Evaluation of the meibomian glands using the tear interferometer wearing orthokeratology lenses

Influential Signs of Dry Eye-Related Ocular Symptoms in Participants With Unstable Tear Film

PURPOSE

The aim of this study was to investigate the factors influencing dry eye disease (DED)-related ocular symptoms in participants with short fluorescein tear break-up time (FTBUT).

METHODS

This cross-sectional study included 82 participants with short FTBUT (<10 seconds). Examinations included Ocular Surface Disease Index (OSDI), FTBUT, average noninvasive tear break-up time (NIBUTave), lid wiper epitheliopathy, lipid layer thickness, blink rate, partial blink, tear meniscus height, and meibomian gland (MG) evaluation which included ratio of residual MG area (RMGA) and MG grade in tarsal plates. One-way analysis of variance was used to detect differences between symptomatic tear film instability group (FTBUT <5 s, OSDI ≥13), asymptomatic tear film instability group (FTBUT <5 s, OSDI <13), and control group (FTBUT ≥5 s, OSDI <13). A bivariate correlation, partial correlation, and multiple linear regression analyses were used to identify major factors. Only the right eye was included.

RESULTS

Among the participants with FTBUT <5 seconds, symptomatic group showed less upper RMGA ( P < 0.001) and NIBUTave ( P = 0.010). OSDI was negatively associated with upper RMGA ( r = -0.450, P < 0.001) and NIBUTave ( r = -0.414, P = 0.001), and positively associated with upper MG grade ( r = 0.277, P = 0.027). Linear regression analysis showed that the upper RMGA significantly affected OSDI (B = -41.895, P = 0.001), while not significantly correlated with age, upper MG grade, and NIBUTave.

CONCLUSIONS

The upper RMGA might be the main factor affecting DED-related discomfort in participants with unstable tear film, indicating an early ocular change in DED.

Characteristics of the Ocular Surface in Myopic Child Candidates of Orthokeratology Lens Wear

INTRODUCTION

The purpose of this study was to investigate the characteristics of objective ocular surface parameters using non-invasive objective instruments in children with myopia who are candidates for orthokeratology lens wear.

METHODS

Children with myopia who are candidates for orthokeratology lens wear were retrospectively investigated. The subjects were divided into three age groups. The Keratograph 5M and LipiView interferometry were used to assess non-invasive tear meniscus height (TMH), non-invasive tear film break-up time (NIBUT), conjunctival hyperemia redness score (RS), meibomian gland loss (MGL) score, lipid layer thickness (LLT), and blink pattern analysis, including the number of partial blinks (PB) and total blinks (TB), as well as the partial blink rate (PBR).

RESULTS

A total of 1119 children with myopia (2070 eyes) aged 7-18 years were selected. The mean TMH, NIBUT, and LLT of the subjects was 0.21 mm, 12.45 s, and 65.28 nm, respectively. The mean RS and upper and lower MGL scores were 0.64, 1.00, and 1.06, respectively. The mean PB, TB, and PBR was 5.13, 6.46, and 0.81, respectively. Age was significantly correlated to all ocular surface parameters (p = 0.00), except for PB. NIBUT and LLT did not differ between male participants and female participants (all p > 0.05). TMH, RS, and upper and lower MGL were significantly higher in male participants than in female participants (all p < 0.01). In addition, NIBUT was positively associated with TMH (r = 0.13, p = 0.00) and LLT (r = 0.28, p = 0.00). Both upper and lower MGL were positively correlated with TMH, PB, and TB (all p = 0.00), whereas upper MGL was negatively correlated with NIBUT and LLT (all p < 0.05). TB was negatively correlated with NIBUT and LLT (all p = 0.00). PB had no relation with TMH, NIBUT, and LLT (all p > 0.05). In addition, PBR was positively correlated with NIBUT and LLT (all p = 0.00) but not with TMH, RS, or MGL (all p > 0.05). Overall, 57.00% had a TMH ≤ 0.2 mm, 43.20% had a NIBUT ≤ 10 s, 48.10% had an LLT ≤ 60 nm, and 88.10% had a PBR > 0.4.

CONCLUSIONS

Child orthokeratology candidates have enhanced tear secretion and increased meibomian gland deficiency with aging. In addition, the adult dry eye diagnostic criteria may apply to orthokeratology candidates aged 12-18 years but should be lower for younger candidates. Given the proportion of abnormal risk, it is necessary to assess tear film status and blink pattern by reliable and feasible objective examination before fitting orthokeratology.

The Effects of Spectacles or Orthokeratology on the Tear Film in Children and Adolescents

INTRODUCTION

Myopia prevalence among adolescents is increasing annually. While orthokeratology (OK) is effective for controlling myopia progression, it may also be detrimental. We investigated tear film parameters [including tear mucin 5AC (MUC5AC) concentration] in children and adolescents with myopia treated with spectacles or OK compared with those with emmetropia.

METHODS

This prospective case-control study enrolled children (aged 8-12 years; 29 and 39 with myopia treated with OK and spectacles, respectively, and 25 with emmetropia) and adolescents (aged 13-18 years; 38 and 30 with myopia treated with OK and spectacles, respectively, and 18 with emmetropia). We recorded the ocular surface disease index (OSDI), visual analog scale (VAS) score, tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), meibomian gland score (meiboscore), ocular redness score, and tear MUC5AC concentration in the emmetropia, spectacle (after 12 months of spectacle wearing), and OK (baseline, and after 1-, 3-, 6-, and 12-month use) groups. We observed changes from baseline to 12 months in the OK group and compared parameters among the spectacle, 12-month OK, and emmetropia groups.

RESULTS

The 12-month OK group differed significantly from the spectacle and emmetropia groups in most indicators among children and adolescents (P < 0.05). Differences were not noticeable between the spectacle and emmetropia groups (only PVAS < 0.05 among the children). In the OK group, the 12-month NIBUT was significantly decreased (P < 0.05) in both age groups; the upper meiboscore was increased at 6 and 12 months (both P < 0.05) among children; ocular redness scores were higher at 12 months than at baseline (P = 0.007), 1 month (P < 0.001), and 3 months (P = 0.007) among children; and the MUC5AC concentration was decreased at 6 and 12 months among adolescents, but only at 12 months among children (all P < 0.05).

CONCLUSIONS

Long-term OK can negatively influence the tear film in children and adolescents. Moreover, changes are masked by spectacle wearing.

TRIAL REGISTRATION

This trial is registered with "ChiCTR2100049384."

Intense pulsed-light treatment improves objective optical quality in patients with meibomian gland dysfunction

BACKGROUND

To evaluate changes in objective optical quality following intense pulsed light (IPL) treatment combined with meibomian gland (MG) expression (MGX) in patients with MG dysfunction (MGD).

METHODS

This retrospective cross-sectional study included MGD-related dry eye disease (DED) patients who received IPL treatment between March and December 2021 at Kim's Eye Hospital, Seoul, Republic of Korea. Each patient underwent four sessions of IPL treatment using Lumenis M22 (Lumenis Ltd., Yokneam, Israel) and MGX at three-week intervals.

RESULTS

This study included 90 eyes from 45 patients with MGD. The mean age was 52.3 ± 16.1 years (range, 20-75 years), and 53.3% (24/45) of patients were female. Compared with the baseline, all clinical symptoms and signs significantly improved after IPL treatment combined with MGX. All optical quality parameters obtained with an optical quality analysis system (OQAS: Visiometrics, Castelldefels, Spain) have improved significantly over the baseline (p < 0.001).

CONCLUSIONS

In patients with MGD, IPL treatment combined with MGX improved the objective optical quality and clinical signs and symptoms of DED.