Traditional imaging may miss viable segments of meibomian glands
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Key takeaways:
- Subjective grading was significantly different between Visante OCT and Keratograph 5M for the lower eyelid but not the upper.
- Percent gland visibility was significantly greater with Visante OCT vs. the K5M.
OCT imaging captured significantly greater meibomian gland length than traditional meibography, likely due to a longer wavelength that penetrates deeper into the eyelids, according to a study published in Contact Lens and Anterior Eye.
“About 3 or 4 years ago, I found at least three papers that said that meibomian glands may regenerate posttreatment, which, to me, didn't make sense,” Andrew D. Pucker, OD, PhD, FAAO, FSLS, FBCLA, study author and executive director of clinical and medical science at Lexitas Pharma Services, told Healio. “I’ve always thought that once your gland atrophied and was gone you couldn’t get it back, so this was really intriguing to me.”
To determine whether an imaging device with a longer wavelength could better visualize meibomian glands, Pucker and Swetha Ravichandran, from the University of Alabama at Birmingham School of Optometry, conducted a study of 30 healthy adults aged 18 to 40 years (median age, 23 years; 53.3% women) whose right upper and lower eyelids were imaged using the Visante OCT (Carl Zeiss), which has a wavelength of 1,310 nm, and the Keratograph 5M (Oculus), with a wavelength of 880 nm.
“Longer wavelengths are able to penetrate deeper tissue,” Pucker said. “A caveat is that often the longer wavelength provides a little worse resolution, which is something we saw in the study. With this approach I wanted to see if we were just not noticing some of the glands with the K5M.”
Participants completed the Standard Patient Evaluation of Eye Dryness questionnaire at baseline and underwent clinical testing for dry eye disease. Overall, they were asymptomatic with normal tear films. Researchers graded the meibomian gland images taken with both devices on a 0 to 3 meiboscore scale and evaluated the relative percent length of the central five meibomian glands.
The researchers reported that meiboscores between the two imaging devices were significantly different for the lower eyelid, but not the upper eyelid. However, the mean percent gland visibility of both upper and lower eyelids was significantly greater with the Visante OCT compared with the Keratograph 5M.
Further, Pucker and Ravichandran reported an 8.3% difference between the Visante OCT and the Keratograph 5M in meibomian gland length for the central five meibomian glands on the upper eyelid and a 16.1% difference for the glands on the lower eyelid.
“This suggests that in the previous studies the glands were there, but they were unhealthy, and once treated they produce better meibum and become healthy glands, making them thicker and easier to see on meibography,” Pucker said. “This needs more study, but, clinically, this suggests that we can make glands healthier with treatment, but we’re probably not making them longer.”
He added, “I’d like to see manufacturers optimize their wavelength to find how to maximize seeing all the gland. I think that’s a path for research.”
For more information:
Andrew D. Pucker, OD, PhD, FAAO, FSLS, FBCLA, is the executive director of clinical and medical sciences at Lexitas Pharma Services. He can be reached at andrew.pucker@lexitas.com or found on social media at https://www.linkedin.com/in/andrew-d-pucker-od-phd-faao-diplomate-fsls-fbcla-70036638/.
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