Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study

José Vicente García-Marqués,Rute Juliana Macedo-De-Araújo,Alejandro Cerviño,Santiago García-Lázaro,Jose Manuel González-Méijome

doi:10.1016/j.clae.2021.101571

José Vicente García-Marqués, Rute Juliana Macedo-De-Araújo + Show 3 more

Open Access

https://doi.org/10.1016/j.clae.2021.101571

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Abstract

ObjectivesTo validate a previously developed algorithm based on the visibility of meibomian gland images obtained with Cobra fundus camera and to assess the changes in meibomian glands in scleral lens wearers over one year of lens wear. MethodsInfrared meibography was obtained from the upper eyelid using the Cobra fundus camera in forty-three volunteers (34.2 ± 10.1 years). Meibographies were classified into 3 groups: Group 1 = good subjective gland visibility and gland drop-out < 1/3 of the total area; Group 2 = low visibility and gland drop-out < 1/3; and Group 3 = low visibility and gland drop-out > 1/3. Meibomian gland visibility metrics were then calculated using the developed algorithm from the pixel intensity values of meibographies. Repeatability of new metrics and their correlations with gland drop-out were assessed. Meibographies and ocular symptoms were also assessed after 1 year of scleral lens wear in 29 subjects. ResultsGland drop-out percentage was not statistically different between groups 1 and 2 (p = 0.464). Nevertheless, group 1 showed higher grey pixel intensity values than the other groups. Statistically significant correlations were found between gland visibility metrics and gland drop-out percentage. Repeatability was acceptable for all metrics, coefficient of variation achieving values between 0.52 and 3.18. While ocular symptoms decreased with scleral lens wear (p < 0.001), no statistically significant differences were found in gland drop-out percentage (p = 0.157) and gland visibility metrics (p > 0.217). ConclusionsThe proposed method can assess meibomian gland visibility in an objective and repeatable way. Scleral lens wear appears to not adversely affect meibomian gland drop-out and visibility while might improve dry eye symptoms after one year of lens wear. These preliminary results should be confirmed with a control group.

Highlights

Scleral lenses are large-diameter contact lenses that rest on the bulbar conjunctiva overlying the sclera
An objective, semiautomatic algorithm based on the analysis of the visibility of meibomian glands, Table 4 Comparison of Ocular Surface Disease Index (OSDI), gland drop-out and gland visibility in baseline and after one year of scleral lens fitting
Meibomian gland visibility assessment could be relevant because the link between gland drop-out and gland function is not clear [60]

Summary

Introduction

Scleral lenses are large-diameter contact lenses that rest on the bulbar conjunctiva overlying the sclera. As scleral lenses are inserted with liquid (preservative-free saline solution), they create a tear reser voir that keeps the cornea moistened This characteristic along with correcting anterior corneal aberrations allows these devices to often deliver clear as well as minimize dry eye-related symptoms in patients with irregular corneas and/or severe ocular surface disease [1,2,3,4,5,6,7,8,9,10]. Meibomian Gland Dysfunction (MGD) occurs when meibomian glands produce an abnormal secretion, are obstructed or atrophied It is a chronic disorder and is the leading cause of DED [12,15,17,19,20,21]. Some studies concluded that soft and rigid contact lens wear may potentiate meibomian gland drop-out, alter gland morphology such as length and width, alter meibum expressibility and quality, and induce dry eye (http://creativecommons.org/licenses/by/4.0/)

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