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Ajouz L, Hallak J, Naik R, Nguyen A, Zhao C, Robinson MR, Nichols KK. Evaluation of the Impact of Meibomian Gland Dysfunction Using a Novel Patient-Reported Outcome Instrument. J Ocul Pharmacol Ther 2024; 40:48-56. [PMID: 37910805 PMCID: PMC10890943 DOI: 10.1089/jop.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose: This study was intended to characterize the impact of meibomian gland dysfunction (MGD) on patients' quality of life. Methods: In this prospective, multicenter, noninterventional clinical study (NCT01979887), eligible individuals (age ≥40 years; absence of uncontrolled ocular/systemic disease) were categorized, based on composite grading of ocular symptoms, Schirmer score, and meibum quality, into (1) non-MGD, (2) mild/moderate MGD, or (3) severe MGD cohorts. The MGD Impact Questionnaire (MGD IQ), a 10-item patient-reported outcome measure, was self-administered at clinic visit on day 1, and readministered on day 22 to assess intervisit agreement regarding MGD IQ responses. Results: In total, 75 subjects were assigned to the study cohorts (25 per cohort). Across cohorts, MGD IQ item scores rose incrementally with increasing MGD severity. The severe MGD cohort experienced greater difficulty with reading and performance of leisure activities, greater time on eye care, and greater bother with eye care and eye appearance than the mild/moderate MGD cohort (all P < 0.05). Compared with the non-MGD cohort, the mild/moderate MGD cohort had greater difficulty working on computer, whereas the severe MGD cohort had greater difficulty reading, driving, and performing leisure activities, more frequent difficulty with outdoor activities, more time on eye care, and greater bother with eye care (all P < 0.05). Intervisit agreement between MGD IQ responses was fair to moderate (weighted kappa statistic 0.33‒0.58). Conclusions: Vision-related activities are negatively impacted by increasing severity of MGD. The MGD IQ instrument can help characterize disease severity and amplify the patient's voice in patient-centric clinical research. ClinicalTrials.gov NCT01979887.
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Affiliation(s)
- Layla Ajouz
- Allergan (an AbbVie company), Irvine, California, USA
| | - Joelle Hallak
- Allergan (an AbbVie company), Irvine, California, USA
| | - Rupali Naik
- Noesis Healthcare Technologies, Redwood City, California, USA
| | - Ashley Nguyen
- Allergan (an AbbVie company), Irvine, California, USA
| | - Cathy Zhao
- Allergan (an AbbVie company), Irvine, California, USA
| | | | - Kelly K. Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
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Schjerven Magno M, Olafsson J, Beining M, Moschowits E, Lagali N, Wolffsohn JS, Craig JP, Vehof J, Dartt DA, Utheim TP. Hot towels: The bedrock of Meibomian gland dysfunction treatment - A review. Cont Lens Anterior Eye 2023; 46:101775. [PMID: 36715292 DOI: 10.1016/j.clae.2022.101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meibomian gland dysfunction (MGD) reduces quality-of-life and hinders work productivity of millions of patients, with high direct and indirect societal costs. Thickened meibum obstructs the glands and disrupts ocular surface health. Heating the eyelids to soften and express meibum from the glands can be beneficial. The most accessible method for eyelid warming uses heated, wet towels. However, the efficacy of this treatment is reliant on the methodology, and evidence-based best-practice recommendations are needed. PURPOSE To evaluate the literature on hot towels in MGD treatment and recommend a best-practice protocol for future research and patient treatment. METHODS Studies were identified through PubMed on the May 28, 2021, with the search terms: (warm* OR heat* OR thermal* OR towel OR wet towel) AND (meibomian OR MGD OR eyelid OR "dry eye" OR DED). All relevant original articles with English full-text were included. RESULTS The search yielded 903 results, of which 22 met the inclusion criteria. Across studies, hot towels were found to be effective at reducing ocular symptoms. However, without reheating, the temperature quickly fell below the therapeutic range, which was deemed to be between 40 °C and 47 °C. Towels heated to around 45 °C and reheated every-two minutes were most effective at increasing eyelid temperature, comparable or better than several commercially available eyelid warming devices. No adverse effects were reported in the studies. CONCLUSION Hot towel treatment effectively warms the eyelids and reduces ocular symptoms, but must be standardized, and towels reheated to achieve maximum benefit. Future research should assess patient satisfaction with different hot towel treatment methods that reheat or replace the towel at least every-two minutes, to establish which methods yield the greatest compliance. Guidelines or clinical recommendations that do not mention the need for regular reheating during hot towel compress treatment should be updated to include this.
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Affiliation(s)
- Morten Schjerven Magno
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jonatan Olafsson
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Beining
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emily Moschowits
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Neil Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - James S Wolffsohn
- School of Optometry, College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Jennifer P Craig
- School of Optometry, College of Health & Life Sciences, Aston University, Birmingham, United Kingdom; Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Jelle Vehof
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dutch Dry Eye Clinic, Emmastraat 21, 6881SN, Velp, the Netherlands
| | - Darlene A Dartt
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 20 Staniford St., Boston, MA 02114, United States
| | - Tor P Utheim
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Stavanger University Hospital, Oslo, Norway; Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; Department of Computer Science, Oslo Metropolitan University, Oslo, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway; National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway; Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; The Norwegian Dry Eye Clinic, Oslo, Norway
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Sheppard JD, Nichols KK. Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape. Ophthalmol Ther 2023; 12:1397-1418. [PMID: 36856980 PMCID: PMC10164226 DOI: 10.1007/s40123-023-00669-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/27/2023] [Indexed: 03/02/2023] Open
Abstract
Meibomian gland dysfunction (MGD) is highly prevalent and is the leading cause of evaporative dry eye disease (DED). MGD is characterized by a reduction in meibum secretion and/or a change in meibum composition that results in the disruption of the tear film lipid layer and an increase in the tear film evaporation rate. Excessive evaporation causes tear film instability, desiccation, tear hyperosmolarity, inflammation, and apoptosis of ocular surface cells, resulting in a continuous cycle of DED. The primary treatment goal for DED associated with MGD is to restore the tear film lipid layer and decrease evaporation, thereby reducing ocular signs and symptoms. The management of MGD includes home care options (eyelid hygiene, warming eye masks, ocular lubricants) and office-based treatments (manual expression, microblepharoexfoliation, thermal pulsation, intense pulsed light, intraductal probing). Topical ophthalmic prescription medications attempt to alter various factors that may contribute to DED (e.g., inflammation, bacterial growth, inadequate tear production). In this review, clinical evidence regarding available treatments and emerging therapies from randomized studies in patients with DED associated with MGD is summarized. Although some treatment modalities have been evaluated specifically for DED patients with MGD, large-scale randomized controlled trials are needed to confirm efficacy and safety in this patient population. Currently, there are no approved prescription pharmacologic treatments specifically indicated for DED associated with MGD, and those medications approved for the treatment of DED do not target the key driver of the disease (i.e., excessive evaporation). NOV03 (perfluorohexyloctane; under review with the US Food and Drug Administration) is the most advanced emerging therapy for DED associated with MGD and has demonstrated statistically significant improvements in both signs and symptoms in randomized controlled trials. Development of novel pharmacotherapies will improve therapeutic options and allow for a more individualized approach for patients with DED associated with MGD.
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Affiliation(s)
- John D Sheppard
- Virginia Eye Consultants and Eastern Virginia Medical School, Suite #210, 241 Corporate Blvd, Norfolk, VA, 23502, USA. .,Eyecare Partners, St. Louis, MO, USA.
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
Meibomian gland dysfunction (MGD) is characterized by the obstruction and/or inflammation of the meibomian glands that result in decreased and altered meibum secretion. This results in deficiencies in the tear film lipid layer which contributes to increased evaporation and destabilization of the tear film. One of the mainstay therapies for MGD is medical devices that apply heat and/or pressure to the eyelids and promote the liquification and outflow of meibum into the tear film. Over the past two decades, there have been a surge of interest in diagnosing and managing MGD. As a result, numerous medical devices have been developed and each have their own unique approach to treating MGD. This narrative review was conducted to summarize the current state of knowledge on eyelid warming devices, specifically warm eye coverings, devices that direct heat and/or pressure to the eyelids, moisture chamber goggles, and light-based therapy. This review summarized 58 human clinical studies and found that most eyelid warming devices were efficacious in improving signs and symptoms in a wide range of MGD severities and were generally safe to use.
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Affiliation(s)
- Brandon Bzovey
- Centre for Ocular Research & Education, School of Optometry & Vision Science University of Waterloo, Waterloo, Ontario, Canada
| | - William Ngo
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Eye and Vision Research (CEVR), Hong Kong, People’s Republic of China
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Rhim JW, Eom Y, Yoon EG, Park SY, Choi Y, Song JS, Kim HM. Efficacy of a 0.05% cyclosporine a topical nanoemulsion in dry eyes with obstructive meibomian gland dysfunction. Jpn J Ophthalmol 2022. [PMID: 35233694 DOI: 10.1007/s10384-022-00906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of topical cyclosporin A (CsA) in obstructive meibomian gland dysfunction (MGD). STUDY DESIGN Prospective, randomized, single-blinded, controlled clinical study. METHODS Fifty-one patients with obstructive MGD were randomly assigned to one of two groups. The CsA group received 0.05% CsA topical nanoemulsion (Cyporin N®; Taejoon Pharm) twice daily, 0.15% hyaluronic acid eye drops four times daily, and 10 min of warm compress placement on the eyelids twice daily. In the control group, 0.15% hyaluronic acid eye drops were administered six times daily and warm compress was conducted twice daily for 10 min. The ocular surface disease index (OSDI), Schirmer 1 test, tear film break-up time (TBUT), corneal and conjunctival surface staining using fluorescein, eyelid debris and eyelid redness/swelling, upper and lower meibomian gland (MG) secretion scores, and upper and lower MG loss were assessed at the three-month visits. RESULTS There were no significant differences in observed parameters between the two groups at baseline. At the three-month evaluation, the CsA group showed significantly better improvements in the TBUT, eyelid debris, eyelid redness/swelling, and lower MG secretion score (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). There was no improvement in upper or lower MG loss in either group. CONCLUSION Treatment with 0.05% CsA nanoemulsion in combination with warm compress twice daily alleviated signs of dry eyes with obstructive MGD. However, although MG secretion was improved, glandular loss could not be restored with three months of CsA nanoemulsion treatment.
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García-Marqués JV, Talens-Estarelles C, Martínez-Albert N, García-Lázaro S, Cerviño A. Evaluation of the MGDRx eyebag treatment in young and older subjects with dry eye symptoms. J Fr Ophtalmol 2021; 45:20-27. [PMID: 34840000 DOI: 10.1016/j.jfo.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to evaluate the relationship between application of the MGDRx thermal eyebag and dry eye signs and symptoms in young and older subjects and to compare the results between the two groups. METHODS Thirty young, healthily volunteers between 18 and 31 years of age (23.95±3.94 years) and thirty older subjects between 61 and 90 years of age (77.97±8.11 years) participated in this study. Ocular surface parameters were assessed using the Oculus Keratograph 5M, following the guidelines of the Tear Film and Ocular Surface Dry Eye Workshop II Diagnostic Methodology report. Only subjects with a positive score on at least one questionnaire and an initial Non-Invasive Keratograph Break-Up Time (NIKBUT) under 10seconds were included in the study. After thermal bag self-application in both eyes every day for 2 weeks, the protocol was carried out again. Lid massage was performed after lid warming. Compliance and degree of improvement were also assessed. MAIN RESULTS The young volunteer group showed an improvement in NIKBUT, lipid layer score, upper eyelid gland drop-out percentage and dry eye symptoms over the two week treatment period. Improvements in meibum quality, gland obstruction, telangiectasia scores, and dry eye symptoms were found in the older subjects. Mixed ANOVA revealed better NIKBUT and lipid layer values in the young subjects. Despite the treatment compliance being statistically higher in the older group than in the younger subjects (P=0.002), there were no significant differences in subjective improvement between groups (P=0.097). CONCLUSION Dry eye-related symptoms were improved after thermal bag application, while NIKBUT and lipid layer thickness were improved only in the younger subjects.
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Affiliation(s)
- J V García-Marqués
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - C Talens-Estarelles
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - N Martínez-Albert
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - S García-Lázaro
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - A Cerviño
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain.
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Olafsson J, Lai X, Landsend ECS, Olafsson S, Parissi E, Utheim ØA, Raeder S, Badian RA, Lagali N, Dartt DA, Utheim TP. TheraPearl Eye Mask and Blephasteam for the treatment of meibomian gland dysfunction: a randomized, comparative clinical trial. Sci Rep 2021; 11:22386. [PMID: 34789807 DOI: 10.1038/s41598-021-01899-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Meibomian gland dysfunction (MGD) is the most common cause of dry eye disease (DED). In this study, we aimed to compare the effects of eyelid warming treatment using either TheraPearl Eye Mask (Bausch & Lomb Inc., New York, USA) or Blephasteam (Spectrum Thea Pharmaceuticals LTD, Macclesfield, UK) in a Norwegian population with mild to moderate MGD-related DED. An open label, randomized comparative trial with seventy patients (49 females, 21 males; mean age 53.6 years). Patients were randomly assigned to treatment with Blephasteam (n = 37) or TheraPearl (n = 33). All received a hyaluronic acid based artificial tear substitute (Hylo-Comod, Ursapharm, Saarbrücken, Germany). Patients were examined at baseline, and at three and six months initiation of treatment. Treatment efficacy was primarily evaluated by fluorescein breakup time (FBUT) and Ocular Surface Disease Index (OSDI) scores. Other outcome measures included ocular surface staining (OSS), Schirmer’s test, and meibomian quality and expressibility. Baseline parameter values did not differ between the groups. After six months of treatment, Blephasteam improved FBUT by 3.9 s (p < 0.01) and OSDI by 13.7 (p < 0.01), TheraPearl improved FBUT by 2.6 s (p < 0.01) and OSDI by 12.6 (p < 0.01). No difference between treatments was detected at 6 months (p = 0.11 for FBUT and p = 0.71 for OSDI), nor were there differences in the other tested parameters between the treatment groups. Blephasteam and TheraPearl are equally effective in treating mild to moderate MGD in a Norwegian population after 6-months of treatment. Clinicaltrials.gov ID: NCT03318874; Protocol ID: 2014/1983; First registration: 24/10/2017.
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Huynh CB, Ngo W. Quantifying the Effect of Spectacle Frame Dimensions on Wind-Induced Ocular Plane Evaporation Using an in Vitro Model. Eye Contact Lens 2021; 47:347-351. [PMID: 33840747 DOI: 10.1097/icl.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantify the effect of spectacle frame dimensions on wind-induced ocular plane evaporation. METHODS A drop of 0.5 μL water was pipetted onto an eye of a mannequin head. The face was fitted with a spectacle frame. A fan positioned 10 cm away directed air (185 CFM) toward the face and the time required for the drop to evaporate was recorded. This procedure was repeated with 31 different frames to obtain evaporation times for various eye sizes, vertical heights, vertex distances, temperature, and humidity. This was also repeated 30 times without spectacle wear to obtain evaporation times for various temperature and humidity conditions. RESULTS Spectacle wear increased evaporation times compared with nonspectacle wear, in both high (>35%) and low humidity (<30%) conditions (both P<0.01). Humidity was correlated with evaporation time, regardless of spectacle and nonspectacle wear (both P<0.01). Evaporation time did not correlate with spectacle eye size, vertical height, or vertex distance (all P≥0.21). CONCLUSION This study showed that spectacle wear guarded against wind-induced evaporation at the ocular plane compared with nonspectacle wear. However, once spectacles were worn, eye size, vertical height, and vertex distance were not correlated with evaporation times. Humidity drove evaporation independent of spectacle wear.
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Affiliation(s)
- Cassandra B Huynh
- Centre for Ocular Research and Education (C.B.H., W.N.), University of Waterloo School of Optometry and Vision Science, Waterloo, ON, Canada ; and Centre for Eye and Vision Research (CEVR) (W.N.), Hong Kong
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Pauk SV, Petriček I, Tomić M, Bulum T, Jandroković S, Kalauz M, Masnec S, Jukić T. Manual interferometric device for routine non-invasive tear film break-up time assessment. Semin Ophthalmol 2021; 36:94-102. [PMID: 33641610 DOI: 10.1080/08820538.2021.1884272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine the feasibility of non-invasive tear break-up time (NIBUT) assessment using the Handheld tear lipid layer thickness assessment instrument and compare it with the standard tear break-up time (TBUT) test and other dry eye tests.Subjects and methods: 108 subjects were enrolled, 56 with and 52 without dry eye symptoms. Schein questionnaire was used to determine the severity of dry eye symptoms. Ocular signs were assessed by NIBUT, TBUT, lipid layer thickness (LLT), lid-parallel conjunctival folds (LIPCOF), conjunctival hyperemia, and corneal staining.Results: Median NIBUT and TBUT, and other clinical test values significantly differed among the dry eye symptoms group and control group. NIBUT yielded the most significant difference between the groups (NIBUT: 7 sec vs. 17.5 sec, p < .001, Z = 5.94; TBUT: 5 sec vs. 10 sec, p < .001, Z = 4.38; LLT: p = .007; LIPCOF: p < .001, conjunctival hyperemia: p < .047, corneal staining: p < .010). Spearman's test showed a significant correlation between NIBUT and TBUT (p < .001), NIBUT and LLT (p = .001), NIBUT and LIPCOF (p = .019), NIBUT and conjunctival hyperemia (p = .002), and NIBUT and corneal staining (p = .012) in the dry eye symptoms group. NIBUT did not significantly differ among the three measurements in both groups of patients (p = .061, p = .096), while TBUT values did in the control group (p < .001). Short NIBUT values were the main predictors and indicators of dry eye complaints (AOR = 0.87, p < .001), superior to TBUT (AOR = 0.88, p = .008) and other tests even after adjustment for age and gender.Conclusion: NIBUT measured by Handheld instrument is a simple, accessible, practical, and, most of all, reproducible and objective method that might allow NIBUT assessment on a regular basis.
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Affiliation(s)
- Sania Vidas Pauk
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia
| | - Igor Petriček
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Martina Tomić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Sonja Jandroković
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miro Kalauz
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sanja Masnec
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Jukić
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Abstract
A biomarker is a "characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions." Recently, calls for biomarkers for ocular surface diseases have increased, and advancements in imaging technologies have aided in allowing imaging biomarkers to serve as a potential solution for this need. This review focuses on the state of imaging biomarkers for ocular surface diseases, specifically non-invasive tear break-up time (NIBUT), tear meniscus measurement and corneal epithelial thickness with anterior segment optical coherence tomography (OCT), meibomian gland morphology with infrared meibography and in vivo confocal microscopy (IVCM), ocular redness with grading scales, and cellular corneal immune cells and nerve assessment by IVCM. Extensive literature review was performed for analytical and clinical validation that currently exists for potential imaging biomarkers. Our summary suggests that the reported analytical and clinical validation state for potential imaging biomarkers is broad, with some having good to excellent intra- and intergrader agreement to date. Examples of these include NIBUT for dry eye disease, ocular redness grading scales, and detection of corneal immune cells by IVCM for grading and monitoring inflammation. Further examples are nerve assessment by IVCM for monitoring severity of diabetes mellitus and neurotrophic keratitis, and corneal epithelial thickness assessment with anterior segment OCT for the diagnosis of early keratoconus. However, additional analytical validation for these biomarkers is required before clinical application as a biomarker.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jie L, Shang-Kun O, Wei L, Zu-Guo L, Qing-Hua P. Physical Therapy Modalities of Western Medicine and Traditional Chinese Medicine for Meibomian Gland Dysfunction. Digital Chinese Medicine 2020. [DOI: 10.1016/j.dcmed.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Valencia-Nieto L, Novo-Diez A, Blanco-Vázquez M, López-Miguel A. Therapeutic Instruments Targeting Meibomian Gland Dysfunction. Ophthalmol Ther 2020; 9:797-807. [PMID: 32968960 DOI: 10.1007/s40123-020-00304-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023] Open
Abstract
The most prevalent type of meibomian gland dysfunction (MGD), which is obstructive, is the main cause of evaporative dry eye and is characterized by changes in the meibum composition and duct obstruction. Eyelid hygiene has usually been the most common clinical approach. However, alternative therapies for MGD are emerging on the market. Some warming and humidity devices have led to an improvement in the signs and symptoms in MGD patients. Likewise, eyelid massaging and cleaning devices are also beneficial for ocular signs and symptoms; however, patients usually need more than one session to maintain the therapeutic effect. Thermal pulsation has been reported to be more efficient than other strategies, and the effects can last up to 12 months. Moreover, intense pulsed light therapy has been demonstrated to improve ocular signs and symptoms alone and in combination with other therapies. Proper counseling of clinicians considering MGD status and patient compliance will help patients to undergo the adequate technique that best suits their condition.
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Abstract
OBJECTIVES To evaluate recent studies on available therapies for meibomian gland dysfunction (MGD). METHODS A literature search on recent publications, within the last five years, concerning treatment options for MGD was performed. RESULTS A total of 35 articles were reviewed after curation by the authors for relevance. In general, all modalities of treatments were shown to have clinical efficacy in alleviating dry eye signs and symptoms, although the extent of improvement and persistency of outcomes varied between the different treatments. Evidence from published studies demonstrate that thermal pulsation produces the longest lasting effect per treatment, but it also incurs the highest per-treatment cost. Reusable methods for warm compress with lipid/semi-fluorinated alkane-containing eye drops are recommended as first-line treatment for mild-to-moderate dry eye patients, because this option is most technically feasible and cost-effective in clinical practice. Intense pulsed light (IPL) therapy and thermal pulsation may be suitable as second line for patients unresponsive to warm compress therapy; however, their respective limitations need to be considered. For refractory MGD with features of periductal fibrosis or severe blepharitis, supplementary treatment with meibomian gland probing or oral antibiotics may be used. CONCLUSIONS All eight forms of treatments, including self-applied eyelid warming, thermal pulsation, IPL, MG probing, antibiotics, lipid-containing eye drops, and perfluorohexyloctane, were effective against MGD, although with varying extent of clinical improvements. A better understanding on the mechanisms of actions may guide physicians to make better treatment decisions targeting the root causes.
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Affiliation(s)
- Pun Yuet Lam
- Department of Ophthalmology (P.Y.L., K.C.S., P.Y.F., T.C.Y.C., A.L.-K.N.), Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR; Department of Ophthalmology (T.C.Y.C.), Hong Kong Sanatorium and Hospital, Hong Kong SAR; Department of Ophthalmology (V.J.), University of Pittsburgh Medical Centre, Pittsburgh, PA; Cornea and External Eye Disease Service (L.T.), Singapore National Eye Centre, Singapore; and Ocular Surface Research Group (L.T.), Singapore Eye Research Institute, Singapore
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Li J, Li D, Zhou N, Qi M, Luo Y, Wang Y. Effects of chalazion and its treatments on the meibomian glands: a nonrandomized, prospective observation clinical study. BMC Ophthalmol 2020; 20:278. [PMID: 32652956 PMCID: PMC7353760 DOI: 10.1186/s12886-020-01557-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background To observe the effects of chalazion and its treatments on meibomian gland function and morphology in the chalazion area. Methods This nonrandomized, prospective observational clinical study included 58 patients (67 eyelids) who were cured of chalazion, including 23 patients (23 eyelids) treated with a conservative method and 35 patients (44 eyelids) treated with surgery. Infrared meibomian gland photography combined with image analysis by ImageJ software was used to measure the chalazion area proportion. Slit-lamp microscopy was employed to evaluate meibomian gland function, and a confocal microscope was used to observe meibomian gland acinar morphology before treatment and 1 month after complete chalazion resolution. Results At 1 month after chalazion resolution, the original chalazion area showed meibomian gland loss according to infrared meibomian gland photography in both groups. In patients who received conservative treatment, the meibomian gland function parameters before treatment were 0.74 ± 0.75, 0.48 ± 0.67, and 1.22 ± 0.60, respectively. One month after chalazion resolution, the parameters were 0.35 ± 0.49, 0.17 ± 0.49, and 0.91 ± 0.60, respectively; there was significant difference (P < 0.05). The proportion of the chalazion area before treatment was 14.90 (11.03, 25.3), and the proportion of meibomian gland loss at 1 month after chalazion resolution was 14.64 (10.33, 25.77); there was no significant difference (P > 0.05). In patients who underwent surgery, the meibomian gland function parameters before surgery were 0.93 ± 0.87, 1.07 ± 0.70, and 1.59 ± 0.76, respectively, and at 1 month after chalazion resolution, they were 0.93 ± 0.82, 0.95 ± 0.75, and 1.52 ± 0.70, respectively; there was no significant difference (P > 0.05). The proportion of the chalazion area before surgery was 14.90 (12.04, 21.6), and the proportion of meibomian gland loss at 1 month after chalazion resolution was 14.84 (11.31, 21.81); there was no significant difference (P > 0.05). The acinar structure could not be observed clearly in the meibomian gland loss area in most patients. Conclusions Chalazion causes meibomian gland loss, and the range of meibomian gland loss is not related to the treatment method but to the range of chalazion itself. A hot compress as part of conservative treatment can improve meibomian gland function at the site of chalazion in the short term.
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Affiliation(s)
- Junping Li
- Aier Eye Hospital (East of Chendu), Chendu, China
| | - Dongping Li
- Hankou Aier Eye Hospital, Wuhan, 430021, China
| | - Na Zhou
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Mengying Qi
- Hankou Aier Eye Hospital, Wuhan, 430021, China
| | - Yanzhu Luo
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Yuhong Wang
- Hankou Aier Eye Hospital, Wuhan, 430021, China.
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