Kara L. Menzies

Infrared imaging of meibomian gland structure using a novel keratograph.

Purpose. To examine the ability of a novel non-contact device (Keratograph 4) to image the meibomian gland (MG) structures and their morphological changes in the upper and lower eyelids. Methods. Thirty-seven participants (mean age 57.8 ± 8.5 years; 3 males and 34 females) completed the Ocular Surface Disease Index questionnaire to assess dryness symptoms. Meibum secretion quality score, number of blocked gland orifices, and meibum expressibility scores were assessed. The lower lid (LL) and upper lid (UL) of all subjects were everted and images of the MGs were taken using the Keratograph 4 (OCULUS). A MG dropout score (MGDS) due to complete or partial gland loss of both lids was obtained using a subjective 4-grade scoring system, and digital analysis of the images using ImageJ was performed. Presence of tortuosity and visible acinar changes of the MGs were also noted. Results. MGDS for both lids was significantly positively correlated with the Ocular Surface Disease Index score (r = 0.51; p < 0.05). The MGDS determined using the digital grading was also significantly positively correlated (UL: r = 0.68, p < 0.05; LL: r = 0.42, p < 0.05). The sum of the MGDS for both lids using the subjective grading scale was significantly different between the non-MGD and MGD group (1.3 ± 1.0 vs. 3.1 ± 1.1; p = 0.0004). MGDS assessment using the digital grading was significantly different between non-MGD (UL = 6%, LL = 8%) and MGD group (UL = 32%, LL = 42%; p = 0.001). Tortuous MG was observed only on the UL in 6% of the participants. Visible acinar changes were noted in 40% of the study participants. Conclusions. Infrared meibography is now possible in a clinical setting using commercially available devices, and meibography can help determine differences in MG structure in subjects symptomatic of dry eye.

The impact of contact angle on the biocompatibility of biomaterials.

Biomaterials may be defined as artificial materials that can mimic, store, or come into close contact with living biological cells or fluids and are becoming increasingly popular in the medical, biomedical, optometric, dental, and pharmaceutical industries. Within the ophthalmic industry, the best example of a biomaterial is a contact lens, which is worn by ∼125 million people worldwide. For biomaterials to be biocompatible, they cannot illicit any type of unfavorable response when exposed to the tissue they contact. A characteristic that significantly influences this response is that related to surface wettability, which is often determined by measuring the contact angle of the material. This article reviews the impact of contact angle on the biocompatibility of tissue engineering substrates, blood-contacting devices, dental implants, intraocular lenses, and contact lens materials.

In Vitro Analysis of the Physical Properties of Contact Lens Blister Pack Solutions

Purpose. Since the initial development of silicone hydrogels, many modifications to the bulk and surface properties of the lenses have been undertaken to improve the wettability and comfort of the lenses. Recently, manufacturers have incorporated various “wetting agents” or surface-active agents into the blister packaging solutions (BPSs) of the lenses to improve initial comfort of the lens on eye. The purpose of this study was to measure and compare the pH, surface tension (ST), viscosity, and osmolality of BPSs for a variety of silicone hydrogel and polyHEMA-based hydrogel lenses. In addition, two saline solutions were tested for comparison purposes. Methods. The pH, osmolality, ST, and viscosity were measured for the BPSs for lotrafilcon B and lotrafilcon A and lotrafilcon B with a “modified BPS” (m-lotrafilcon A, m-lotrafilcon B) (CIBA Vision, Duluth, GA); balafilcon A (Bausch & Lomb, Rochester, NY); galyfilcon A, senofilcon A, and narafilcon A (Johnson & Johnson, Jacksonville, FL); and comfilcon A and enfilcon A (CooperVision, Pleasanton, CA) and BPSs from two conventional polyHEMA-based materials—etafilcon A (Johnson & Johnson) and omafilcon A (CooperVision). The two saline solutions tested were Unisol (Alcon, Fort Worth, TX) and Softwear Saline (CIBA Vision). Results. The pH results for the two saline solutions and all BPSs remained in the pH range of tears (6.6–7.8). The ST of the modified BPS was significantly lower (p < 0.01) than the original non-modified BPS. Viscosity measurements ranged between 0.90 and 1.00 cP for all BPSs and saline solutions, except for the modified BPS, which had significantly higher viscosities (p < 0.001). Osmolality measurements were not significantly different (p > 0.05) between BPSs made by the same manufacturer but were significantly different compared with BPSs made by different manufacturers (p < 0.05). Conclusions. The incorporation of wetting agents and surfactants into BPSs does alter the physical properties of the BPSs, which may have clinical implications regarding initial in-eye comfort.

Infrared Imaging of Meibomian Glands and Evaluation of the Lipid Layer in Sjogren's Syndrome Patients and Nondry Eye Controls

PURPOSE The purpose of this study was to evaluate meibomian gland dropout and lipid layer thickness (LLT) in patients with and without Sjögrens syndrome dry eye (SS). METHODS We recruited 11 participants with SS (males/females [M/F], 1:10; mean age = 56.0 ± 9.1 years) and 10 control subjects without dry eye (M/F, 3:7; mean age = 58.5 ± 4.7 years). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The LLT was assessed using the Tearscope Plus based on the appearance of the lipid layer. Noninvasive tear break-up time (NITBUT) also was measured. The lower and upper lids were everted, and the meibomian glands were imaged using the infrared camera of the Keratograph 4. A meibomian gland dropout score due to gland loss was obtained. Statistical analysis was conducted using the Mann-Whitney U test and correlations were determined using Spearman rank correlations. RESULTS Of the SS participants, 100% reported ocular and oral dryness symptoms in the AECC questionnaire. The SS group recorded a higher OSDI score (median = 48.00, interquartile range [IQR] 23.0-56.2 vs. 2.1, IQR 0.0-2.6; P < 0.001), reduced LLT (median [IQR] = 15.0 [15.0-15.0] vs. 60.0 [45.0-100.0] nm; P = 0.001), and lower NITBUT (median [IQR] = 3.7 [2.5-4.2] vs. 9.5 [6.4-17.6] sec; P < 0.001) compared to the controls. Digital meibomian gland dropout score (% dropout) was significantly higher for the SS group (16.0% [IQR 12.1-40.0%] vs. 6.7% [IQR 1.5-12.7%]; P = 0.01). Subjective meibomian gland dropout score (0-6 score) was significantly higher for the SS group (median [IQR] = 1.5 [1.0-4.0] vs. 1.0 [0.0-1.25]; P = 0.03). CONCLUSIONS Patients with SS showed higher meibomian gland dropout scores and reduced LLT and NITBUT, which likely contribute to the severe dry eye symptoms reported by SS subjects.

In vitro contact angle analysis and physical properties of blister pack solutions of daily disposable contact lenses.

Objectives: The purpose of this study was to measure the advancing and receding contact angles (CAs) of five daily disposable (DD) lenses and the osmolality, surface tension (ST), and pH of each blister pack solution. Methods: The advancing and receding CAs were measured directly out of the blister pack for five DD lenses: omafilcon A (CooperVision), nelfilcon A (CIBA Vision), modified nelfilcon A (CIBA Vision), etafilcon A (Johnson & Johnson), and narafilcon A (Johnson & Johnson). Advancing CAs were measured using sessile drop and Wilhelmy balance methods. Receding CAs were measured using the Wilhelmy balance method. ST, pH, and osmolality were measured for each blister pack solution from all the DD lenses. Results: The advancing CAs for the nelfilcon A lenses were statistically lower (P<0.05) than the advancing CAs of the other three lenses. The receding CAs for etafilcon A were statistically lower (P<0.05) than the receding CAs for the other four lenses. The pH of all the blister pack solutions was relatively neutral (7.01–7.43). The ST of the blister pack solution for the modified nelfilcon A was significantly lower (P<0.05) than the ST of all other blister pack solutions. The osmolality of the blister pack solutions for the etafilcon A and narafilcon A lenses were significantly higher (P<0.05) than the other blister pack solutions. Conclusions: The modified nelfilcon A lens had low advancing CAs and low receding CAs showing minimal hysteresis. The blister pack solution for the modified nelfilcon A lens had the lowest ST, a low osmolality, and a neutral pH.

Imaging meibomian glands on a patient with chalazia in the upper and lower lids: A case report

AIM To describe the meibomian gland (MG) appearance in a case of eyelid chalazia, using a novel meibography method. METHODS A 29-year-old female of South Asian origin presented with mild swelling in the lower lid of the left eye. The patient also presented with a history of a recurrent chalazion in the upper lid of the same eye, which later progressed to an active chalazion. A chalazion also developed in the upper lid of the right eye. Meibography was performed using a novel Keratograph (Keratograph 4, OCULUS, Wetzlar, Germany) to evaluate the structure of the MG in the area affected by the chalazia. RESULTS The area of the recurrent chalazion in the upper left lid showed partial and/or complete MG loss. The active chalazia in the lower left lid and the upper right lid showed inflammation and MG drop out at the affected site. The inflammation was found to be reduced during the follow-up visits, however disappearance of MG very specific to the region of the chalazion was observed. CONCLUSION The Keratograph 4 was able to image the MG structures clearly, allowing the clinician to monitor the progression of chalazia and the MG loss in the affected areas.