Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery Evaluation

Abstract

Purpose To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation. Methods Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0–4) for gland atrophy and 3-point scale for gland tortuosity (0–2). Lipid layer thickness and partial blinks were also recorded. Results One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 ± 9.2 years) were reviewed. The mean meiboscale was 1.1 ± 1.0 and the mean tortuosity score was 1.0 ± 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale >0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade ≥1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 ±0.79 and 1.38 ±1.07 for those <35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman’s rho 0.3829, p <0.001). Conclusion Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.

Morphology of Meibomian Glands in a 65-Year-Old Norwegian Population without Dry Eye Disease

“…In the present study, no significant difference in MG morphology between males and females was detected, potentially because the most significant decline in androgen production occurs before the age of 60 years [26], and as Yeotikar et al suggested [27], both men and women at 65 years of age are androgen deficient, resulting in similar alterations in MGs. Our results of no sex differences were in accordance with several previous publications [9,[27][28][29][30]. However, they are not in line with other studies [8,11,31].…”

Correlation of meiboscale symptom score and sign score for primary meibomian gland dysfunction in Indian eyes – A cross-sectional study

“…However, they did not correlate the two parameters among MGD patients. Brooks and Gupta[ 22 ] showed that the mean Meiboscale score was 0.89 for subjects <35 years of age going for refractive surgery and 1.38 for those >35 years. However, they have not provided details about those with preexisting MGD.…”

The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery

“…Brooks and Gupta used meibography to demonstrate the prevalence of abnormal meibomian gland morphology prior to refractive surgery [21 ▪▪ ]. In a sample of 120 patients who were scheduled for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK) or phakic intraocular lens surgery, nearly three-quarters had some degree of meibomian gland atrophy, and 8.3% had a significant degree of atrophy.…”