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Wu J, Liang Y, Shi F, Tu X, Zhang J, Qiu Q. Meibomian gland dropout of upper eyelids as a novel biomarker for early diagnosis of primary Sjögren's syndrome: a pilot study. Ther Adv Musculoskelet Dis 2024; 16:1759720X241274726. [PMID: 39228398 PMCID: PMC11369872 DOI: 10.1177/1759720x241274726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Background Early diagnosis of primary Sjögren's syndrome (pSS) remains difficult due to its insidious onset. Objectives To identify whether meibomian gland dropout (MGD) is a sensitive and noninvasive predictor of pSS by studying its association with histopathology in labial salivary gland biopsy in patients with clinically suspected pSS. Design Prospective, randomized, multicenter, comparative effectiveness study. Methods The study was conducted from July 2022 to July 2023. In all, 56 eligible participants with clinically suspected pSS were recruited from three combined ophthalmology medicine/rheumatology SS clinics. All participants with suspected pSS were evaluated and diagnosed by ophthalmology and rheumatology consultants and underwent infrared imaging of the meibomian glands using Keratograph 5M and histopathological evaluation of labial salivary gland biopsies. The length, width, and tortuosity of the meibomian glands were measured; the dropout rate in the nasal, temporal, and total eyelids was analyzed; and the dropout score was calculated using meibography grading scales. Results Among the 56 participants, 34 were identified with pSS, and 22 were diagnosed with non-SS dry eye (NSSDE) and served as the control group. We recorded significant differences in the temporal and total MGD rates of the upper eyelids between the pSS and NSSDE groups (all p < 0.01). Improved prediction accuracy was achieved with the temporal and total MGD rates in the upper eyelids, with area under the curve values of 0.94 and 0.91, and optimal cutoff points of 0.78 and 0.75, respectively. Conclusion MGD in the upper eyelids, especially in the temporal portion, is strongly associated with the histopathological outcome of labial salivary gland biopsy in pSS and is proposed as a highly predictive and noninvasive biomarker for the early diagnosis of pSS. Trial registration ClinicalTrials.gov identifier: ChiCTR2000038911.
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Affiliation(s)
- Jing Wu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongying Liang
- Department of Rheumatology, Shanghai University of Traditional Chinese Medicine Affiliated Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Fanjun Shi
- Department of Ophthalmology, Wuhu Eye Hospital, Anhui, China
| | - Xianghong Tu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingfa Zhang
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, 518000 China. C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, 518000 China. C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, 999077 China
| | - Qinghua Qiu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ravichandran S, Pucker AD. Comparing meibomian gland visibility on optical coherence tomography and Keratograph 5M images using objective and subjective grading methods. Cont Lens Anterior Eye 2024; 47:102162. [PMID: 38565442 DOI: 10.1016/j.clae.2024.102162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To investigate if there is a visible difference in meibomian gland (MG) length between images captured with the Visante optical coherence tomography (OCT; wavelength = 1,310 nm) and the OCULUS Keratograph 5M (K5M; wavelength = 880 nm). METHODS Adults between 18 and 40 years were recruited. Baseline dry eye disease was evaluated with the Standard Patient Evaluation of Eye Dryness (SPEED) and tear meniscus height and tear breakup time with the K5M. Right upper and lower eyelid MGs were imaged with the K5M and Visante OCT. Each image was graded with the 0 to 3 meiboscore scale. The central 5 MGs were evaluated with ImageJ for percent gland length visibility. RESULTS Thirty participants were analyzed with a median (interquartile range [IQR]) age of 23.0 (5.0) years (53.3 % female). Overall, participants were asymptomatic and had normal tear films. Meiboscores based on K5M and Visante OCT was significantly different for the lower eyelid (0[1] vs 1[2]; p = 0.007) but not the upper eyelid (0[1] vs 0[1]; p = 1.00). The mean percent gland visibility of the upper eyelid (82.7[9.6] vs 75.2[13.5]; p < 0.001) and the lower eyelid (81.2[12.7] vs 64.1[17.6]; p < 0.001) were significantly greater on the Visante OCT than the K5M images, respectively. CONCLUSION OCT images had significantly greater percent visible MG lengths than the K5M images. This suggests viable segments of the MGs may be missed with typical imaging, which may explain how it is possible that studies have found less post-treatment MG atrophy.
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Affiliation(s)
- Swetha Ravichandran
- School of Optometry, University of Alabama at Birmingham, Alabama, United States
| | - Andrew D Pucker
- School of Optometry, University of Alabama at Birmingham, Alabama, United States; Lexitas Pharma Services, Durham, NC, United States.
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Liao Y, Zhao W, Yang J, Li J, Chen J, Chen Z, Jin L, Li L, Huang F, Liang L. Delayed diagnosis of ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Ocul Surf 2024; 34:1-8. [PMID: 38821405 DOI: 10.1016/j.jtos.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/03/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To investigate the delayed diagnosis of chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT), and further analyze potential confounding factors. METHODS This cross-sectional study included 118 patients newly diagnosed as coGVHD after alloHCT at Zhongshan Ophthalmic Center, Sun Yat-sen University. All participants finished the flow path of medical history taking, detailed ophthalmological examination and questionnaire-based survey. coGVHD was diagnosed and graded by International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. Lag time of diagnosis was defined as interval between noting of ocular symptoms and confirmed diagnosis of coGVHD (TN-D). We further compared the clinical parameters between groups categorized by the median TN-D as medium and long delay groups. RESULTS The median TN-D was 6.3 [IQR 2.8-14.5] months. Most coGVHD patients underwent delayed diagnosis of coGVHD longer than 3 months (70 %, 83 of 118), with 90 of 118 diagnosed as severe coGVHD (76 %). The long delay group exhibited higher ICOGCG scores (10 [IQR 9-10.5] vs. 9 [IQR 8-10], P = 0.039) and more pronounced ocular signs, including conjunctival injection, meibomian gland loss, fibrotic tarsal conjunctiva, symblepharon, and corneal complications (all P < 0.05). Delayed diagnosis was strikingly correlated with seeking ophthalmic medical care twice or more prior to diagnosis (adjusted OR = 5.42, 95%CI: 1.40-21.06, P = 0.015) and accurate knowledge of ocular discomfort symptoms in coGVHD (adjusted OR = 0.29, 95%CI: 0.08-1.00, P = 0.050). CONCLUSIONS Delayed diagnosis of coGVHD, associated with disease severity, was common among alloHCT recipients in southern China. Improving patient education and the awareness of ophthalmologists may facilitate early diagnosis of coGVHD.
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Affiliation(s)
- Yinglin Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Wenxin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Jing Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Juejing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Ziyan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Longyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China.
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Liao Y, Li J, Yang J, Zhao W, Chen Z, Wu S, Jin L, Huang F, Liang L. Sleep Quality in Patients With Ocular Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation. Eye Contact Lens 2024; 50:145-151. [PMID: 37791837 DOI: 10.1097/icl.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To investigate the sleep quality in patients with ocular graft-versus-host disease (oGVHD) compared with patients without oGVHD after allogeneic hematopoietic stem cell transplantation (alloHCT) and healthy controls. METHODS This cross-sectional study analyzed 142 patients after alloHCT including 94 patients with oGVHD and 48 without. Fifty healthy controls were also enrolled. oGVHD was diagnosed according to International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Poor sleep quality was defined as CPQSI score greater than 6. RESULTS Patients after alloHCT demonstrated a significantly higher CPQSI score than those of controls {7.0 [interquartile range (IQR) 5.0-10.0] vs. 5.5 [IQR 4.8-7.0], P =0.002}, especially in the oGVHD subgroup (7.5 [IQR 5.0-11.0] vs. 6.0 [IQR 5.0-8.0], P =0.04) with nearly double prevalence of poor sleep quality (58 [62%] vs. 18 [37%], P =0.006). Poor sleep quality was strikingly correlated with oGVHD diagnosis (adjusted odds ratio [OR]=2.55, 95% confidence interval [CI]: 1.02-6.34, P =0.04) and systemic immunosuppressants (adjusted OR=2.61, 95% CI: 1.32-5.71, P =0.02). Among the ocular parameters, poor sleep quality was significantly associated with higher ICOGCG score (adjusted OR=1.20, 95% CI: 1.03-1.39, P =0.02) and lower tear film break-up time (adjusted OR=0.85, 95% CI: 0.74-0.99, P =0.05). CONCLUSIONS Poor sleep quality was associated with an increased severity of oGVHD and tear film instability in the long-term alloHCT survivorship.
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Affiliation(s)
- Yinglin Liao
- State Key Laboratory of Ophthalmology (Y.L., J.L., J.Y., W.Z., Z.C., S.W., L.J., L.L.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease; and Department of Hematology (F.H.), Nanfang Hospital, Southern Medical University, Guangzhou, China
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Chen Y, Zhuang X, Wang L, Xu Y, Sun Z, Ren Y, Chen F, Ma X, Tang X, Zhang X. The Role of IL-6, IL-10, and TNF-α in Ocular GVHD Following Allogeneic Transplantation. Ocul Immunol Inflamm 2024:1-8. [PMID: 38252122 DOI: 10.1080/09273948.2024.2302445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE To figure out the roles of tear inflammatory cytokines in Ocular graft-versus-host disease (oGVHD) symptoms by analyzing tear cytokine levels and related factors. METHODS This prospective study involved 27 post-HSCT patients and 19 controls with dry eye disease. Analyses included tear cytokine (IL-6, IL-10, and TNF-α), ocular surface evaluation, and conjunctival impression cell examination. Tear cytokine levels were evaluated in three grades of corneal epithelial lesions. The study also analyzed the correlation between tear cytokine levels and ocular surface parameters. Tear cytokine levels were then used in a Receiver Operating Characteristic (ROC) curve and linear regression model to predict oGVHD related factors. RESULTS IL-6 has good diagnostic efficacy in oGVHD related dry eye. Elevated levels of tear IL-6 and TNF-α were observed in the group with severe corneal epithelial lesions. IL-6 levels were positively correlated with corneal fluorescein staining (CFS), eyelid margin hyperemia, conjunctival lesions, and meibum secretion. IL-6 showed excellent predictive ability with Area Under the Curve (AUC) values all greater than 0.70 (p < 0.05). IL-10 and TNF-α were negatively correlated with the meibomian gland proportion and conjunctival goblet cell (GC) density, while TNF-α was positively correlated with CFS and eyelid margin hyperemia. CONCLUSION Dry eye symptoms related to ocular GVHD, can be partly diagnosed and assessed using various tear cytokine level detection methods.
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Affiliation(s)
- Yingjie Chen
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Xinyu Zhuang
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Lei Wang
- Department of Ophthalmology, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, China
| | - Yue Xu
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhengtai Sun
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yaru Ren
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao Ma
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaowen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaofeng Zhang
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
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Fadel D. Medmont Meridia™: Much More Than a Corneal Topographer. CLINICAL OPTOMETRY 2023; 15:283-301. [PMID: 38054029 PMCID: PMC10695145 DOI: 10.2147/opto.s433899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
In recent years, advanced diagnostic instruments have become widely available in optometric practices, offering various functions that optimize clinical information gathering. This article focuses on the Medmont Meridia™, a state-of-the-art multipurpose diagnostic device with corneal topography and cutting-edge features. Corneal topography is pivotal in the early diagnosis of corneal disorders, determining baseline ocular surface assessment, helping in contact lens fitting, and monitoring ocular health over time. The Medmont Meridia boasts Placido-disc-based imaging with extensive corneal coverage. Furthermore, the Meridia accurately measures the horizontal visible iris diameter, pupil diameter, and palpebral fissure width, which assists in making contact lens parameter decisions. Additionally, it offers sagittal height data for scleral lens design and first lens selection, streamlining the fitting process. Beyond its topography capabilities, the Meridia excels as a comprehensive dry eye assessment tool. With features like tear meniscus height, tear film surface quality, and meibography capabilities, it aids in diagnosing dry eye and monitoring its progression. The device also provides customizable dry eye reports with integrated grading scales and questionnaires, making dry eye management, patient education, and compliance more accessible. In conclusion, the Medmont Meridia consolidates a multitude of examination tools in a single instrument, enhancing practice efficiency and elevating patient care and communication. Its versatility and accuracy make it an invaluable asset in optometric practices worldwide.
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Affiliation(s)
- Daddi Fadel
- Center for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
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Diz-Arias E, Fernández-Jiménez E, Peral A, Gomez-Pedrero JA. A Comparative Study of Two Imaging Techniques of Meibomian Glands. Life (Basel) 2023; 13:life13030791. [PMID: 36983946 PMCID: PMC10051416 DOI: 10.3390/life13030791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
In the present study, two different meibographers, Oculus Keratograph 5M (K5M) that uses 840 nm infrared light and the Visible Light Non-Contact Meibographer (VLNCM) that uses 610 nm visible light have been used to obtain meibography images from normal and Meibomian Gland Dysfunction (MGD) population. The main objective has been to validate and demonstrate that the use of visible light is useful for observation and quantification of MG in clinical practice. Twenty participants were enrolled in this prospective study. The upper eyelids of one randomly chosen eye were used to obtain results. Forty images were captured and analysed. Three specialized observers were recruited to grade images using Pult and Riede Pult 5-degree scale, in two different sessions. Intra-observer agreement between sessions for both devices was shown. Inter-observer variability analysis showed discrepancy between meiboscores obtained from observers with K5M (p-value < 0.05), except for session 2 in the pathology group, while no statistical difference was found with VLNCM. Repeatability analysis found no statistically significant differences between sessions. Correlation between meibographers showed no statistically significant difference and a moderate correlation coefficient between meiboscores graded with the two devices. The current study suggests that VLNCM can allow MG to be properly visualized and classified in the upper eyelids.
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Affiliation(s)
- Elena Diz-Arias
- Optics Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
- Correspondence: ; Tel.: +34-680821782
| | - Elena Fernández-Jiménez
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Assumpta Peral
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Jose A. Gomez-Pedrero
- Optics Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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Du YL, Peng X, Liu Y, Wang JS, Ye YF, Xu KK, Qu JY, Chen H, Xie HT, Zhang MC. Ductal Hyperkeratinization and Acinar Renewal Abnormality: New Concepts on Pathogenesis of Meibomian Gland Dysfunction. Curr Issues Mol Biol 2023; 45:1889-1901. [PMID: 36975492 PMCID: PMC10047716 DOI: 10.3390/cimb45030122] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Meibomian gland dysfunction (MGD) is a functional and morphological disorder of the meibomian glands which results in qualitative or quantitative alteration in meibum secretion and is the major cause of evaporative dry eye (EDE). EDE is often characterized by tear film instability, increased evaporation, hyperosmolarity, inflammation, and ocular surface disorder. The precise pathogenesis of MGD remains elusive. It has been widely considered that MGD develops as a result of ductal epithelial hyperkeratinization, which obstructs the meibomian orifice, halts meibum secretion, and causes secondary acinar atrophy and gland dropout. Abnormal self-renewal and differentiation of the acinar cells also play a significant role in MGD. This review summarizes the latest research findings regarding the possible pathogenesis of MGD and provides further treatment strategies for MGD-EDE patients.
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Affiliation(s)
- Ya-Li Du
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xi Peng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yang Liu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - You-Fan Ye
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kang-Kang Xu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing-Yu Qu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua Chen
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Liao Y, Zhao W, Yang J, Wu S, Jin L, Huang F, Liang L. Vision-specific and cancer-specific quality of life in ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Graefes Arch Clin Exp Ophthalmol 2023; 261:453-465. [PMID: 36029303 DOI: 10.1007/s00417-022-05812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the vision-specific and cancer-specific quality of life (QOL) between patients with and without ocular graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT). METHODS This cross-sectional observational study analyzed 142 patients after alloHCT including 94 patients with oGVHD and 48 without. oGVHD was diagnosed according to International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. QOL was assessed by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). RESULTS Compared with non-oGVHD patients, patients with oGVHD had worse vision-specific (NEI VFQ-25: 64.3 ± 20.3 vs. 77.6 ± 19.3, P < 0.001) and cancer-specific (EORTC QLQ-C30: 59.9 ± 20.3 vs. 67.4 ± 17.5, P = 0.03) QOL, as well as impaired cognitive function (72.7 ± 22.1 vs. 82.3 ± 19.0, P = 0.01). The vision-specific QOL was significantly correlated with ICOGCG score (β = - 1.88, 95%CI: - 3.35 to - 0.41, P = 0.01) and post-alloHCT medical expense (β = - 5.70, 95%CI: - 10.35 to - 1.05, P = 0.02), while cancer-specific QOL was strikingly correlated with post-alloHCT medical expense (β = - 9.91, 95%CI: - 14.43 to - 5.39, P < 0.001), frequency of ophthalmic medication (β = - 0.93, 95%CI: - 1.64 to - 0.21, P = 0.01), education (β = - 6.97, 95%CI: - 13.31 to - 0.62, P = 0.03), and peripheral blood stem cell use (β = - 6.42, 95%CI: - 12.59 to - 0.25, P = 0.04). CONCLUSIONS Patients with oGVHD experienced significant impairment in both vision-specific and cancer-specific QOL including cognitive function when compared with those without after alloHCT. Multidimensional QOL assessment should be included in the long-term alloHCT survivorship care.
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Affiliation(s)
- Yinglin Liao
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Wenxin Zhao
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Jing Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Shaowen Wu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, 1838S North of Guangzhou Avenue, Guangzhou, 510515, China.
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
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Zhuang XY, Sun ZT, Xu Y, Ren YR, Chen YJ, Chen F, Ma X, Tang XW, Zhang XF. Correlative factors of ocular surface lesions after allogeneic hematopoietic stem cell transplantation: A retrospective study. Front Oncol 2022; 12:1040679. [PMID: 36479063 PMCID: PMC9719980 DOI: 10.3389/fonc.2022.1040679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/07/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Ocular graft-versus-host disease (oGVHD) is one of the complications after allogeneic hematopoietic stem cell transplantation (HSCT), which impairs the quality of life and may indicate poor prognosis. In this retrospective study, the aim was to investigate the characteristics of ocular surface after HSCT, and analyze the risk factors related to the severity of ocular surface lesions. METHODS 248 post-HSCT patients were enrolled in this retrospective study. Subjects were divided into no lesion group, mild lesion group and severe lesion group, according to the severity of ocular surface lesions. The correlations between grades of ocular surface lesions and gender, age, primary disease, donor source, human leukocyte antigen (HLA) type, kinship, donor-recipient relationship, blood type, source of stem cell and systemic GVHD were analyzed. RESULTS The median scores of corneal epitheliopathy, lid margin lesions and meibomian gland loss were 3, 6 and 2 points, respectively. The grade of corneal epitheliopathy was related to donor source (P<0.001), kinship (P=0.033), HLA-matching (P<0.001), and systemic GVHD (P=0.007), especially oral GVHD (P<0.001) and liver GVHD (P=0.002). The grade of lid margin lesions was related to donor source (P=0.019), HLA-matching (P=0.006), and systemic GVHD (P=0.013), especially skin GVHD (P=0.019) and oral GVHD (P=0.019). The grade of meibomian gland loss was related to age (P=0.035) and gastrointestinal GVHD (P=0.007). The grade of corneal epitheliopathy after HSCT was related to the lid margin lesion score (P<0.001). CONCLUSIONS The occurrence and development of ocular GVHD are mostly accompanied by the history of systemic GVHD. While in few cases, ocular surface lesions related to GVHD can be observed prior to the rejection of other tissues and organs. Severe corneal epitheliopathy occurs in patients with severe lid margin lesions in ocular GVHD. The lesions of corneal epithelium and lid margin are milder in HLA partially matching transplantation.
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Affiliation(s)
- Xin-Yu Zhuang
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zheng-Tai Sun
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Xu
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ya-Ru Ren
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying-Jie Chen
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Feng Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao Ma
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao-Wen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao-Feng Zhang
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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11
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Is contact lens discomfort related to meibomian gland morphology? Cont Lens Anterior Eye 2022; 45:101743. [PMID: 36028427 DOI: 10.1016/j.clae.2022.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the relationship between contact lens (CL) discomfort and meibomian gland (MG) morphology assessed by a semi-objective software in subjects without an alteration of MG function (meibum quality and expressibility). METHODS Nineteen symptomatic (CLDEQ-8 ≥ 12) CL wearers, 19 asymptomatic (CLDEQ-8 < 12) wearers, and 22 non-wearers were recruited. Upper and lower eyelid meibography images were taken and the following parameters were analysed using a semi-objective software in the central 2/3 of each eyelid: number of MG, number of partial MG, percentage of MG loss and percentage of tortuosity. One-way ANOVA or Kruskal-Wallis H test were used for comparisons among groups. The relationships between CLDEQ-8 and MG morphology parameters were analysed using the Spearman correlation coefficient and multivariable linear regression models. RESULTS No significant differences were found among groups in the MG morphology of the upper or lower eyelids. In all CL wearers, a significant correlation with CLDEQ-8 was found in the upper eyelid for the number of MG (rho = 0.47, p = 0.003). In symptomatic wearers, significant correlations with CLDEQ-8 were found in the lower eyelid for the number of partial MG (rho = 0.49, p = 0.03) and the percentage of partial MG (rho = 0.61, p = 0.005). In all CL wearers, multivariable models were fitted to explain CLDEQ-8 score including the number of MG, the number of partial MG and the percentage of MG loss from the lower eyelid (R2 = 0.19; p = 0.007), and the number of MG from the upper eyelid (R2 = 0.19; p = 0.001). In symptomatic wearers, a model was fitted including the percentage of MG loss from the lower eyelid (R2 = 0.30; p = 0.016). CONCLUSIONS Alterations of MG morphology, without clinically apparent alteration of MG function, can be involved in causing CL discomfort and influence the degree of symptoms. The differences in findings between eyelids indicate the need to monitor both eyelids, especially the lower one, in CL wearers.
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2D Short-Time Fourier Transform for local morphological analysis of meibomian gland images. PLoS One 2022; 17:e0270473. [PMID: 35749421 PMCID: PMC9491703 DOI: 10.1371/journal.pone.0270473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022] Open
Abstract
Meibography is becoming an integral part of dry eye diagnosis. Being objective
and repeatable this imaging technique is used to guide treatment decisions and
determine the disease status. Especially desirable is the possibility of
automatic (or semi-automatic) analysis of a meibomian image for quantification
of a particular gland’s feature. Recent reports suggest that in addition to the
measure of gland atrophy (quantified by the well-established “drop-out area”
parameter), the gland’s morphological changes may carry equally clinically
useful information. Here we demonstrate the novel image analysis method
providing detailed information on local deformation of meibomian gland pattern.
The developed approach extracts from every Meibomian image a set of six
morphometric color-coded maps, each visualizing spatial behavior of different
morphometric parameter. A more detailed analysis of those maps was used to
perform automatic classification of Meibomian glands images. The method for
isolating individual morphometric components from the original meibomian image
can be helpful in the diagnostic process. It may help clinicians to see in which
part of the eyelid the disturbance is taking place and also to quantify it with
a numerical value providing essential insight into Meibomian gland dysfunction
pathophysiology.
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13
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Latest developments in meibography: A review. Ocul Surf 2022; 25:119-128. [PMID: 35724917 DOI: 10.1016/j.jtos.2022.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
Meibography is a visualisation technique that has been used for over 40 years. There have been significant improvements in image quality, examination technique and image interpretation over this period. Although meibography has received sporadic reviews in the past, an updated review is timely due to the rapid recent rise of relevant technology and advances in both image processing and artificial intelligence. The primary aim of this paper is to review recent research into Meibomian gland imaging and update the community about the most relevant technologies and approaches used in the field.
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Luo X, Wen W, Wang J, Xu S, Gao Y, Huang J. Health classification of Meibomian gland images using keratography 5M based on AlexNet model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106742. [PMID: 35398622 DOI: 10.1016/j.cmpb.2022.106742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE We aim to present effective diagnostics in the field of ophthalmology and improve eye health. The purpose of this study is to examine the capability of health classification of Meibomian gland dysfunction (MGD) using Keratography 5M and AlexNet method. METHOD A total of 4,609 meibomian gland images were collected from 2,000 patients using Keratography 5M in the hospital. Then, MGD dataset for eyelid gland health recognition was constructed through image pre-processing, labelling, cropping and augmentation. Furthermore, AlexNet network was used to identify the eyelid gland health. The effects of different optimization methods, different learning rates, Dropout methods and different batch sizes on the recognition accuracy were discussed. RESULTS The results show that the effect of model recognition is the best when the optimized method is Adam, the number of iterations is 150, the learning rate is 0.001, and the batch size is 80, then, the overall test accuracy of health degree is 94.00%. CONCLUSION Our research provides a reference to the clinical diagnosis or screening of eyelid gland dysfunction. In future implementations, ophthalmologists can implement more advanced learning algorithms to improve the accuracy of diagnosis.
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Affiliation(s)
- Xianxian Luo
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou 362000, China; Fujian Provincial Key Laboratory of Data Intensive Computing, Quanzhou 362000, China
| | - Wenghao Wen
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou 362000, China; Fujian Provincial Key Laboratory of Data Intensive Computing, Quanzhou 362000, China
| | - Jingru Wang
- Department of Ophthalmology, 2nd Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China
| | - Songya Xu
- Faculty of Educational Science, Quanzhou Normal University, Quanzhou 362000, China
| | - Yingying Gao
- Department of Ophthalmology, 2nd Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
| | - Jianlong Huang
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou 362000, China; Fujian Provincial Key Laboratory of Data Intensive Computing, Quanzhou 362000, China
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Zhang Z, Lin X, Yu X, Fu Y, Chen X, Yang W, Dai Q. Meibomian Gland Density: An Effective Evaluation Index of Meibomian Gland Dysfunction Based on Deep Learning and Transfer Learning. J Clin Med 2022; 11:2396. [PMID: 35566522 PMCID: PMC9099803 DOI: 10.3390/jcm11092396] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to establish an artificial intelligence (AI) system based on deep learning and transfer learning for meibomian gland (MG) segmentation and evaluate the efficacy of MG density in the diagnosis of MG dysfunction (MGD). First, 85 eyes of 85 subjects were enrolled for AI system-based evaluation effectiveness testing. Then, from 2420 randomly selected subjects, 4006 meibography images (1620 upper eyelids and 2386 lower eyelids) graded by three experts according to the meiboscore were analyzed for MG density using the AI system. The updated AI system achieved 92% accuracy (intersection over union, IoU) and 100% repeatability in MG segmentation after 4 h of training. The processing time for each meibography was 100 ms. We discovered a significant and linear correlation between MG density and ocular surface disease index questionnaire (OSDI), tear break-up time (TBUT), lid margin score, meiboscore, and meibum expressibility score (all p < 0.05). The area under the curve (AUC) was 0.900 for MG density in the total eyelids. The sensitivity and specificity were 88% and 81%, respectively, at a cutoff value of 0.275. MG density is an effective index for MGD, particularly supported by the AI system, which could replace the meiboscore, significantly improve the accuracy of meibography analysis, reduce the analysis time and doctors’ workload, and improve the diagnostic efficiency.
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Affiliation(s)
- Zuhui Zhang
- School of Ophthalmology and Optometry, The Eye Hospital of Wenzhou Medical University, 270 Xueyuanxi Road, Wenzhou 325027, China; (Z.Z.); (X.Y.); (Y.F.); (X.C.)
| | - Xiaolei Lin
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai 200126, China;
| | - Xinxin Yu
- School of Ophthalmology and Optometry, The Eye Hospital of Wenzhou Medical University, 270 Xueyuanxi Road, Wenzhou 325027, China; (Z.Z.); (X.Y.); (Y.F.); (X.C.)
| | - Yana Fu
- School of Ophthalmology and Optometry, The Eye Hospital of Wenzhou Medical University, 270 Xueyuanxi Road, Wenzhou 325027, China; (Z.Z.); (X.Y.); (Y.F.); (X.C.)
| | - Xiaoyu Chen
- School of Ophthalmology and Optometry, The Eye Hospital of Wenzhou Medical University, 270 Xueyuanxi Road, Wenzhou 325027, China; (Z.Z.); (X.Y.); (Y.F.); (X.C.)
| | - Weihua Yang
- Affiliated Eye Hospital, Nanjing Medical University, No.138 Hanzhong Road, Nanjing 210029, China
| | - Qi Dai
- School of Ophthalmology and Optometry, The Eye Hospital of Wenzhou Medical University, 270 Xueyuanxi Road, Wenzhou 325027, China; (Z.Z.); (X.Y.); (Y.F.); (X.C.)
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua 321004, China
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Hanna S, Hartstein M, Mukari A, Shor S, Habib G, Hamed Azzam S. Global improvement in meibomian glands after chalazion surgery demonstrated by meibography. Int Ophthalmol 2022; 42:2591-2598. [PMID: 35412124 DOI: 10.1007/s10792-022-02307-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the use of meibography as an objective measure of the effects of incision & curettage (I&C) chalazion surgery on meibomian gland loss and morphology as well as dry eye syndrome. METHODS This prospective, interventional clinical study included adult patients with a primary chalazion which persisted despite conservative treatment. All patients underwent I&C surgery. The following parameters were compared both preoperatively and 21 days postoperatively: meibography, tear breakup time (TBUT), Schirmer test, meibum expression, tear meniscus height, meibomian gland dysfunction (MGD) grading, and the Ocular Surface Disease Index (OSDI). RESULTS Thirty eyelids were enrolled in the study. The mean age ± SD was 40.56 ± 13.94 years. Meibography demonstrated a significant decrease in meibomian gland loss (P = 0.00) and improvement in morphology. The most common meibomian gland pathology preoperatively noted was morphological signs of atrophy that included fluffy areas and tortuous glands. Both of these findings improved postoperatively (P = 0.04 and P = 0.02, respectively). There were a significant change in MGD grading and a significant decrease in meibum expression score postoperatively (P = 0.00). TBUT and tear meniscus height also improved significantly (P = 0.00 and P = 0.003, respectively). The OSDI score improved significantly as well (P = 0.00). CONCLUSION While incision and drainage surgery is a time-honored, standard treatment for chalazion, meibography now demonstrates a global improvement in the meibomian glands, not just the ones involved with the chalazion. In addition to the improvements in the clinical and dry eye syndrome parameters improvements, meibography findings demonstrate that early I&C surgery restores the meibomian glands architecture significantly.
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Affiliation(s)
- Saleem Hanna
- Ophthalmology Department, Baruch Padeh Medical Center, Dov Hoz 0., 15208, Poriya, Israel
| | - Morris Hartstein
- Ophthalmology Department, Shamir Medical Center, Tzrifin, Israel
| | | | - Slava Shor
- Ophthalmology Department, Baruch Padeh Medical Center, Dov Hoz 0., 15208, Poriya, Israel
| | - George Habib
- Rheumatology Unit, Laniado hospital, Netanya, Israel
| | - Shirin Hamed Azzam
- Ophthalmology Department, Baruch Padeh Medical Center, Dov Hoz 0., 15208, Poriya, Israel.
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A Pilot Study of the Effects of Swimming Goggles on Meibomian Glands. Eye Contact Lens 2022; 48:169-174. [PMID: 35296628 DOI: 10.1097/icl.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated whether swimming goggle wear contributes to meibomian gland (MG) atrophy or functional change. METHODS Subjects included minimal goggle wear experience (normal subjects) and maximal goggle wear experience (competitive swimmers). Principal outcome measures were meiboscore and percent MG area remaining percent gland area remaining [PGAR]). Clinical tests included symptoms, tear meniscus height, lipid layer thickness, fluorescein tear breakup time, corneal and conjunctival staining, lower lid margin signs, gland secretion quality, Schirmer I, and meibography. RESULTS Forty-two age-matched, and sex-matched subjects completed the study (25 normal subjects and 17 goggle-wearing swimmers). Tear breakup time was significantly shorter in goggle wearers (P=0.016, Mann-Whitney U). Differences in meibography, symptoms, and other clinical dry eye workup parameters were not statistically significant (all P values >0.05). Regression analysis indicated that sex, tear breakup time, and meiboscore statistically impacted PGAR. CONCLUSIONS There was no apparent difference in MG morphology and function between goggle-wearing swimmers and nongoggle-wearing control subjects in this study sample. Although swimming goggles have been documented as having adverse effects on the periorbital tissues, mechanical forces from long-term swimming goggle wear may not impact MG morphology or function. The tarsal plate likely plays a protective role for the MGs from external mechanical friction from swimming goggles.
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Panjiyar M, Sadhu S, Shobha PS, S S, Agarwal S, Srinivasan B, Iyer G. Structural and Functional Evaluation of Meibomian Glands and Its Correlation With Dry Eye Parameters in Stevens-Johnson Syndrome. Am J Ophthalmol 2022; 240:187-193. [PMID: 35288074 DOI: 10.1016/j.ajo.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the structural and functional changes of the meibomian gland and correlate with subjective and other objective dry eye parameters in Stevens-Johnson syndrome (SJS) patients. DESIGN Prospective cross-sectional study. METHODS This study recruited 60 patients (120 eyes) with SJS and chronic ocular sequelae. All patients underwent evaluation with a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear osmolarity, Keratograph 5M, LipiView, Schirmer's 1, corneal staining, Meibum Expression score (MES, 0-3), and Meibum Quality score (MQS, 0-3). The meibomian gland dropout area (meiboscore) was calculated for both lids and graded on a 4-point scale from 0 to 3. RESULTS The mean age of patients (n = 60) was 31.08 ± 12.94 years; 25 were males. The commonest cause for SJS, in 51 patients (85%), was drug reaction. The mean tear osmolarity, lipid layer thickness (LLT), Schirmer's test-1, and tear break-up time was 322.70 ± 17.82 mOsm/L, 53.07 ± 27.0 nm, 6.62 ± 5.74 mm, 3.38 ± 1.90 seconds, respectively. Out of 240 eyelids (both upper and lower), 160 (65%) eyelids revealed severe meibomian gland loss. The mean upper and lower lid gland loss was 77.36 ± 28.82% and 76.65 ± 29.33%, respectively, Seventy-four eyelids (61%) had no expressible glands. Meiboscore showed positive correlation with SPEED (P < .001), corneal staining scores (P < .001), MES (P < .001), and MQS (P < .001). The LLT negatively correlation with SPEED (P < .01), meiboscore (P < .001), MES (P < .01), and MQS (P < .001). CONCLUSION Significant alterations in anatomical and functional aspects of the meibomian gland are seen in SJS. The high meiboscore, MES, MQS, and decreased LLT contributed to the worsening dry eye state, as seen by their correlation with other dry eye parameters. This study highlights the need to evaluate meibomian gland structure and function in patients with chronic ocular sequelae of SJS.
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Lid Margin Score Is the Strongest Predictor of Meibomian Area Loss. Cornea 2022; 41:699-708. [DOI: 10.1097/ico.0000000000002913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
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Morphology of Meibomian Glands in a 65-Year-Old Norwegian Population without Dry Eye Disease. J Clin Med 2022; 11:jcm11030527. [PMID: 35159978 PMCID: PMC8836511 DOI: 10.3390/jcm11030527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
Analyses of meibography may help in the diagnosis, prevention, and management of meibomian gland dysfunction (MGD). However, there is currently a paucity of data regarding meibography analyses in the young elderly populations in the Nordic countries. In the current study, meibography of the upper and lower eyelids of 117 65-year-old residents in Oslo, Norway, who did not fulfil the diagnosis of dry eye disease (DED) were analysed. Meibomian gland (MG) dropout and tarsal areas were measured semi-automatically using ImageJ software. The relationship between morphological features of the MGs and clinical dry eye tests was examined. The median percent MG dropout was 26.1% and 40.7% in the upper and lower eyelids, respectively. There was no significant difference between males and females. None of the MG morphological parameters demonstrated significant values in discriminating abnormal dry eye symptom loads or MGD diagnosis from the normal loads. We therefore concluded that moderate MG atrophy was common among the Norwegian population of 65-year-olds without DED and showed no sexual differences. Meibography alone cannot discriminate MGD from non-MGD; thus, both morphological and functional MG tests are necessary when screening for MGD.
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Tian L, Wen Y, Li S, Zhang P, Wang Y, Wang J, Cao K, Du L, Wang N, Jie Y. Benefits and Safety of Astaxanthin in the Treatment of Mild-To-Moderate Dry Eye Disease. Front Nutr 2022; 8:796951. [PMID: 35096941 PMCID: PMC8792747 DOI: 10.3389/fnut.2021.796951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: To evaluate the effect of astaxanthin in the treatment of mild-to-moderate dry eye disease (DED) in middle-aged and elderly patients. Methods: 120 eyes of 60 middle-aged and elderly patients with mild-to-moderate DED were enrolled in this prospective, one-group, quasi-experimental study. Six milligram Astaxanthin tablets (Weihong Haematococcus Pluvialis Astaxanthin, Hangzhou Xinwei Low Carbon Technology R&D Co., Ltd., China) were administered orally, twice daily for 30 ± 2 days. History of eye diseases, treatment, systemic disease, and medication before the test were recorded. In addition, the ocular surface disease index (OSDI) questionnaire, non-invasive tear break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining (CFS) score, eyelid margin signs, meibomian gland (MG) expressibility, meibum quality, meibomian gland dropout (MGDR), Schirmer I test (SIt), tear meniscus height (TMH), bulbar conjunctiva congestion degree, blink frequency, incomplete blink rate, and thickness of tear film lipid layer were collected before treatment, 2 weeks after the initiation of treatment, and at the end of treatment. Visual acuity (VA), intraocular pressure (IOP), anterior segment, fundus, discomfort symptoms and other adverse reactions were also monitored throughout the study to assess the safety. Results: OSDI score, NIBUT, BUT, CFS score, eyelid margin signs, MG expressibility, meibum quality, and blink frequency improved significantly to varying degrees after treatment compared with those before the treatment (P < 0.05), while TMH, SIt, conjunctival congestion, the thickness of tear film lipid layer, MGDR, incomplete blink rate, VA and IOP did not differ (P > 0.05). Conclusions: Oral administration of astaxanthin improves the symptoms and signs of middle-aged and elderly patients with mild-to-moderate DED.
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Polat OA, Çetinkaya Z, Evereklioğlu C, Karaca Ç, Erkiliç K. Effect of Repeated Topical Povidone-Iodine and Antibiotic Applications on Meibomian Glands and Ocular Surface Parameters in Patients With Repeated Intravitreal Injections. Eye Contact Lens 2021; 47:651-654. [PMID: 34570021 DOI: 10.1097/icl.0000000000000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. METHODS Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). RESULTS Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P<0.001, P<0.001, respectively). Fluorescein tear break-up time and noninvasive tear break-up time were significantly lower in the intravitreal injection group compared with the control group (P<0.001, P<0.001). There was no significant difference between the AMD and DME groups for these parameters. CONCLUSION This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.
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Affiliation(s)
- Osman A Polat
- Department of Ophthalmology (O.A.P., C.E., Ç.K., K.E.), Erciyes University, Faculty of Medicine, Kayseri, Turkey; and Department of Ophthalmology, Kahramanmaraş Elbistan State Hospital (Z.Ç.), Kahmaranmaraş, Turkey
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Deng Y, Wang Q, Luo Z, Li S, Wang B, Zhong J, Peng L, Xiao P, Yuan J. Quantitative analysis of morphological and functional features in Meibography for Meibomian Gland Dysfunction: Diagnosis and Grading. EClinicalMedicine 2021; 40:101132. [PMID: 34541482 PMCID: PMC8435692 DOI: 10.1016/j.eclinm.2021.101132] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To explore the performance of quantitative morphological and functional analysis in meibography images by an automatic meibomian glands (MGs) analyser in diagnosis and grading Meibomian Gland Dysfunction (MGD). METHODS A cross-sectional study collected 256 subjects with symptoms related to dry eye and 56 healthy volunteers who underwent complete ocular surface examination was conducted between January 1, 2019, and December 31, 2020. The 256 symptomatic subjects were classified into MGD group (n = 195) and symptomatic non-MGD group (n = 61). An automatic MGs analyser was used to obtained multi-parametric measurements in meibography images including the MGs area ratio (GA), MGs diameter deformation index (DI), MGs tortuosity index (TI), and MGs signal index (SI). Adjusted odds ratios (ORs) of the multi-parametric measurements of MGs for MGD, and the area under the receiver operating characteristic (AUC-ROC) curves of multi-parametric measurements for MGD diagnosing and grading were conducted. FINDINGS When consider age, sex, ocular surface condition together, the estimated ORs for DI was 1.62 (95% CI, 1.29-2.56), low-level SI was 24.34 (95% CI, 2.73-217.3), TI was 0.76(95% CI, 0.54-0.90), and GA was 0.86 (95% CI, 0.74-0.92) for MGD. The combination of DI-TI-GA-SI showed an AUC = 0.82 (P < 0.001) for discriminating MGD from symptomatic subjects. The DI had a higher AUC in identifying early-stage MGD (grade 1-2), while TI and GA had higher AUCs in moderate and advanced stages (grade 3-5). Merging DI-TI-GA showed the highest AUCs in distinguish MGD severities. INTERPRETATION The MGs area ratio, diameter deformation, tortuosity and signal intensity could be considered promising biomarkers for MGD diagnosis and objective grading. FUNDING This work was supported by the Key-Area Research and Development Program of Guangdong Province (No. 2019B010152001), the National Natural Science Foundation of China under Grant (81901788) and Guangzhou Science and Technology Program (202002030412).
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Affiliation(s)
- Yuqing Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qian Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongzhou Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Saiqun Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bowen Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lulu Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
- Correspondence Author: Peng Xiao, PhD Zhongshan Ophthalmic Centre, Sun Yat-Sen University, 7 Jinsui Road, Tianhe District, Guangzhou, China, 510060, Tel.: (86)18826070428, Fax: (8620) 87331550
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
- Correspondence Author: Jin Yuan, MD, PhD Zhongshan Ophthalmic Centre, Sun Yat-Sen University,7 Jinsui Road, Tianhe District, Guangzhou, China, 510060, Tel.: (86)13825141659, Fax: (8620) 87331550
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Noh SR, Chung JL, Lee JM, Seo KY, Koh K. Meibomian gland atrophy with duration of Sjogren's syndrome in adult females. Int Ophthalmol 2021; 42:191-200. [PMID: 34409540 DOI: 10.1007/s10792-021-02013-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To investigate the correlation between the duration of Sjögren syndrome (SS) and ocular surface parameters in patients with SS-related dry eye. METHODS We analyzed 108 eyes of 108 female patients with primary SS-related dry eye. All patients underwent rheumatoid serologic tests and ocular surface assessments. The ocular surface assessment included the Standard Patient Evaluation of Eye Dryness (SPEED) score, meibomian gland (MG) atrophy, lipid layer thickness (LLT), partial and total blinking, partial blinking rate, Schirmer's I test, non-invasive tear break-up time, and ocular surface staining score. Correlations between the duration of SS and ocular surface assessments were calculated. RESULTS The average age and SS duration of the participants were 56.7 ± 10.2 (range 21-78) years and 54.15 ± 41.10 (range 1-134) months, respectively. There was a strong positive correlation between SS duration and MG atrophy (r = 0.766, p < 0.001). The correlation between SS duration and MG atrophy rate remained significant after controlling for age (r = 0.559, p < 0.001). Average, maximum, and minimum LLTs showed weak negative correlations with SS duration (r = - 0.310, - 0.211, and-0.304, respectively, p = 0.014, 0.028, and 0.022, respectively) and MG atrophy (r = - 0.191, - 0.326, and - 0.299, respectively, p = 0.049, 0.002, and 0.009, respectively). SPEED score showed a weak positive correlation to SS duration (r = 0.303, p = 0.042) and a moderate positive correlation to MG atrophy (r = 0.450, p = 0.029). CONCLUSIONS Longer duration of primary SS was related to more severe MG atrophy. Therefore, it is necessary to perform meibography in SS patients to verify MG atrophy status. A comparative study with non-SS dry eye patients is required to validate this study.
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Affiliation(s)
- Sung Rae Noh
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, 136 Youngshinro, Youngdeungpo-gu, Seoul, 07301, Republic of Korea
| | | | - Jeong Min Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, 136 Youngshinro, Youngdeungpo-gu, Seoul, 07301, Republic of Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungmin Koh
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, 136 Youngshinro, Youngdeungpo-gu, Seoul, 07301, Republic of Korea.
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Setu MAK, Horstmann J, Schmidt S, Stern ME, Steven P. Deep learning-based automatic meibomian gland segmentation and morphology assessment in infrared meibography. Sci Rep 2021; 11:7649. [PMID: 33828177 PMCID: PMC8027879 DOI: 10.1038/s41598-021-87314-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/21/2021] [Indexed: 12/22/2022] Open
Abstract
Meibomian glands (MG) are large sebaceous glands located below the tarsal conjunctiva and the abnormalities of these glands cause Meibomian gland dysfunction (MGD) which is responsible for evaporative dry eye disease (DED). Accurate MG segmentation is a key prerequisite for automated imaging based MGD related DED diagnosis. However, Automatic MG segmentation in infrared meibography is a challenging task due to image artifacts. A deep learning-based MG segmentation has been proposed which directly learns MG features from the training image dataset without any image pre-processing. The model is trained and evaluated using 728 anonymized clinical meibography images. Additionally, automatic MG morphometric parameters, gland number, length, width, and tortuosity assessment were proposed. The average precision, recall, and F1 score were achieved 83%, 81%, and 84% respectively on the testing dataset with AUC value of 0.96 based on ROC curve and dice coefficient of 84%. Single image segmentation and morphometric parameter evaluation took on average 1.33 s. To the best of our knowledge, this is the first time that a validated deep learning-based approach is applied in MG segmentation and evaluation for both upper and lower eyelids.
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Affiliation(s)
- Md Asif Khan Setu
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.,Division of Dry Eye and Ocular GvHD, University Hospital Cologne, 50937, Cologne, Germany
| | - Jens Horstmann
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | | | - Michael E Stern
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.,Division of Dry Eye and Ocular GvHD, University Hospital Cologne, 50937, Cologne, Germany.,ImmunEyez LLC, Irvine, CA, USA
| | - Philipp Steven
- Department of Ophthalmology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937, Cologne, Germany. .,Division of Dry Eye and Ocular GvHD, University Hospital Cologne, 50937, Cologne, Germany.
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Xiao P, Luo Z, Deng Y, Wang G, Yuan J. An automated and multiparametric algorithm for objective analysis of meibography images. Quant Imaging Med Surg 2021; 11:1586-1599. [PMID: 33816193 DOI: 10.21037/qims-20-611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Meibography is a non-contact imaging technique used by ophthalmologists and eye care practitioners to acquire information on the characteristics of meibomian glands. One of its most important applications is to assist in the evaluation and diagnosis of meibomian gland dysfunction (MGD). As the artificial qualitative analysis of meibography images can lead to low repeatability and efficiency, automated and quantitative evaluation would greatly benefit the image analysis process. Moreover, since the morphology and function of meibomian glands varies at different stages of MGD, multiparametric analysis offering more comprehensive information could help in discovering subtle changes to glands during MGD progression. Therefore, an automated and multiparametric objective analysis of meibography images is urgently needed. Methods An algorithm was developed to perform multiparametric analysis of meibography images with fully automatic and repeatable segmentation based on image contrast enhancement and noise reduction. The full architecture can be divided into three steps: (I) segmentation of the tarsal conjunctiva area as the region of interest (ROI); (II) segmentation and identification of glands within the ROI; and (III) quantitative multiparametric analysis including a newly defined gland diameter deformation index (DI), gland tortuosity index (TI), and gland signal index (SI). To evaluate the performance of this automated algorithm, the similarity index (k) and the segmentation error including the false-positive rate (rP ) and the false-negative rate (rN ) were calculated between the manually defined ground truth and the automatic segmentations of both the ROI and meibomian glands of 15 typical meibography images. Results The results of the performance evaluation between the manually defined ground truth and automatic segmentations were as follows: for ROI segmentation, the similarity index (k)=0.94±0.02, the false-positive rate (rP )=6.02%±2.41%, and the false-negative rate (rN )=6.43%±1.98%; for meibomian gland segmentation, the similarity index (k)=0.87±0.01, the false-positive rate (rP )=4.35%±1.50%, and the-false negative rate (rN )=18.61%±1.54%. The algorithm was successfully applied to process typical meibography images acquired from subjects of different meibomian gland health statuses, by providing the gland area ratio (GA), the gland length (L), gland width (D), gland diameter deformation index (DI), gland tortuosity index (TI), and gland signal index (SI). Conclusions A fully automated algorithm was developed which demonstrated high similarity with moderate segmentation errors for meibography image segmentation compared with the manual approach, offering multiple parameters to quantify the morphology and function of meibomian glands for the objective evaluation of meibography images.
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Affiliation(s)
- Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhongzhou Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Gengyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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García-Marqués JV, García-Lázaro S, Martínez-Albert N, Cerviño A. Meibomian glands visibility assessment through a new quantitative method. Graefes Arch Clin Exp Ophthalmol 2021; 259:1323-1331. [PMID: 33409681 DOI: 10.1007/s00417-020-05034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of this study is to develop a new objective semiautomatic method for analysing Meibomian glands visibility quantitatively. METHODS One hundred twelve healthy volunteers aged between 18 and 90 years (48.29 ± 27.46 years) participated in this study. Infrared meibography was obtained from the right upper eyelid through Oculus Keratograph 5 M. Meibographies were classified into 3 groups: Group 1 = patients with good subjective glands visibility and a gland dropout percentage < 1/3 of the total Meibomian gland area; Group 2 = patients with low subjective glands visibility and a gland dropout < 1/3; and Group 3 = patients with low subjective glands visibility and a gland dropout > 1/3. New metrics based on the visibility of the Meibomian glands were calculated and later compared between groups. Rho Spearman test was used to assess the correlation between each metric, and Meibomian gland dropout percentage with the entire sample and after excluding Group 2. A p value less than 0.05 was defined as statistically significant. RESULTS Fifty-six subjects were classified in Group 1 (24.48 ± 9.62 years), 19 in Group 2 (69.16 ± 21.30 years) and 37 in Group 3 (73.59 ± 13.70 years). No statistically significant differences were found between Groups 1 and 2 in dropout percentage. All metrics, with the exception of entropy, showed a higher Meibomian gland visibility in Group 1 than in the other two groups. Moderate correlations were statistically significant for all metrics with the exception of entropy. Correlations were higher after excluding Group 2. CONCLUSION The proposed method is able to assess Meibomian gland visibility in an objective and repeatable way, which might help clinicians enhance Meibomian gland dysfunction diagnosis and follow-up treatment.
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Affiliation(s)
- José Vicente García-Marqués
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
| | - Santiago García-Lázaro
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain.
| | - Noelia Martínez-Albert
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
| | - Alejandro Cerviño
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
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Bilkhu P, Vidal-Rohr M, Trave-Huarte S, Wolffsohn JS. Effect of meibomian gland morphology on functionality with applied treatment. Cont Lens Anterior Eye 2021; 45:101402. [PMID: 33397598 DOI: 10.1016/j.clae.2020.12.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To determine how Meibomian gland (MG) morphology affects MG function by means of gland expression with the effect of treatment. METHODS Fifteen patients (aged 31.6 ± 13.1 years) from a dry eye clinic diagnosed with MG dysfunction had their 365 lower lid MGs visualised with a slit-lamp biomicroscopy. Using infrared meibography (Oculus K5m), MG length, width and tortuosity were objectively measured. Each MG was expressed and the meibum graded (0=clear fluid, 1=cloudy fluid, 2= particulate fluid, 3=inspissated, or 4 = no expression) to determine its functionality. Participants had functionality repeated each time following a sequence of a warm compress, debridement, and forcible expression after 5 min. RESULTS Just over 10 % of complete length MGs gave clear expression, while about 5% did not express at all, with most expressed meibum being particulate in nature. In contrast, the majority of partial length glands gave inspissated expression (38 %), with 32 % not expressing at all. No MG of <10 % length expressed. MG gland length was correlated with gland expression (r=-0.507, p < 0.001) and MG tortuosity (r=-0.129, p < 0.001), but not MG width (r=-0.090, p = 0.167). Regardless of MG length, warm compress increased the quality of expression (p < 0.002). Debridement further improved expression in partial MGs (p = 0.003), but not forcible expression (p = 0.529). CONCLUSIONS Length is the key functional morphology metric of lower lid MGs. Warm compress and massage increase the quality of expression in all, but the shortest glands and patients with partial length glands also benefit from debridement.
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Affiliation(s)
- Paramdeep Bilkhu
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom
| | - Maria Vidal-Rohr
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom
| | - Sonia Trave-Huarte
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom
| | - James S Wolffsohn
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom.
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Lee JM, Jeon YJ, Kim KY, Hwang KY, Kwon YA, Koh K. Ocular surface analysis: A comparison between the LipiView ® II and IDRA ®. Eur J Ophthalmol 2020; 31:2300-2306. [PMID: 33267698 DOI: 10.1177/1120672120969035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare the lipid layer thickness (LLT), meibomian gland (MG) dropouts, and blinking pattern determined by the analysis of images acquired from the LipiView® II (LVII) and the IDRA® Ocular surface analyzer. METHODS A cross-sectional single-visit observational study was conducted. The LLT (minimum, maximum, and average), percentages of MG dropouts, and partial blink rates (PBR) were taken from both eyes of 47 participants using LVII and IDRA. Both devices were used to image the inferior eyelid of each participant in a random order. RESULTS Forty-seven participants (mean age 56.77 ± 14.47 (21-79) years, 66% female) completed the study. There was no significant difference in LLT between the two devices. A significant difference in percentages of MG dropouts was obtained between the LVII (36.51 ± 17.53) and the IDRA (45.36 ± 21.87), p = 0.003). There was also a significant difference in PBR between the LVII (0.51 ± 0.37) and the IDRA (0.23 ± 0.27), p < 0.001). CONCLUSION No significant difference in LLT was obtained between LVII and IDRA. IDRA had a significantly lesser percentage of MG dropout and a higher PBR compared to LVII. These results indicate that these devices should not be used interchangeably for the evaluation of MG dropouts and PBR.
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Affiliation(s)
- Jeong Min Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young Joon Jeon
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kook Young Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kyu-Yeon Hwang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young-A Kwon
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kyungmin Koh
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Ha M, Kim JS, Hong SY, Chang DJ, Whang WJ, Na KS, Kim EC, Kim HS, Hwang HS. Relationship between eyelid margin irregularity and meibomian gland dropout. Ocul Surf 2020; 19:31-37. [PMID: 33246034 DOI: 10.1016/j.jtos.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine the relationship between lid margin abnormalities and meibomian gland loss in infrared meibography. METHODS This study was a retrospective chart review of 170 patients with dry eye disease. A correlation analysis between eyelid margin abnormalities and meibomian gland dropout in infrared meibography was performed using data from 141 eyes. We graded the following eyelid margin abnormalities: irregular lid margin, vascular engorgement, plugging, anterior placement of the mucocutaneous junction, exposed terminal duct, and presence of tattoos. Multiple regression analyses were performed with meiboscore (meibomian gland dropout grade) as the dependent variable and age, sex, lid margin abnormality grades, and total grading score of lid margin abnormalities as the covariates. In addition, Meibomian glands structure were examined in those with eyelid margin dimpling using meibography in 25 eyes. RESULTS In the multiple regression analysis, an irregular lid margin in the upper eyelid was associated with a higher meiboscore after controlling for age and sex (coefficients B = 1.379, p = 0.025). Other lid margin abnormalities did not significantly affect the meiboscore. In the lower eyelids, irregular lid margin (coefficients B = 0.602, p = 0.009) and total grading score of lid margin abnormality were associated with higher meiboscores (coefficients B = 0.100, p = 0.022). Of the 25 eyes with dimples, 21 (84%) showed focal or complete meibomian gland loss at the site. CONCLUSIONS Lid margin abnormalities were found to be associated with meibomian gland dropout.
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Affiliation(s)
- Minji Ha
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin Soo Kim
- Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Seo-Yeon Hong
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Jin Chang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woong-Joo Whang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Chul Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Seung Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Hwang HS, Mikula E, Xie Y, Brown DJ, Jester JV. A novel transillumination meibography device for in vivo imaging of mouse meibomian glands. Ocul Surf 2020; 19:201-209. [PMID: 33075493 PMCID: PMC10388835 DOI: 10.1016/j.jtos.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/17/2020] [Accepted: 08/31/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE While mouse models of dry eye disease (DED) have been developed, studies evaluating the role of the meibomian glands limited by the inability to temporally document changes. In this report we describe the development of a novel mouse transillumination meibography device and assess the ability of this device to detect age-related changes in the meibomian glands of young and old mice. METHODS The mouse meibography device was comprised of a 3 mm wide right angle prism attached to broad spectrum light source by an optical fiber. Eyelids were then pulled over the prism using double tooth forceps and imaged using a stereomicroscope and low light level camera. Meibomian glands from four young and four old male, BALB/c mice were then imaged and analyzed using ImageJ. RESULTS In young mice, meibography documented the presence of 7-8 meibomian glands appearing as black and distinct eyelid structures with the length shorter in the lower eyelid compared to the upper eyelids. Eyelids of old mice showed apparent dropout of meibomian glands along with smaller and more irregularly shaped acini. The mean acini area of one meibomian gland was 0.088 ± 0.025 mm2 in young mice and 0.080 ± 0.020 mm2 in old mice (p = 0.564), but the Meibomian gland density was significantly lower in older mice (41.7 ± 6.4%, 27.3 ± 4.2%) (p = 0.021). CONCLUSION We have developed an in vivo meibography device that may prove useful in sequentially documenting changes during development of meibomian gland dysfunction and following treatment.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Eric Mikula
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Yilu Xie
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Donald J Brown
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - James V Jester
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States.
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Profile of tear lipid mediator as a biomarker of inflammation for meibomian gland dysfunction and ocular surface diseases: Standard operating procedures. Ocul Surf 2020; 26:318-327. [PMID: 33022413 DOI: 10.1016/j.jtos.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
Human tear is a biological fluid rich in lipids that is increasingly collected in clinical and biological research. The repertoire of small lipids or lipid mediators (often termed eicosanoids or oxylipins) found in human tear provides insight into metabolism of fatty acids and physiology of the ocular surface and Meibomian glands. Disturbances in the tear lipid mediators profile also occur during inflammation of the ocular surface that is not directly linked to lipid metabolism. The changes in the levels of pro-inflammatory and pro-resolution lipid mediators in the tear help assess the severity and stage of inflammation in ocular surface tissues. Mass spectrometry, used in the evaluation of tear lipid mediators, is an emerging tool in clinical diagnostics and personalized medicine. Here we describe the reproducibility, accuracy, and precision of quantifying lipid mediators in human tears, with a suggested method for tear collection and sample handling. The ranges of lipid mediators concentrations in tear fluid of healthy and diseased individuals with Meibomian gland dysfunction are reported, as well as the impact of age and disease on individual lipid mediators. We would like to recommend a set of guidelines, which can be further discussed in workshops. This will facilitate harmonization of future tear lipid mediators data across different instrument platforms in various laboratories. We hope that other fields requiring lipid mediators assays will also benefit from such an effort.
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Karakus S, Dai X, Zhu X, Gottsch JD. The role of lid margin structures in the meibomian gland function and ocular surface health. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1826309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sezen Karakus
- Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Xi Dai
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xi Zhu
- Department of Biology and Public Health Studies, Johns Hopkins University, Baltimore, MD, USA
| | - John D Gottsch
- Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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2D fourier transform for global analysis and classification of meibomian gland images. Ocul Surf 2020; 18:865-870. [PMID: 32916252 DOI: 10.1016/j.jtos.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/25/2020] [Accepted: 09/05/2020] [Indexed: 02/02/2023]
Abstract
In recent years, significant progress has been made in the Meibography technique resulting from the use of advanced image analysis methods allowing a quantitative description of the Meibomian gland structures. Many objective measures of gland distortion were previously proposed allowing for user-independent classification of acquired gland images. However, due to the complicated nature of gland deformation, none of the single-valued parameters can fully describe the analyzed gland images. There is a need to increase the number of descriptive factors, selectively sensitive to different gland features. Here we show that global 2D Fourier transform analysis of infra-red gland images provides values of two new such parameters: mean gland frequency and anisotropy in gland periodicity. We show that their values correlate with gland dysfunction and can be used to automatically categorize the images into the three subjective classes (healthy, intermediate and unhealthy). We also demonstrated that classification performance can be improved by dimensionality reduction approach using principal component analysis.
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Villani E, Marelli L, Dellavalle A, Serafino M, Nucci P. Latest evidences on meibomian gland dysfunction diagnosis and management. Ocul Surf 2020; 18:871-892. [PMID: 32927081 DOI: 10.1016/j.jtos.2020.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 01/08/2023]
Abstract
Meibomian gland dysfunction (MGD) can be considered the leading cause of dry eye disease (DED) and one of the most common ophthalmic disorders found in clinical practice. The growing body of literature provides a substantial amount of information on this condition, but more efforts are needed to better interpret research data and to properly apply them to daily clinical practice., In this article, we reviewed the most recent publications on MGD diagnosis and management, focusing on the highest available level of evidence, provided by well-designed and well-reported studies on humans., Latest evidences on MGD diagnosis are mainly focused on imaging techniques, including meibography, optical coherence tomography (OCT), and in vivo confocal microscopy. Meibographic parameters, such as drop-out and glands' distortion, show great diagnostic accuracy, which accounts for their widespread use in clinical practice and research., Recent randomized controlled clinical trials on MGD treatment provided data on the role of antibiotics, steroids, essential fatty acids, intraductal meibomian gland probing, electronic heating devices and intense pulsed light therapy.
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Affiliation(s)
- Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan. Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy; Lid and Meibomian Gland Working Group (LIME), Japan.
| | - Luca Marelli
- Department of Clinical Science and Community Health, University of Milan. Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Andrea Dellavalle
- Department of Clinical Science and Community Health, University of Milan. Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Massimiliano Serafino
- Department of Clinical Science and Community Health, University of Milan. Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Science and Community Health, University of Milan. Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
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Llorens‐Quintana C, Garaszczuk IK, Szczesna‐Iskander DH. Meibomian glands structure in daily disposable soft contact lens wearers: a one‐year follow‐up study. Ophthalmic Physiol Opt 2020; 40:607-616. [DOI: 10.1111/opo.12720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Clara Llorens‐Quintana
- Department of Biomedical Engineering Wroclaw University of Science and Technology Wroclaw Poland
| | - Izabela K. Garaszczuk
- Department of Optics and Photonics Wroclaw University of Science and Technology Wroclaw Poland
- Department of Optics and Optometry and Visual Sciences University of Valencia Valencia Spain
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Guo Y, Ha JY, Piao HL, Sung MS, Park SW. The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study. BMC Ophthalmol 2020; 20:277. [PMID: 32650746 PMCID: PMC7350718 DOI: 10.1186/s12886-020-01550-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023] Open
Abstract
Background To determine if 3% diquafosol (DQS) can preserve the meibomian gland morphology in glaucoma patients treated with prostaglandin analogs (PGA) for a 12-month follow-up period. Methods This study included 84 eyes of 46 normal tension glaucoma (NTG) patients who were treated with either preservative-containing PGA (PC-PGA; 16 patients, 28 eyes), preservative-free PGA (PF-PGA; 21 patients, 39 eyes), or a combination of PC-PGA and 3% DQS (PC-PGA + DQS; 9 patients, 17 eyes). The meibography of the upper eyelid was acquired using Keratograph® 5 M at baseline and at each follow-up (1, 3, 6, 9, and 12 months). Meibomian gland loss (MGL) was quantitatively analyzed by using ImageJ software. Results In the PC-PGA group, MGL increased significantly from baseline to month 9 and month 12, whereas no significant changes were observed in the PF-PGA and PC-PGA + DQS groups during the entire 12 months. All groups showed similar MGL at each follow-up time from baseline to six months. However, MGL in the PC-PGA group was significantly higher than those in the PF-PGA and PC-PGA + DQS groups at the 9 and 12 months. Conclusions Combining 3% DQS with PC-PGA was as effective as PF-PGA in preserving the meibomian gland morphology for at least 12 months. Our results suggest that 3% DQS may be a promising strategy for managing glaucoma patients with a high risk of developing meibomian gland dysfunction due to preservative-containing topical medications.
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Affiliation(s)
- Yue Guo
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.,Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Young Ha
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea
| | - He Long Piao
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.,Department of Ophthalmology, Yanbian University Hospital, Yanji, Jilin, China
| | - Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.
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38
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Yoon CH, Ryu JS, Hwang HS, Kim MK. Comparative Analysis of Age-Related Changes in Lacrimal Glands and Meibomian Glands of a C57BL/6 Male Mouse Model. Int J Mol Sci 2020; 21:ijms21114169. [PMID: 32545199 PMCID: PMC7313015 DOI: 10.3390/ijms21114169] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
It is not known how biological changes in the lacrimal (LGs) and meibomian (MGs) glands contribute to dry eye disease (DED) in a time-dependent manner. In this study, we investigated time-sequenced changes in the inflammation, oxidative stress, and senescence of stem cells in both glands of an aging-related DED mouse model. Eight-week (8W)-, one-year (1Y)-, and two-year (2Y)-old C57BL/6 male mice were used. MG areas of the upper and lower eyelids were analyzed by transillumination meibography imaging. The number of CD45+, 8-OHdG+, Ki-67+, and BrdU+ cells was compared in both glands. Increased corneal staining and decreased tear secretion were observed in aged mice. The MG dropout area increased with aging, and the age-adjusted MG area in lower lids was negatively correlated with the National Eye Institute (NEI) score. Increased CD4+ interferon (IFN)-γ+ cells in LGs were found in both aged mice. An increase in 8-OHdG+ cells in both glands was evident in 2Y-old mice. Reduced Ki-67+ cells, but no change in CD45+ cells, was observed in the MGs of 1Y-old mice. Increased BrdU+ cells were observed in the LGs of aged mice. This suggests that age-dependent DED in C57BL/6 mice is related to inflammation of the LGs, the development of MG atrophy, and oxidative stress in both glands.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea;
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Korea;
- Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin Suk Ryu
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Korea;
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
- Correspondence: (H.S.H.); (M.K.K.); Tel.: +82-2-3779-1025 (H.S.H.); +82-2-2072-2665 (M.K.K.); Fax: +82-2-761-6869 (H.S.H.); +82-2-741-3187 (M.K.K.)
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea;
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Korea;
- Department of Ophthalmology, Seoul National University Hospital, Seoul 03080, Korea
- Correspondence: (H.S.H.); (M.K.K.); Tel.: +82-2-3779-1025 (H.S.H.); +82-2-2072-2665 (M.K.K.); Fax: +82-2-761-6869 (H.S.H.); +82-2-741-3187 (M.K.K.)
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Düzgün E, Özkur E. The effect of oral isotretinoin therapy on meibomian gland morphology and dry eye tests. J DERMATOL TREAT 2020; 33:762-768. [DOI: 10.1080/09546634.2020.1774041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eyüp Düzgün
- Department of Ophthalmology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Özkur
- Department of Dermatology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Lin X, Wu Y, Chen Y, Zhao Y, Xiang L, Dai Q, Fu Y, Zhao Y, Zhao YE. Characterization of Meibomian Gland Atrophy and the Potential Risk Factors for Middle Aged to Elderly Patients With Cataracts. Transl Vis Sci Technol 2020; 9:48. [PMID: 32832253 PMCID: PMC7414668 DOI: 10.1167/tvst.9.7.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To explore the characteristics of meibomian gland (MG) atrophy and its potential risk factors in the age-related cataract population. Methods Patients who underwent cataract surgery at age 40 or older were enrolled in this study. Preoperative clinical measurement records were obtained, including lipid layer thickness, tear meniscus height, noninvasive breakup time, and meiboscore. The meibomian gland atrophy ratio (MGAR) was measured by the ImageJ software. Univariate regression analysis and multivariate regression analysis were used to analyze the risk factors for MG atrophy. Results Female patients had less atrophy of the MG compared with male patients. The MGAR, meiboscore, tear meniscus height (TMH), and lipid layer thickness (LLT) gradually increased with age. However, the noninvasive breakup time decreased with age. The multivariate regression analysis indicated that dyslipidemia and increased triglyceride levels were identified as independent protective factors for MG atrophy. We further stratified the model by sex, and the following results showed only in the female patients with dyslipidemia and increased triglyceride had decreased MG atrophy. No significant correlation was observed between MG atrophy and tear film parameters including TMH, noninvasive breakup time, and LLT. Conclusions Our study suggests that age, sex, and diabetes are potential risk factors for MG atrophy. In addition, dyslipidemia and increased triglyceride levels are independent protective factors for MG atrophy in the elderly female population. Translational Relevance MG atrophy is the leading cause of meibomian gland dysfunction. To study the characteristics and risk factors of MG atrophy in cataract patients would be helpful to predict and prevent postoperative development of MGD.
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Affiliation(s)
- Xiaolei Lin
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Wu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Yiqin Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Yuyu Zhao
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Linfeng Xiang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Qi Dai
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Yana Fu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Yinying Zhao
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
| | - Yun-e Zhao
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou, Zhejiang, China
- National Center for Clinical and Medical Research, Wenzhou, Zhejiang, China
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Fineide F, Arita R, Utheim TP. The role of meibography in ocular surface diagnostics: A review. Ocul Surf 2020; 19:133-144. [PMID: 32416235 DOI: 10.1016/j.jtos.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022]
Abstract
The meibomian glands are lipid-secreting glands located in the tarsal plates, whose secretory products cover the tear film, thereby reducing evaporation as well as ensuring lubrication of the ocular surface. The meibomian glands can be visualized at different levels of magnification by infrared meibography, laser confocal microscopy, and optical coherence tomography. These imaging modalities have been subject to much research and progress in clinical practice and have shaped our current understanding of meibomian glands in health and disease. In this review, we explore the evolution of meibography over the past decades, the major contributions of various meibographic modalities, and discuss their clinical significance.
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Affiliation(s)
- Fredrik Fineide
- Department of Medical Biochemistry, Oslo University Hospital, Norway; The Norwegian Dry Eye Clinic, Ole Vigs Gate 32 E, 0366, Oslo, Norway.
| | - Reiko Arita
- Itoh Clinic, 626-11 Minaminakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan; Lid and Meibomian Gland Working Group, Japan
| | - Tor P Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Norway; The Norwegian Dry Eye Clinic, Ole Vigs Gate 32 E, 0366, Oslo, Norway; Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Norway; Department of Ophthalmology, Stavanger University Hospital, Norway
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42
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Zhou N, Edwards K, Colorado LH, Schmid KL. Development of Feasible Methods to Image the Eyelid Margin Using In Vivo Confocal Microscopy. Cornea 2020; 39:1325-1333. [DOI: 10.1097/ico.0000000000002347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meibomian Gland Morphology: The Influence of Structural Variations on Gland Function and Ocular Surface Parameters. Cornea 2020; 38:1506-1512. [PMID: 31498246 DOI: 10.1097/ico.0000000000002141] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To objectively and quantitatively characterize meibomian gland morphology and to investigate the influence of morphological variations on gland function and ocular surface and tear film parameters. METHODS One hundred fifty subjects were enrolled. The examinations included tear osmolarity, tear meniscus height, bulbar conjunctival hyperemia, noninvasive tear film breakup time, lid margin thickness, foam secretion, meibomian gland expressibility, count of functioning glands, corneal and conjunctival staining, fluorescein breakup time, lid wiper epitheliopathy, and Schirmer test. Patient symptoms were assessed using the Ocular Surface Disease Index questionnaire. Images from noncontact meibography were analyzed using an automated method that objectively estimates dropout area, number of glands, gland length and width, and gland irregularity. RESULTS Gland irregularity highly correlated with dropout area (r = -0.4, P < 0.001) and showed significant partial correlations with fluorescein breakup time (r = 0.162, P = 0.049) and the Ocular Surface Disease Index questionnaire (r = -0.250, P = 0.002) Subjects with dropout area <32% were divided into 2 groups: high and low irregularity. Gland expressibility was statistically significantly different between the 2 groups (U = 319.5, P = 0.006). In the high irregularity group, gland irregularity correlated with the Schirmer test (r = 0.530, P = 0.001) and corneal fluorescein staining (r = -0.377, P = 0.021). CONCLUSIONS Automated morphological analysis of meibomian gland structure provides additional quantitative and objective information regarding gland morphology. The link between dropout area and gland function is not clear. Assessment of gland irregularity might better predict gland function and its effects on ocular surface and tear film parameters.
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Gu T, Zhao L, Liu Z, Zhao S, Nian H, Wei R. Evaluation of tear film and the morphological changes of meibomian glands in young Asian soft contact lens wearers and non-wearers. BMC Ophthalmol 2020; 20:84. [PMID: 32131774 PMCID: PMC7057503 DOI: 10.1186/s12886-020-1328-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 01/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background The aim of this study was to explore the differences in terms of tear film and meibomian glands (MGs) between young Asian soft contact lens (CL) wearers and non-wearers. Methods A prospective, cross-sectional observational study was conducted using 148 subjects (63 non-wearers, and 85 soft CL wearers who had been wearing CLs for more than 1 year) recruited from a clinic in Tianjin, China. All subjects first responded to an Ocular Surface Disease Index (OSDI) questionnaire and then underwent a standardized dry eye examination, which included measuring tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and corneal fluorescein staining (CFS). The MGs were evaluated via ImageJ, distorted MG count and the MG dropout were recorded. Results Compared to the control group (non-wearers), the CL group recorded higher OSDI and CFS scores, lower TMH and NITBUT values, a larger distorted MG count, and larger MG dropout (all P < 0.05). Pearson correlation analysis found a correlation between MG dropout and the duration of CL use (r = 0.440, P < 0.001), OSDI (r = 0.298, P = 0.006), and CFS scores (r = 0.442, P < 0.001). Conclusion CL wearers showed higher MG dropout and reduced TMH and NITBUT, which likely contributes to severe CL-related dry eye symptoms. CL use may lead to a higher MG dropout rate, and the extent of the MG dropout presumably influences the tear film status in CL wearers.
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Affiliation(s)
- Tianpu Gu
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China.,Eye Institute and School of Optometry, Tianjin, 300384, China.,Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Lu Zhao
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China.,Eye Institute and School of Optometry, Tianjin, 300384, China.,Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Zhuzhu Liu
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China.,Eye Institute and School of Optometry, Tianjin, 300384, China.,Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China.,Eye Institute and School of Optometry, Tianjin, 300384, China.,Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Hong Nian
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China. .,Eye Institute and School of Optometry, Tianjin, 300384, China. .,Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Disease, Tianjin, 300384, China. .,Eye Institute and School of Optometry, Tianjin, 300384, China. .,Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
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Gu T, Du B, Bi H, Zhou L, Liu G, Jin N, Liu Z, Zhang B, Wei R. Meibomian Gland Dropout, not Distortion, Can Distinguish Dry Eyes from Normal Eyes in Contact Lens Wearers. Curr Eye Res 2020; 45:897-903. [PMID: 32066267 DOI: 10.1080/02713683.2020.1731829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the effectiveness of using meibomian gland (MG) dropout and distortion for dry eye disease (DED) diagnosis in a young population with long-term contact lens (CL) wear. METHODS Seventy-three CL-wearers and 68 non-CL-wearers (20-28 years old) participated in the study. The diagnosis of DED was based on an ocular surface disease index ≥ 13, and a noninvasive breakup time < 10 seconds or positive corneal fluorescein staining. The MG dropout and distortion in each subject were quantified with non-invasive meibography. Receiver operating characteristic (ROC) curves were created to evaluate the effectiveness of using MG dropout and distortion to determine the presence of DED in CL-wearers and non-CL-wearers. RESULTS In non-CL-wearers, the MG distortion was significantly higher in DED subjects than in normal subjects (3.83 ± 1.81 versus 1.59 ± 1.04). In CL-wearers, MG distortion was not significantly different (5.12 ± 4.11 versus 5.51 ± 3.15 in normal and DED subjects respectively). The area under the ROC curve (AUC) for MG distortion was 0.783 in the non-CL-wearers, but 0.507 in CL-wearers. In non-CL-wearers, MG dropout was significantly higher in DED subjects than in normal subjects (0.22 ± 0.08 versus 0.15 ± 0.06). In CL-wearers, MG dropout was also significantly higher in DED subjects than in normal subjects (0.29 ± 0.11 versus 0.22 ± 0.08). The AUC for MG dropout used to classify DED was 0.740 in the non-CL-wearers and 0.715 in CL-wearers. CONCLUSIONS MG dropout was effective in distinguishing subjects with DED from normal subjects in both CL wearers and non-CL wearers. MG distortion can only distinguish DED subjects from normal ones in non-CL wearers, but not in CL wearers.
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Affiliation(s)
- Tianpu Gu
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
| | - Bei Du
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
| | - Hua Bi
- College of Optometry, Nova Southeastern University , Davie, Florida, USA
| | - Lu Zhou
- Department of Ophthalmology, Affiliated Children's Hospital of Nanjing Medical University , Nanjing, China
| | - Guihua Liu
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
| | - Nan Jin
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
| | - Zhuzhu Liu
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
| | - Bin Zhang
- College of Optometry, Nova Southeastern University , Davie, Florida, USA
| | - Ruihua Wei
- Department of Optometry, Tianjin Medical University Eye Hospital , Tianjin, China
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Lee JS, Jun I, Kim EK, Seo KY, Kim TI. Clinical Accuracy of an Advanced Corneal Topographer with Tear-Film Analysis in Functional and Structural Evaluation of Dry Eye Disease. Semin Ophthalmol 2020; 35:134-140. [PMID: 32306802 DOI: 10.1080/08820538.2020.1755321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Dry eye disease (DED) is a common condition that significantly lowers the quality of life. As the disease grows more prevalent, multiple commercial instruments have been developed to measure the ocular surface of dry eyes, but no single device has yet been successful in comprehensive measurements. The current study aimed to investigate the clinical accuracy and utility of the Antares topographer in the diagnosis of DED.Methods: Thirty-three consecutive patients underwent analyses of their non-invasive first tear-film break-up time (NIF-BUT), tear meniscus height (TMH) and meibography with the Antares topographer. The meibography with the LipiView scan was conducted. Slit-lamp examinations were done for assessments of meibomian glands (MG) and fluorescein tear-film break-up time (FBUT). Schirmer 1 test was done. The Ocular Surface Disease Index (OSDI) scores were graded.Results: Thirty-three eyes of 33 patients (mean age 61.5 ± 10.6 years, range 37.5-76.4 years, 27.3% males) completed the study. According to the Antares measurements, the NIF-BUT of the patient population was 5.0 ± 3.4 seconds on average (1.1-15.0 seconds), and the TMH was 0.2 ± 0.1 mm at center (0.1-0.5 mm). The average OSDI score was 22.4 ± 16.6 points (0.0-79.5 points). When correlations were calculated, significant correlations were found between the NIF-BUT from the Antares topographer and FBUT (r = 0.538, P = .001), and between MG dropout from the Antares topographer and that from the LipiView interferometer (r = 0.446, P=.009). Antares NIF BUT and FBUT were in agreement with one another (95% limits of agreement (LOA) -5.04 ± 6.37, P=.198) as were the infrared images from the Antares topographer and those from the LipiView interferometer (95% LOA -0.25 ± 0.35, P=.073).Conclusion: The Antares topographer is useful in the diagnosis of DED. Among its outputs, the NIF-BUT and MG dropout most closely correlated with currently accepted modes of diagnosis. However, concurrent clinical examinations are recommended for clinical follow-up.
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Affiliation(s)
- Jihei Sara Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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Garza-Leon M, Gonzalez-Dibildox A, Ramos-Betancourt N, Hernandez-Quintela E. Comparison of meibomian gland loss area measurements between two computer programs and intra-inter-observer agreement. Int Ophthalmol 2020; 40:1261-1267. [PMID: 31974824 DOI: 10.1007/s10792-020-01292-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meibography is a diagnostic test that allows in vivo evaluation of meibomian gland (MG). Nowadays, it is unknown whether the two available computer programs are equivalent to evaluate the glandular loss area. METHODS This is a prospective, longitudinal, and observational study. A random selection of meibography photographs from healthy patients from the ocular surface clinic at Destellos de Luz foundation is made. The upper eyelid images were taken with the Antares® meibography (CSO, Florence, Italy); they were classified in five sessions with a week of separation between each measurement by an expert observer for each program, Phoenix (MAGL) and ImageJ (LAGB). An analysis of the meibomian gland loss area was performed, calculating it semiautomatically with Phoenix and manually with ImageJ. Intra-observer agreement was assessed through an intra-class correlation coefficient and the mean of standard deviations within subjects. Comparison between the two computational programs MG loss was made trough a nonparametric test. RESULTS Fifty-four images from x patients (n, 67.3% female) were analyzed. The limits of concordance analysis between the two programs showed a range between - 18.55 and 9.14%. The mean MG loss area through ImageJ by observer 1 was 27.91 ± 14.82% (IC 95% 23.87 to 31.96), and that by observer 2 was 29.05 ± 15.17% (95% CI 24.91 to 33.19). The mean MG loss area through Phoenix by observer 1 was 24.48 ± 13.97% (IC 95% 20.67 to 28.29), and that by observer 2 was 24.93 ± 12.70% (95% CI 21.46, 28.40) CONCLUSIONS: The comparison of the measurement of meibomian gland loss with both programs showed a statistically significant difference. Intra-observer repeatability and inter-observer repeatability were good, with no clinical or statistical difference.
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Affiliation(s)
- Manuel Garza-Leon
- Clinical Science Department, Science of Health Division, University of Monterrey, Ave Hidalgo # 2425 Poniente, Colonia Centro, C.P 64700, Monterrey, Nuevo León, Mexico.
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico.
| | - Alejandra Gonzalez-Dibildox
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
| | - Nallely Ramos-Betancourt
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
| | - Everardo Hernandez-Quintela
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
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Impact of meibomian gland width on successful contact lens use. Cont Lens Anterior Eye 2019; 42:646-651. [DOI: 10.1016/j.clae.2019.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/08/2019] [Accepted: 06/17/2019] [Indexed: 01/13/2023]
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Diagnostic Test Efficacy of Meibomian Gland Morphology and Function. Sci Rep 2019; 9:17345. [PMID: 31758085 PMCID: PMC6874668 DOI: 10.1038/s41598-019-54013-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022] Open
Abstract
Meibomian gland dysfunction (MGD) is the leading cause of dry eye and proposed treatments are based on disease severity. Our purpose was to establish reliable morphologic measurements of meibomian glands for evaluating MGD severity. This retrospective, cross-sectional study included 100 MGD patients and 20 controls. The patients were classified into dry eye severity level (DESL) 1–4 based on symptoms and clinical parameters including tear-film breakup time, ocular staining and Schirmer I. The gland loss, length, thickness, density and distortion were analyzed. We compared the morphology between patients and controls; examined their correlations to meibum expressibility, quality, and DESL. Relative to controls, the gland thickness, density and distortion were elevated in patients (p < 0.001 for all tests). The area under the receiver operating characteristic curve was 0.98 (95% confidence interval [CI], 0.96–1.0) for gland loss, and 0.96 (CI 0.91–1.0) for gland distortion, with a cutoff value of six distorted glands yielding a sensitivity of 93% and specificity of 97% for MGD diagnosis. The gland distortion was negatively correlated to the meibum expressibility (r = −0.53; p < 0.001) and DESL (r = −0.22, p = 0.018). In conclusion, evaluation of meibomian gland loss and distortion are valuable complementary clinical parameters to assess MGD status.
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Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction. Optom Vis Sci 2019; 95:930-936. [PMID: 30234832 DOI: 10.1097/opx.0000000000001285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
SIGNIFICANCE Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility. PURPOSE Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy. METHODS Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. RESULTS Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = -0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy. CONCLUSIONS Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.
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