March 09, 2017
1 min read

Meibomian gland imaging shows increasing dropout rates

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ATLANTA – “Start looking at patients’ meibomian glands, and you will be surprised at how much meibomian dropout you’ll be seeing in 35-year-olds,” Carl Spear, OD, said here at SECO.

He and Blair Lonsberry, OD, spoke together at a symposium that was cosponsored by Primary Care Optometry News.

Blair Lonsberry

“LipiView [TearScience] is a game-changer,” Lonsberry said.

He showed images of his own meibomian glands taken with the LipiView, and it was apparent that some of the glands were dead.

“It’s important to show this to patients,” he said.

“The more people we image, we are seeing younger and younger patients with significant meibomian gland dropout,” Spear said. “If you don’t have a LipiView or an Oculus [Meibo-Scan, Keratograph 5M], you can do it with a transilluminator.”

Spear said blink rate is drastically decreasing with the increased utilization of electronic devices such as computers, phones and tablets – from every 3 to 4 seconds to every 10 to 15 seconds with device usage.

“The general thought process with a lot of the dry eye and ocular surface type of diseases is that the blink process is instrumental in flushing the glands,” he said. “You blink, that causes compression, and you get expression of the meibomian glands. If you’re not blinking, that stasis sets in and, subsequently, the atrophy and the dropout. And the dropout [is being seen] in the younger kids.”

Carl Spear
Carl Spear

Spear said he queried an audience at the American Academy of Optometry’s meeting, and 60% of attendees said that at least 80% of their patients had dry eye.

He recommended administering the Ocular Surface Disease Index (OSDI) or Standard Patient Evaluation of Eye Dryness (SPEED) questionnaires to screen every patient.

“And take that 5 seconds and look at the meibomian glands,” Spear said. “The amount of dropout is shocking.” – by Nancy Hemphill, ELS, FAAO


Lonsberry B, Spear C. Treating with oral meds: From dry eye to dendrites. Presented at: SECO; March 1-5, 2017; Atlanta.

Disclosures: Lonsberry reported he is a consultant for Alcon, Carl Zeiss Meditec, Optovue and Shire. Spear reported no relevant financial disclosures.