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IntroductionThis study investigated the equivocal association between contact lens (CL) wear and meibomian gland dysfunction (MGD) by comparing the morphological, functional and subjective outcomes of CL wearers versus control, non‐CL wearers. CL wearers were examined as two cohorts based on the annual attendance of follow‐up visits (FLU—attended these visits, whereas non‐FLU did not).MethodsHabitual logMAR visual acuity, invasive and non‐invasive tear break‐up time, Schirmer test, Efron grading scales, meibum quality score (MQS), meibum expressibility score (MES), meibomian gland (MG) loss, lid margin abnormalities and subjective dry eye (DE) symptoms were assessed.ResultsOf the 128 participants, 31 were in the FLU cohort, 43 were in the non‐FLU cohort and 54 were controls (mean ages: 22.2 ± 3.1, 23.0 ± 4.6 and 22.3 ± 3.5, respectively). Non‐FLU CL wearers had more symptoms than controls (3.7 ± 2.4 vs. 2.3 ± 2.1, p < 0.01). Morphologically, FLU (16.9 ± 8.8%, p = 0.02) and non‐FLU (18.6 ± 11.3%, p = 0.001) had more MG loss than controls (11.2 ± 6.8%). Functionally, FLU (0.6 ± 0.7, p = 0.01) and non‐FLU (0.8 ± 0.9, p = 0.001) had worse MES than controls (0.2 ± 0.5). FLU and non‐FLU were both associated with corneal staining (odds ratio [OR] = 3.42, 95% CI: 1.16–10.11, p = 0.03 and OR = 5.23, 95% CI: 1.89–14.48, p = 0.001, respectively) and MG loss (OR = 10.47, 95% CI: 1.14–96.29, p = 0.04 and OR = 16.63, 95% CI: 1.96–140.86, p = 0.01, respectively). Non‐FLU CL wear was also associated with abnormal MQS (OR = 12.87, 95% CI: 1.12–148.41, p = 0.04), conjunctival staining (OR = 12.18, 95% CI: 3.66–40.51, p < 0.001) and lid margin telangiectasia (OR = 3.78, 95% CI: 1.55–9.21, p = 0.003). MGD was three times more prevalent in CL wearers (12%) than in controls (4%).ConclusionsBoth CL‐wearing cohorts demonstrated significantly more MG abnormalities than controls though the difference was not clinically significant. Non‐FLU CL wearers had more DE symptoms. Non‐FLU CL wear is an independent predictor for more abnormalities than FLU CL wear, emphasising the importance of follow‐ups.
IntroductionThis study investigated the equivocal association between contact lens (CL) wear and meibomian gland dysfunction (MGD) by comparing the morphological, functional and subjective outcomes of CL wearers versus control, non‐CL wearers. CL wearers were examined as two cohorts based on the annual attendance of follow‐up visits (FLU—attended these visits, whereas non‐FLU did not).MethodsHabitual logMAR visual acuity, invasive and non‐invasive tear break‐up time, Schirmer test, Efron grading scales, meibum quality score (MQS), meibum expressibility score (MES), meibomian gland (MG) loss, lid margin abnormalities and subjective dry eye (DE) symptoms were assessed.ResultsOf the 128 participants, 31 were in the FLU cohort, 43 were in the non‐FLU cohort and 54 were controls (mean ages: 22.2 ± 3.1, 23.0 ± 4.6 and 22.3 ± 3.5, respectively). Non‐FLU CL wearers had more symptoms than controls (3.7 ± 2.4 vs. 2.3 ± 2.1, p < 0.01). Morphologically, FLU (16.9 ± 8.8%, p = 0.02) and non‐FLU (18.6 ± 11.3%, p = 0.001) had more MG loss than controls (11.2 ± 6.8%). Functionally, FLU (0.6 ± 0.7, p = 0.01) and non‐FLU (0.8 ± 0.9, p = 0.001) had worse MES than controls (0.2 ± 0.5). FLU and non‐FLU were both associated with corneal staining (odds ratio [OR] = 3.42, 95% CI: 1.16–10.11, p = 0.03 and OR = 5.23, 95% CI: 1.89–14.48, p = 0.001, respectively) and MG loss (OR = 10.47, 95% CI: 1.14–96.29, p = 0.04 and OR = 16.63, 95% CI: 1.96–140.86, p = 0.01, respectively). Non‐FLU CL wear was also associated with abnormal MQS (OR = 12.87, 95% CI: 1.12–148.41, p = 0.04), conjunctival staining (OR = 12.18, 95% CI: 3.66–40.51, p < 0.001) and lid margin telangiectasia (OR = 3.78, 95% CI: 1.55–9.21, p = 0.003). MGD was three times more prevalent in CL wearers (12%) than in controls (4%).ConclusionsBoth CL‐wearing cohorts demonstrated significantly more MG abnormalities than controls though the difference was not clinically significant. Non‐FLU CL wearers had more DE symptoms. Non‐FLU CL wear is an independent predictor for more abnormalities than FLU CL wear, emphasising the importance of follow‐ups.
(English) Meibomian gland dysfunction (MGD) is a chronic and diffuse abnormality of the meibomian glands (MGs) that occurs in 38% of contact lens (CL) wearers, though the influence of CLs on MGD is equivocal. A topical literature review examining the influence of CL wear on MGs found 15 studies reporting an effect of CLs on MGs vs. seven studies who did not. Discrepancies may be due to varying definitions of MGD, types of questionnaires, assessment methods, CL types, and measurement of one vs. both eyelids. The review concluded that the effect of CL wear on MGD should be addressed with a prospective study including non-CL wearing controls and employing an objective assessment of MGs. The Cobra HD meibographer is an objective instrument used in research studies whose inter-session repeatability (ISR), inter-examiner reproducibility (IER) and within-subject variability (WSV) has not been investigated. These measures were evaluated in participants with and without dry eye (DE) symptoms based on their Ocular Surface Disease Index (OSDI) questionnaire. Seventy-two participants (mean age: 23±5 years, 36 asymptomatic) were examined by Examiner 1 in sessions S1 and S2 to calculate the ISR, and seventy-four (mean age: 23±5 years, 37 asymptomatic) were measured on the same day by examiners E1 and E2 to determine the IER. WSV was determined from three consecutive measurements of the same eyelid. Mean MG loss of the upper (S1:13.5±9.5%,S2:12.8±8.5%, E1:12.7±8.2%, E2:13.1±8%) and lower eyelids (S1:7.5±6.9%,S2:7.3±6.3%, E1:7±6.2%, E2:7.4±6.2%) was not significantly different between sessions or examiners for all cohorts for both eyelids. The ISR within-subject standard deviations (Sw) for the upper and lower eyelids were 1.3% and 1.0%; mean difference (md) was 0.7±3.5% [CI:-6.25%- 7.62%] and 0.1±2.1% [CI:-3.94%- 4.17%], respectively. IER ICC values were >0.86 for all conditions, Sw was 1.3% and 1.2% with md of -0.4±3.2% [CI:-6.65%- 5.9%] and -0.4±2.9% [CI:-6.15%- 5.31%], respectively. WSV Sw values were <1.4%, and ICC values were >0.89 for both eyelids, examiners and sessions. Thus, the Cobra meibographer is repeatable, reproducible and has low WSV. The relationship between MGD and CL wear was assessed in 31 fitted CL wearers, 43 over the counter (OTC) CL wearers, and 54 non-CL wearing controls (mean ages: 22.2±3.1, 22.3±3.5, and 23±4.6, respectively). Habitual LogMAR visual acuity (VA), Meibum Quality Score (MQS), Meibum Expressibility Score (MES), MG loss, lid margin abnormalities and DE symptoms of the right eyes of the cohorts were compared using Kruskal-Wallis for ordinal and Pearson Chi-Square test for categorical variables, respectively. Univariate logistic regression examined if CLs are an independent risk factor for MG abnormalities. OTC CL wearers had lower VA than controls (0.82±0.17 vs. 0.93±0.12, p=0.002) and more DE symptoms (3.7±2.4 vs. 2.3±2.1, p=0.002). CL wearers (Fitted:0.6±0.7, p<0.01, OTC:0.8±0.9, p<0.0008) had worse MES than controls (0.2±0.5) and more MG loss (Fitted:16.9%±8.8%, p=0.02, OTC:18.6%±11.3%, p=0.001) than controls (11.2%±6.8%). CL wear was associated with corneal staining (odds ratio(OR)=3.42, 95% confidence interval(CI):1.16–10.11, p=0.03 and OR=5.23, 95%CI: 1.89-14.48, p=0.001, respectively) and MG loss (OR=10.47, 95%CI:1.14-96.29, p=0.04 and OR=16.63, 95%CI:1.96-140.86, p=0.01, respectively). OTC CL wear was also associated with abnormal MQS (OR=12.87, 95%CI:1.12-148.41, p=0.04), conjunctival staining (OR=12.18, 95%CI:3.66-40.51, p=0.0005), and lid margin telangiectasia (OR=3.78, 95%CI:1.55-9.21, p=0.003). CL wearers had significantly more morphological and functional abnormalities than controls. OTC resulted in more DE symptoms, poorer VA, and were an independent predictor for more functional and morphological abnormalities than Fitted CL wearers, emphasizing the importance of proper fitting and aftercare. (Català) La disfunció de les glàndules de Meibomi (MGD) és una anomalia crònica i difusa de les glàndules de Meibomi (MG) que ocorre en el 38% dels usuaris de lents de contacte (LC), encara que la seva influència a la MGD és equívoca. Una revisió de la literatura especialitzada va trobar 15 estudis que van informar d’un efecte de les LC a les MG enfront de set que no. Les discrepàncies poden ser degudes a les diferents definicions de MGD, tipus de qüestionaris, mètodes d'avaluació, tipus de LC i mesurament d'una o de les dues parpelles. Es va concloure que la influència de les LC a la MGD hauria d'abordar-se amb estudis prospectius que incloguin controls no usuaris i una avaluació objectiva. El meibògraf Cobra HD és un instrument de recerca del qual no s’han constatat la repetibilitat entre sessions (ISR), reproductibilitat inter examinadors (IER) i variabilitat intra subjecte (WSV). Aquestes mesures es van avaluar en participants amb símptomes d'ull sec i sense (DE) segons el qüestionari de l'Índex de malaltia de la superfície ocular (OSDI). 72 participants (23±5 anys, 36 asimptomàtics) van ser avaluats per l'examinador 1 a les sessions S1 i S2 per calcular la ISR, i 74 (23±5 anys, 37 asimptomàtics) el mateix dia pels examinadors E1 i E2 per a determinar la IER. La WSV es va establir a partir de tres mesures consecutives de la mateixa parpella. La pèrdua mitjana de MG de les parpelles superior (S1:13.5±9.5%, S2:12.8±8.5%, E1:12.7±8.2%, E2:13.1±8%) i inferior (S1:7.5±6.9 %, S2:7.3± 6.3%, E1:7±6.2%, E2:7.4±6.2%) no va ser significativament diferent entre sessions ni examinadors per a totes les cohorts i per a les dues parpelles. Les desviacions estàndard (Sw) de la ISR intra subjecte per a les parpelles superior i inferior van ser 1.3 % i 1 %; la diferència mitjana (md) va ser 0.7±3.5% i 0.1±2.1%, respectivament. Els valors de IER ICC van ser >0.86 per a totes les condicions, la Sw 1.3% i 1.2% amb md -0.4±3.2% i -0.4±2.9%, respectivament. La Sw WSV <1.4 % i els valors d'ICC >0.89 per a les dues parpelles, examinadors i sessions. Per tant, el meibògraf Cobra és repetible, reproduïble i té una baixa WSV. La relació entre l’ús de LC i la MGD es va avaluar en 31 usuaris de LC adaptades, 43 usuaris de venda sense recepta (OTC) i 54 controls no usuaris. Es van valorar l'agudesa visual (AV) LogMAR habitual, i les puntuacions de qualitat (MQS) i d'expressivitat de Meibomi (MES), la pèrdua de MG, les anomalies al marge de la parpella i els símptomes de DE dels ulls drets de les cohorts i es van comparar utilitzant test de Kruskal-Wallis per a variables ordinals i prova de Chi-quadrat de Pearson per a variables categòriques. La regressió logística univariant va determinar si les LC són un factor de risc independent per a les disfuncions de MG. Els usuaris de LC sense recepta tenien una AV més baixa que els controls (p=0.002) i més símptomes de DE (p=0.002). Els usuaris de LC (Adaptades, p<0.01 i OTC, p<0.0008) tenien pitjor MES que els controls i més pèrdua de MG (Adaptades, p=0.02 i OTC, p=0.001) que els controls. L'ús de LC es va associar amb tincions corneals (odds ratio (OR)=3.42, interval de confiança (IC) del 95%: 1.16-10.11, p=0.03 i OR=5.23, IC del 95%: 1.89-14.48, p=0.001, respectivament) i pèrdua de MG (OR=10.47, IC 95%: 1.14-96.29, p=0.04 i OR=16.63, IC 95%: 1.96-140.86, p=0.01, respectivament). L'ús de LC sense recepta també es va associar amb MQS anormal (OR=12.87, IC del 95%: 1.12-148.41, p=0.04), tinció conjuntival (OR=12.18, IC del 95%: 3.66-40.51, p=0.0005 ) i telangiectàsia en marge palpebral (OR=3.78, IC95%:1.55-9.21, p=0.003). Els usuaris de LC van mostrar més anomalies morfològiques i funcionals que els controls. Els usuaris sense recepta van evidenciar més símptomes de DE i pitjor AV, i van ser un predictor independent de més anomalies funcionals i morfològiques que els usuaris de LC adaptades, cosa que emfatitza la importància d'una adaptació i controls de seguiment adients. (Español) La disfunción de las glándulas de Meibomio (MGD) es una anomalía crónica y difusa de las glándulas de Meibomio (MG) que ocurre en el 38 % de los usuarios de lentes de contacto (LC), aunque su influencia en la MGD es equívoca. Una revisión de la literatura especializada encontró 15 estudios que informaron un efecto de las LC en las MG frente a siete que no. Las discrepancias pueden deberse a las distintas definiciones de MGD, tipos de cuestionarios, métodos de evaluación, tipos de LC y medición de uno frente a ambos párpados. Se concluyó que la influencia de las LC en la MGD debería abordarse con estudios prospectivos que incluya controles no usuarios y la evaluación objetiva. El meibógrafo Cobra HD es un instrumento de investigación cuya repetibilidad entre sesiones (ISR), reproducibilidad inter examinadores (IER) y variabilidad intra sujeto (WSV) no han sido determinadas. Estas medidas se evaluaron en participantes con y sin síntomas de ojo seco (DE) según el cuestionario del Índice de enfermedad de la superficie ocular (OSDI). 72 participantes (23±5 años, 36 asintomáticos) fueron evaluados por el examinador 1 en las sesiones S1 y S2 para calcular la ISR, y 74 (23±5 años, 37 asintomáticos) en el mismo día por los examinadores E1 y E2 para determinar la IER. La WSV se estableció a partir de tres medidas consecutivas del mismo párpado. La pérdida media de MG de los párpados superior (S1:13.5±9.5%, S2:12.8±8,5%, E1:12.7±8.2%, E2:13.1±8%) e inferior (S1:7.5±6.9%, S2:7.3± 6.3%, E1:7±6.2%, E2:7.4±6.2%) no fue significativamente diferente entre sesiones ni examinadores para todas las cohortes y para ambos párpados. Las desviaciones estándar (Sw) de la ISR intra sujeto para los párpados superior e inferior fueron 1.3 % y 1 %; la diferencia media (md) fue 0.7±3.5% y 0.1±2.1%, respectivamente. Los valores de IER ICC fueron >0.86 para todas las condiciones, la Sw 1.3% y 1.2% con md -0.4±3.2% y -0.4±2.9%, respectivamente. La Sw WSV <1.4 % y los valores de ICC >0.89 para ambos párpados, examinadores y sesiones. Por lo tanto, el meibógrafo Cobra es repetible, reproducible y tiene una baja WSV. La relación entre uso de LC y MGD se evaluó en 31 usuarios de LC adaptadas, 43 usuarios de venta sin receta (OTC) y 54 controles no usuarios. Se evaluaron la agudeza visual (AV) LogMAR habitual, las puntuaciones de calidad de Meibomio (MQS) y de expresividad de Meibomio (MES), la pérdida de MG, las anomalías en el margen del párpado y los síntomas de DE de los ojos derechos de las cohortes y se compararon utilizando test de Kruskal-Wallis para variables ordinales y prueba de Chi-cuadrado de Pearson para variables categóricas. La regresión logística univariante determinó si las LC son un factor de riesgo independiente para las disfunciones de MG. Los usuarios de LC sin receta tenían una AV más baja que los controles (p=0.002) y más síntomas de DE (p=0.002). Los usuarios de LC (Adaptadas, p < 0.01 y OTC, p < 0.0008) tenían peor MES que los controles y más pérdida de MG (Adaptadas, p=0.02 y OTC, p=0.001) que los controles. El uso de LC se asoció con tinciones corneales (odds ratio (OR)=3.42, intervalo de confianza (IC) del 95 %: 1.16-10.11, p=0.03 y OR=5.23, IC del 95 %: 1.89-14.48, p=0.001, respectivamente) y pérdida de MG (OR=10.47, IC 95 %: 1.14-96.29, p=0.04 y OR=16.63, IC 95 %: 1.96-140.86, p=0.01, respectivamente). El uso de LC sin receta también se asoció con MQS anormal (OR=12.87, IC del 95 %: 1.12-148.41, p=0.04), tinción conjuntival (OR=12.18, IC del 95 %: 3.66-40.51, p=0.0005) y telangiectasia en margen palpebral (OR=3.78, IC95%:1.55-9.21, p=0.003). Los usuarios de LC mostraron más anomalías morfológicas y funcionales que los controles. Los usuarios de LC sin receta evidenciaron más síntomas de DE y peor AV, y fueron un predictor independiente de más anomalías funcionales y morfológicas que los usuarios de LC adaptadas, lo que enfatiza la importancia de una adaptación y controles de seguimiento adecuados.
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