Evaluation of the diagnostic value for meibomian gland dysfunction examinations

Abstract

To evaluate the sensitivity and specificity of clinical examinations in meibomian gland dysfunction (MGD). A prospective case-controlled study. Fifty-two patients with MGD and 32 healthy age- and sex-matched control subjects were included from January to August 2013. All subjects were underwent the examinations sequentially as follows: evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index (OSDI); lid margin and ocular surface examination by slit lamp microscrope; infrared meibomian photography; cornea sensation testing using the Cochet-Bonnet esthesiometer; tear film break-up time (BUT); corneal and conjunctival staining (Oxford scale); and Schirmer I test. One eye of each subject was included in the study. The parameters between MGD group and the control group were compared using the independent-samples T test. Spearman's correlation analysis was used to analyze the correlation of each parameter of MGD group. Receiver operating characteristic curve (ROC curve) and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate MGD from normal eyes. OSDI score, lid margin abnormality score, miss rate of meibomian glands and corneal and conjunctival staining score were obviously higher in MGD group (36.13 ± 14.71, 2.37 ± 0.937, (52.64 ± 17.23) %, 1.06 ± 1.75) than those in control group(5.22 ± 11.97, 0.94 ± 0.564, (23.97 ± 6.36) %, 0.03 ± 0.18) (t = 10.019, 7.808, 8.796, 3.293, respectively; P < 0.01). BUT, schirmer I value and corneal sensitivity score were significantly lower in MGD group (4.57 ± 2.13, 6.04 ± 7.09, 5.77 ± 0.38) than those in control group (13.31 ± 2.54, 12.56 ± 6.99, 5.98 ± 0.07) (t = -16.97, -4.119, -3.018, respectively; P < 0.01). AUC value of BUT was the largest (0.995), and the followings were the miss rate of meibomian (0.944), OSDI (0.925) and lid margin abnormalities (0.811). The sensitivity and the specificity of BUT were 90.4% and 100.0%; the miss rate of meibomian were 76.9% and 100.0%; OSDI were 97.4% and 87.1%; and lid margin abnormalities were 79.5% and 79.4%. The diagnostic value of these four parameters were better than the rest ones. BUT and the miss rate of meibomian have great value in diagnosis of MGD. Patients considered MGD can be performed these examinations to confirm the diagnosis.