line 103. Were the TBUT in the study fluorescein stained? Judging from the TBUT inspection picture in the results section, it should be a non-contact method, and generally no fluorescein staining is required.
6. Materials and Methods
The brand and manufacturer of all instruments should be stated, eg those used for TBUT and OCTA.
7. Results
The resolution of all figures is too bad, need clearer figures.
8. Results
Page 6. Statistically different results in Figure 4 should be noted
9. Results
Page 7. Table 3 should at least have the mean ± standard deviation of the inspection results. Or add another table to show the average of each test result in different treatment periods.
Comments for author File: 
Comments.docx
Author Response
First of all, we thank the Reviewer for his/her generally positive comment. As can be seen in the following, we reviewed the manuscript taking seriously into account all his/her questions and comments. All the performed changes were made using the “Track Changes” function.
Reviewer 2
- Introduction
Page 2 line 66-67. One of the aims of this study mentioned in the text was to assess whether TECAR treatment could improve subjective symptoms of patients, however nothing was written about the patients' subjective symptom assessment in both the methods and results sections. If a relevant evaluation is not performed, then the purpose of the study needs to be modified.
We added the sentences in both “materials and methods” and results sections.
- Introduction
Page 2 line 70-72. It is sufficient to have a description of the statistical analysis in the methods section. It does not need to be stated in the introduction section.
Following your suggestion, we deleted the sentence from Introduction section
- Materials and Methods
Page 2 line 91. What are the reasons why lacrimal meniscus height needs to be greater than 0.20 mm in the inclusion criteria?
0.2 mm refers to patients who are already ill, so we tried to get answers about the therapy. It represents a subjective criterion used for this study.
- Materials and Methods
Page 3 line 103. Whether all letters of "group " need to be capitalized before and after should be uniform.
We corrected the letters of the word “Group”
- Materials and Methods
Page 3 line 103. Were the TBUT in the study fluorescein stained? Judging from the TBUT inspection picture in the results section, it should be a non-contact method, and generally no fluorescein staining is required.
We corrected it
- Materials and Methods
The brand and manufacturer of all instruments should be stated, eg those used for TBUT and OCTA.
We added model and manufacturer of the used instruments.
- Results
The resolution of all figures is too bad, need clearer figures.
We modified figures 1 and 4. Figures 2 and 3 are furnished by used instrumentations.
- Results
Page 6. Statistically different results in Figure 4 should be noted
We modified figure 4 following your suggestion.
- Results
Page 7. Table 3 should at least have the mean ± standard deviation of the inspection results. Or add another table to show the average of each test result in different treatment periods.
We modified Table 3. In this revised version, following reviewer 1 suggestion, it is named Table 2.
Author Response File: Author Response.pdf
