A critical look at meibometry as a means to monitor Meibomian gland function

Abstract

Abstract Purpose To evaluate the diagnostic performance of meibometry in classifying and quantifying Meibomian gland dysfunction(MGD) Methods Ninety‐six patients with MGD (138 eyes, 62 women, 34 men) and 30 normal control subjects(55 eyes)were enrolled. Eighty six eyes were classified as high delivery (HD)‐MGD (meibomian seborrhea/hypersecretory MGD), 52 as low delivery (LD)‐MGD on the basis of expression quality scores and morphological signs. Direct Meibometry (DM) measurements were made with an MB550 Meibometer (Courage‐Khazaka GmbH). Standard curves were constructed relating arbitrary Meibometer optical density units (AU). Integrated Meibometry (IM) was performed on scanned images of the lipid blots. Symptoms were scored by OSDI,Schirmer test I, Break Up Time (BUT), tear osmolarity (Tearlab, Ocusense), conjunctival scraping cytology were performed. Statistical analysis used SPSS 14.0 and MedCalc 5.0 Results AU values plotted on a log scale correlated highly with the lipid equivalent values (R2= 0.913). Significant differences were found between control subjects vs all MGD patients and between HD vs LD‐MGD patients for all the parameters evaluated. In particular: controls: 300+/‐121 AU (0.04+/‐0.015 microliter), LD‐MGD: 218+/‐122 AU (0.03+/‐0.015) and HD‐MGD: 564+/‐115 AU (0.07+0.015) (median+/‐SD). Significant correlation was found DM vs IM (r=0.691,p<0.0001) and DM was shown to be correlated with BUT, OSDI score, scraping score and tear osmolarity, especially in LD‐MGD patients. The selected DM diagnostic cut off for LD‐MGD was <275 AU (sens 73, spec 60, PPV 63) and for HD‐MGD was >450 AU; (sens 86, spec 87, PPV 91) Conclusion Meibometry is confirmed to be a reliable method to distinguish normal subjects from MGD subgroups with a good degree of accuracy