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. 2024 Jun 3;13(6):6.
doi: 10.1167/tvst.13.6.6.

Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography

Man Hu  1   2 , Chenchen Wang  1   2 , Ying Li  1   2 , Hongfang Zhang  1   2 , Hongzhe Li  1   2 , Qi Dai  1   2 , Hengli Lian  1   2 , Yun-E Zhao  1   2 , Yana Fu  1   2
Affiliations

Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography

Man Hu et al. Transl Vis Sci Technol. .

Abstract

Purpose: To evaluate the ability of swept-source optical coherence tomography angiography (SS-OCTA) to assess lid margin vascularity.

Methods: This prospective, cross-sectional trial enrolled 125 participants, including 15 control subjects and 110 meibomian gland dysfunction (MGD) patients. Lid margin blood flow density (LMBFD) was obtained using SS-OCTA. LMBFD was assessed for repeatability in 54 of 125 participants and for reproducibility in 23 of 125 participants. The efficacy of LMBFD was validated in the 125 participants, who were divided into mild (n = 46), moderate (n = 42), and severe groups (n = 37) according to the lid margin vascularity severity shown in the slit-lamp photographs. Correlations between LMBFD and MG-related parameters, such as ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), cornea fluorescein staining (CFS), lid margin score (LMS), and meibomian gland expressibility (ME), were analyzed in all 125 participants.

Results: Repeatability and reproducibility coefficients were satisfactorily high in the scan mode with a scan area of 6 mm × 6 mm (intraclass correlation coefficient [ICC] repeatability = 0.905; ICC reproducibility = 0.986) and a scan area of 9 mm × 9 mm (ICC repeatability = 0.888; ICC reproducibility = 0.988). The LMBFD gradually increased in the mild, moderate, and severe groups (P < 0.001). LMBFD was significant correlated with OSDI (r = 0.290, P = 0.001), FTBUT (r = -0.195, P = 0.030), CFS (r = 0.352, P < 0.001), ME (r = 0.191, P = 0.033), and LMS (r = 0.370, P < 0.001).

Conclusions: LMBFD may be a noninvasive, repeatable, reproducible, and efficient index for the quantitative evaluation of eyelid margin vascularity in the future.

Translational relevance: We demonstrated that SS-OCTA has the potential to evaluate the eyelid margin vascularity in MGD patients and guide future treatment strategies in clinics.

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Conflict of interest statement

Disclosure: M. Hu, None; C. Wang, None; Y. Li, None; H. Zhang, None; H. Li, None; Q. Dai, None; H. Lian, None; Y. Zhao, None; Y. Fu, None

Figures

Figure 1.
Figure 1.
Images of lid margins with different severities of vascularity: (A) grade 0, no capillaries visible; (B) grade 1, zero to five capillaries visible; (C) grade 2, six to 10 capillaries visible; (D) grade 3, more than 10 capillaries visible.
Figure 2.
Figure 2.
SS-OCTA measurement of the blood flow density of the upper lid margin in an MGD patient. (A) The lid margin vascularity shown in the slit-lamp photograph was severe. (B) The blood flow shown in the OCTA diagram was consistent with the blood vessel shown in (A) and (C). (C) The analysis center was located at the palpebral margin below the yellow asterisk, as shown in the OCTA enface images. (D) The measured depth of vascularity was approximately 500 µm in the OCT image. (E) Vascular density map with a 1 mm × 1 mm grid.
Figure 3.
Figure 3.
The average blood flow density increased significantly with the severity of eyelid margin vascularity (**P < 0.001, Mann‒Whitney U tests with Bonferroni correction).
Figure 4.
Figure 4.
Correlation analysis between LMBFD and the ocular surface parameters CFS, FTBUT, ME, and LMS.
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