Diagnostic Test Efficacy of Meibomian Gland Morphology and Function

Jiaxin Xiao,Øygunn A Utheim,Neil S Lagali,Sten Ræder,Jonatan Olafsson,Darlene A Dartt,Muhammed Yasin Adil,Xiangjun Chen,Tor P Utheim

doi:10.1038/s41598-019-54013-4

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.

Highlights

Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye disease (DED)[1]
The meibograde, computerized dropout, number of distorted glands, meibomian gland (MG) thickness and density, and meibum quality were significantly elevated in the MGD patients compared to the healthy controls (Table 1)
The receiver operator characteristics (ROC) curves revealed the ability of morphological features to discriminate between MGD patients and healthy controls (Fig. 1)

Summary

Introduction

Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye disease (DED)[1]. The disease progression is accompanied by specific clinical signs such as meibomian gland (MG) atrophy, altered MG secretion, and changes in lid morphology[2]. Gland enlargement could be a compensatory mechanism for insufficient meibum secretion, and can be an early finding of MGD3. Various clinical tests have been established for evaluation of MG function and morphology. Meibum quality and expressibility assessment are widely used for evaluating MG function[2,7], whereas meibography can be applied for direct observation of MG morphological structure. Atrophy appears to occur in the later stages of the disease in contrast to gland dilatation, which may represent an early stage of MGD. The purpose of the present study was to establish reliable morphologic measurements of the MG for evaluating MGD severity

Objectives

Methods

Results

Conclusion