Examine younger patients for meibomian changes

ANAHEIM, Calif. – Scott Schachter, OD, said optometrists need to consider younger patients when looking for dry eye, based on his research and specialization in ocular surface disease at his private practice in Pismo Beach, Calif.

Schachter, along with his daughter, Aubrey Schachter, MS, and colleagues compared meibomian gland atrophy among male and female patients in a young population averaging 19.1 years of age and reported their results in a presentation here at the American Academy of Optometry meeting.

Patients were randomly selected to participate and included 22 females and 11 males between the ages of 11 years and 25 years. There were no significant differences in age between the two cohorts.

Scott Schachter

Researchers imaged the lower glands using an Oculus Keratograph 5M (Oculus Inc., Arlington, Wash.) and graded for atrophy using the Pult Area of Loss scale (0-4) and for tortuosity (0-4).

Females showed twice as much loss as males, according to the results. The average Pult score was 1.29 for this female population and 0.59 for the males.

“Personally, this has no basis yet, but perhaps we are looking at a situation where testosterone is protecting younger males, as meibomian gland dysfunction (MGD) tends to be similar in men and women at an older age,” Schachter said. “Now we are seeing this [similarity] happen sooner. Hormones are protecting the boys, but now they are subjected to more stress (such as contact lens wear, increased screen use), and MGD catches up as testosterone declines in an older male population.”

Researchers found no statistically significant difference in average tortuosity between the male and female cohorts; females had an average tortuosity score of 2.05, and males averaged 1.68, according to the results.

Prior research has attributed sleep position and allergies as an indicator for MGD, he said.

“In terms of practice, we need to, as a profession, start looking at meibomian glands proactively,” Schachter said. “Don’t wait for patients to be symptomatic. I think we need to establish baselines by transilluminating and recording what the glands look like. Pick a scale, like Pult, or whatever it may be — we need to see what’s going on over time. It’s hard to say it’s a disease unless you are seeing progression.” –by Abigail Sutton

Reference:

Schachter S, et al. Gender differences of meibomian gland atrophy in a younger population. Presented at American Academy of Optometry annual meeting. Anaheim, Calif. November 9-12, 2016.

Disclosure: Schachter is a consultant for Allergan, Bausch + Lomb, Bio-Tissue, Rysurg BlephEx, ScienceBased Health, Sun Pharma and Tear Science.