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Meibomian gland segmentation may precede atrophy
ORLANDO, Fla. – Meibomian gland segmentation may be an early sign of dysfunction, according to a poster presented here at the American Academy of Optometry meeting.
Leslie E. O’Dell, OD, FAAO, and colleagues at five centers in the U.S. and Canada enrolled 69 consecutive patients in this prospective study. They imaged the subjects with LipiView 2 (Johnson & Johnson Vision), LipiScan (J&J Vision) and the Oculus Keratograph 5M and graded 248 meibography images for segmentation.
The researchers also administered several questionnaires, including the University of North Carolina Dry Eye Management Scale, Ocular Surface Disease Index and Standardized Patient Evaluation of Eye Dryness.
O’Dell defined segmentation for Primary Care Optometry News: “It’s like the top and bottom of the gland are disconnected from one another.”
According to the poster, lower lid meibomian gland dropout was negatively correlated to segmentation; as dropout increased, the number of glands with segmentation decreased.
“So, if atrophy was present, this segmentation was not,” O’Dell told PCON, “which made us think it was an early finding of meibography. Even symptoms of the patient didn’t correlate to it, which makes us think it could occur early on in the disease process.”
O’Dell said Steve Maskin, MD, and colleagues presented another poster at the meeting that showed what he called periductal fibrosis in confocal images of the meibomian glands.
“It’s like the inside lining of the meibomian gland was sort of scarred,” she said. “So I think what you can see with meibography is what he can see with confocal. He showed that if that fibrosis is never fixed, then the gland below it would atrophy.”
She explained that when Maskin sees that fissure, “he will probe and help open it up and give the patient a lot of symptom relief.”
O’Dell’s poster included a meibography image clearly indicating meibomian gland segmentation.
“The picture really resonated with people at the poster session,” she said. “Some of the doctors were saying they were going to use that for patient education, to talk about early changes on meibography occurring before atrophy.
“With this disease, if you can catch anything before the gland is gone, you’re going to be way ahead of the game for the long haul with these patients,” O’Dell added.
These study findings will not change when a clinician should perform meibography, she said, “but it might influence doctors as to when they’re going to initiate treatment.”
O’Dell said she and her colleagues are working to develop a grading scale they hope to present in 2020 at the Association for Research in Vision and Ophthalmology meeting. – by Nancy Hemphill, ELS, FAAO
References:
Maskin S, et al. Real-time infrared video meibography feed shows intraductal meibomian gland probing confirms presence of duct and restores intraductal integrity in setting of whole gland atrophy. Presented at: American Academy of Optometry meeting; Orlando, Fla.; October 22-27, 2019.
O’Dell LE, et al. Segmentation of meibomian glands as an early predictor of meibomian gland dysfunction. Presented at: American Academy of Optometry meeting; Orlando, Fla.; October 22-27, 2019.
Disclosure: O’Dell reports she is a consultant for AGN, Bausch Health, Eye Eco, Johnson & Johnson Vision, Kala, Novartis, Sight Sciences and Sun.