Noninvasive ocular surface analyzer as an adjunct in diagnosis and estimating prevalence of meibomian gland dysfunction: Hospital-based comparative study

Abstract

Purpose: To assess the role of noninvasive ocular surface analyzer (OSA) in workup of meibomian gland dysfunction (MGD) and to estimate hospital-based prevalence of MGD using this objective device.

Methods: The study recruited 113 consecutive participants attending the ophthalmology outpatient department of a tertiary care hospital. All participants were administered a symptom questionnaire. Participants underwent a comprehensive ocular examination, including slit-lamp biomicroscopy and meibomian gland expression. Lipid layer thickness (LLT), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and meibomian gland loss (MGL) were assessed using OSA. The presence of either or both reduced/absent meibum secretion and cloudy to toothpaste-like secretion was diagnosed as MGD.

Results: Prevalence of total MGD was 57.52% (95% confidence interval [95% CI]: 48.3%-66.8%) and that of symptomatic MGD was 42.5% (95% CI: 33.2%-51.7%). Prevalence of total and symptomatic MGD was highest in those aged ≥50 years (P < 0.001 and P = 0.004, respectively). Computer vision syndrome increased the odds of symptomatic MGD (odds ratio [OR]: 4.3). NIBUT and MGL significantly differed in MGD and non-MGD groups (P = 0.023 and P < 0.001, respectively). LLT significantly differed between asymptomatic and symptomatic cases (P = 0.033). MGL >25% increased the odds of having MGD (OR: 19.1). Significant negative correlations were observed between MGL and NIBUT (P = 0.04) and between MGL and LLT (P = 0.02). MGL demonstrated the highest diagnostic accuracy for MGD (AUC = 0.827, sensitivity = 75.4%, specificity = 85.4%, cut-off value: ≥26%).

Conclusion: MGD is a common disorder in adults attending the ophthalmology outpatient services of a tertiary eye care hospital. Incorporating noninvasive OSA in clinical practice can aid in rapid and reliable measurements of MGD-related parameters.

Keywords: Dry Eye; meibomian gland dysfunction; meibomian gland loss; meibomian glands; ocular surface analyzer.

Figure 1

Examination of the ocular surface through slit-lamp–mounted ocular surface analyzer, an integrated platform for diagnosis of dry eye disease

Figure 2

ROC curves for NIBUT, MGL, LLT, and TMH. LLT = lipid layer thickness, MGL = meibomian gland loss, NIBUT = noninvasive tear breakup time, ROC = receiver operating characteristic, TMH = tear meniscus height