Meeting News

Look for meibomian gland contrast when evaluating dry eye

SAN ANTONIO – A researcher highlighted the importance of looking at gland atrophy and gland contrast when evaluating dry eye, here at an anterior segment paper session at the American Academy of Optometry meeting.

Thao Yeh, OD, MPH, FAAO, and Meng Lin, OD, PhD, FAAO, developed a case control study to determine if decreased meibomian gland contrast and intensity were associated with thin tear lipid layer thickness and severe dry eye symptoms.

“What we tend to see on meibography [in a patient without dry eye] in the upper lid that the glands will run the full length of the tarsal plate; there are no missing regions,” Yeh said. “When we see full, vibrant glands along the full length of the tarsal plate, we tend to think they are normal, and we think of diseased glands as dilated ducts with gland shortening, what we call ‘atrophy.’”

The literature pays a lot of attention to atrophy, she said.

Glands that lack contrast and appear paler and less vibrant than others are called “ghost glands.”

“Evaluating gland atrophy is obviously important, but does intensity also matter?” she asked. “In two eyes with similar gland lengths, but with one with a little ghosting, would you consider them to be equal? Do you include or exclude the ghost in your atrophy assessment?”

Yeh and Lin compared individuals with severe dry eye symptoms and thin tear lipid layer (TLL) to those with mild-to-no symptoms and thick TLL (controls).

They explored the relationship between percentage of atrophy and meibomian gland contrast, through Standardized Patient Evaluation of Eye Dryness (SPEED) scores, TLL analysis and meibography with the Oculus Keratograph 5M.

They collected 512 images from 22 controls and 12 cases. The researchers measured the intensity of the central five glands and the intensity of the background regions between those glands and defined contrast as the difference between those averages, Yeh said.

“The bottom line is that for the upper eyelid, if you see a difference or change in contrast of 11 units of intensity or greater, that is less likely due to normal variability, and we found that the upper eyelid was more repeatable than the lower lid,” Yeh said.

In general, cases were older and predominately male. Distribution of contact lens wearers and hormonal birth control use was similar between groups, as were Schirmer scores.

As for meibum scores, controls had a higher proportion of no-to-moderate atrophy, and the cases had a higher proportion of severe atrophy.

In the control images, some atrophied glands were present, but the glands that remained were still vibrant and full, she said. In the images from the cases, the glands present are not as vibrant as in the control images.

“I would argue that contrast, or intensity, does matter,” Yeh added.

They calculated meibum quality scores, where the higher the score the better the quality.

The control group, on average, had a higher score than the case group. The meibum quantity score was calculated similarly, and they found the control group had a higher score than the case group and was significant.

“Lipid-deficient dry eye patients have significantly reduced meibomian gland contrast and this is supported here in our data on meibum quantity and quality,” Yeh said.

They found a trend of increasing quality with increasing contrast.

When they looked at the higher intensity groups versus the lower intensity groups, the quality is better in the higher contrast group but is not statistically significant, she added.

The higher contrast group had a higher quantity score, which was significant.

Symptomatic lipid-deficient individuals had significantly greater odds of having decreased meibomian gland contrast and decreased meibum quantity and quality scores, but there was no significantly significant relationship with meibomian gland atrophy.

“Decreased meibomian gland contrast is associated with decreased expressed meibum quantity and significant correlation with increased percent atrophy and associated with worth symptoms in this cohort,” Yeh concluded.

Gland atrophy is still important to consider when evaluating dry eye, but Yeh urged attendees to look as meibomian gland contrast as well. – by Abigail Sutton

Reference:

Yeh T, Lin M. Papers: Anterior segment – Meibomian gland contrast as indicator of lipid-deficient dry eye: A case control study. Presented at: American Academy of Optometry annual meeting; San Antonio; November 7–10, 2018.

Disclosure: Yeh reported no relevant financial disclosures.

SAN ANTONIO – A researcher highlighted the importance of looking at gland atrophy and gland contrast when evaluating dry eye, here at an anterior segment paper session at the American Academy of Optometry meeting.

Thao Yeh, OD, MPH, FAAO, and Meng Lin, OD, PhD, FAAO, developed a case control study to determine if decreased meibomian gland contrast and intensity were associated with thin tear lipid layer thickness and severe dry eye symptoms.

“What we tend to see on meibography [in a patient without dry eye] in the upper lid that the glands will run the full length of the tarsal plate; there are no missing regions,” Yeh said. “When we see full, vibrant glands along the full length of the tarsal plate, we tend to think they are normal, and we think of diseased glands as dilated ducts with gland shortening, what we call ‘atrophy.’”

The literature pays a lot of attention to atrophy, she said.

Glands that lack contrast and appear paler and less vibrant than others are called “ghost glands.”

“Evaluating gland atrophy is obviously important, but does intensity also matter?” she asked. “In two eyes with similar gland lengths, but with one with a little ghosting, would you consider them to be equal? Do you include or exclude the ghost in your atrophy assessment?”

Yeh and Lin compared individuals with severe dry eye symptoms and thin tear lipid layer (TLL) to those with mild-to-no symptoms and thick TLL (controls).

They explored the relationship between percentage of atrophy and meibomian gland contrast, through Standardized Patient Evaluation of Eye Dryness (SPEED) scores, TLL analysis and meibography with the Oculus Keratograph 5M.

They collected 512 images from 22 controls and 12 cases. The researchers measured the intensity of the central five glands and the intensity of the background regions between those glands and defined contrast as the difference between those averages, Yeh said.

“The bottom line is that for the upper eyelid, if you see a difference or change in contrast of 11 units of intensity or greater, that is less likely due to normal variability, and we found that the upper eyelid was more repeatable than the lower lid,” Yeh said.

In general, cases were older and predominately male. Distribution of contact lens wearers and hormonal birth control use was similar between groups, as were Schirmer scores.

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As for meibum scores, controls had a higher proportion of no-to-moderate atrophy, and the cases had a higher proportion of severe atrophy.

In the control images, some atrophied glands were present, but the glands that remained were still vibrant and full, she said. In the images from the cases, the glands present are not as vibrant as in the control images.

“I would argue that contrast, or intensity, does matter,” Yeh added.

They calculated meibum quality scores, where the higher the score the better the quality.

The control group, on average, had a higher score than the case group. The meibum quantity score was calculated similarly, and they found the control group had a higher score than the case group and was significant.

“Lipid-deficient dry eye patients have significantly reduced meibomian gland contrast and this is supported here in our data on meibum quantity and quality,” Yeh said.

They found a trend of increasing quality with increasing contrast.

When they looked at the higher intensity groups versus the lower intensity groups, the quality is better in the higher contrast group but is not statistically significant, she added.

The higher contrast group had a higher quantity score, which was significant.

Symptomatic lipid-deficient individuals had significantly greater odds of having decreased meibomian gland contrast and decreased meibum quantity and quality scores, but there was no significantly significant relationship with meibomian gland atrophy.

“Decreased meibomian gland contrast is associated with decreased expressed meibum quantity and significant correlation with increased percent atrophy and associated with worth symptoms in this cohort,” Yeh concluded.

Gland atrophy is still important to consider when evaluating dry eye, but Yeh urged attendees to look as meibomian gland contrast as well. – by Abigail Sutton

Reference:

Yeh T, Lin M. Papers: Anterior segment – Meibomian gland contrast as indicator of lipid-deficient dry eye: A case control study. Presented at: American Academy of Optometry annual meeting; San Antonio; November 7–10, 2018.

Disclosure: Yeh reported no relevant financial disclosures.