Koshi Maeda

Proposed Diagnostic Criteria for Obstructive Meibomian Gland Dysfunction

PURPOSE To compare clinical findings between patients with obstructive meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for obstructive MGD. DESIGN Cross-sectional, observational case series. PARTICIPANTS Fifty-three eyes of 53 patients (18 men, 35 women; age [mean +/- standard deviation] 71.4 +/- 10.0 years) who were diagnosed with obstructive MGD and 60 eyes of 60 healthy volunteers (22 men, 38 women; 71.0 +/- 9.3 years) as a control group. METHODS Ocular symptoms were scored from 0 to 14 according to the number of existing symptoms. Lid margin abnormality was scored from 0 to 4 depending on the number of existing abnormalities. Meibomian gland changes were scored from 0 to 6 based on noncontact meibography (meibo-score). Superficial punctuate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3 depending on the volume and quality. Tear film production was evaluated by Schirmers test. Receiver operating characteristic curves with calculations of area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate obstructive MGD from normal eyes. MAIN OUTCOME MEASURES Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, SPK score, tear film breakup time (BUT), and the Schirmer value. RESULTS Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, and SPK score were significantly higher in the obstructive MGD group than in the control group (P<0.0001 for all scores). The BUT was significantly shorter in the obstructive MGD group than in the control group (P<0.0001). The AUC values indicated that the ocular symptom score had the highest diagnostic power as a single parameter, followed by the lid margin abnormality score, meibo-score, and BUT. CONCLUSIONS Based on these findings, we recommend that physicians use the ocular symptom score, lid margin abnormality score, and meibo-score to diagnose MGD. Obstructive MGD should be suspected when any 2 of the 3 scores are abnormal. Obstructive MGD is very likely when all 3 scores are abnormal.

Efficacy of diagnostic criteria for the differential diagnosis between obstructive meibomian gland dysfunction and aqueous deficiency dry eye

PurposeTo evaluate diagnostic criteria for obstructive meibomian gland dysfunction (MGD) using three parameters (symptom score, lid margin abnormality score, and meibomian gland morphologic change scores) for differentiating obstructive MGD from aqueous deficiency dry eye (ADDE).MethodsTwenty-five eyes of 25 patients (mean age, 66.6 years) diagnosed with obstructive MGD and 15 eyes of 15 patients (mean age, 61.3 years) diagnosed with ADDE were analyzed. Ocular symptoms were scored from 0 to 14 according to the number of symptoms. Lid margin abnormality was scored from 0 to 4 according to the number of abnormalities. Meibomian gland changes were scored from 0 to 6 using noncontact meibography (meibo-score). Superficial punctate keratopathy was scored from 0 to 3. Meibum was graded from 0 to 3 according to volume and quality. Tear film break-up time was measured consecutively three times after instillation of fluorescein, and the median value was adopted. Tear film production was evaluated using the Schirmer test.ResultsOcular symptom and lid margin abnormality scores and tear film break-up time did not differ significantly between the obstructive MGD and ADDE groups. The meibum score and meibo-score were significantly higher in the obstructive MGD group than in the ADDE group. The Schirmer value was significantly lower in the ADDE group than in the obstructive MGD group. When obstructive MGD was diagnosed on the basis of three scores (ocular symptom score, lid margin abnormality score, and meibo-score) all being abnormal, the sensitivity and specificity for differentiating between obstructive MGD and ADDE were 68.0% and 80%, respectively.ConclusionsAlthough the criteria were moderately reliable for differentiating patients with obstructive MGD from those with ADDE when the diagnosis of obstructive MGD was made on the basis of three abnormal scores, they do not provide comprehensive diagnostic tools for differentiating MGD, ADDE, and healthy individuals. We need to add other parameters such as the Schirmer test value and the meibum score to the diagnostic criteria to enhance their reliability for differentiating MGD and ADDE.

Topical diquafosol for patients with obstructive meibomian gland dysfunction

Aims To evaluate the effect of topical diquafosol in patients with meibomian gland dysfunction (MGD) using tear film parameters and quantitatively analyse the meibomian gland morphology. Subjects and Methods The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the meibomian glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmers test. Quantitative image analysis of the meibomian glands was performed using the original software. Results 10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the meibomian gland area was significantly increased after treatment (p<0.0001). Conclusions Quantitative image analysis was useful for evaluating the morphological changes of the meibomian glands. Topical diquafosol therapy was effective for patients with obstructive MGD.

Comparison of the long-term effects of various topical antiglaucoma medications on meibomian glands.

Purpose: To examine the effects of long-term antiglaucoma eye drop treatment on meibomian glands. Methods: The subjects were 71 eyes of 71 glaucoma patients (group 1) receiving one type of antiglaucoma eye drops, 61 eyes of 61 glaucoma patients (group 2) receiving two types of antiglaucoma eye drops, and 30 eyes of 30 glaucoma patients (group 3) receiving three types of antiglaucoma eye drops. Controls comprised 75 eyes of 75 healthy volunteers. Subjective symptoms were evaluated by questionnaire, and lid margin and superficial punctate keratopathy were evaluated by slit lamp examination. Meibomian glands of upper and lower eyelids were observed and scored using noncontact meibography (meiboscore). Tear film break-up time (BUT) was measured and meibum was graded. Results: Lid margin abnormality, superficial punctate keratopathy, meiboscore, and meibum scores were significantly higher in glaucoma patients than in controls (P < 0.001). BUT and Schirmer scores were significantly lower in glaucoma patients than in controls (P < 0.001). Subgroup analysis of the parameters in group 1 revealed no significant difference between patients receiving prostaglandin and those receiving &bgr;-blockers, or among groups 1, 2, and 3. Multivariate regression analysis demonstrated that meiboscore significantly correlated with lid margin abnormality score (P = 0.007) and BUT (P = 0.045) in group 1; with BUT (P = 0.004), symptom score (P = 0.003), and age (P = 0.026) in group 2; and with lid margin abnormality score (P = 0.001) in group 3. Conclusions: Long-term use of antiglaucoma eye drops was associated with alterations in meibomian gland morphology and function.

Meibomian gland duct distortion in patients with perennial allergic conjunctivitis.

Purpose: To observe morphologic changes of meibomian glands in patients with and without perennial allergic conjunctivitis (AC) and to assess the relation between morphologic changes of the meibomian glands of both eyelids and tear film parameters. Methods: In this study, 55 eyes of 55 patients with perennial AC and 47 eyes of 47 healthy volunteers as controls were included. The following tests were performed: a slit-lamp examination, measurement of tear film breakup time, grading of meibomian gland morphologic changes (meibography score) assessed with a noncontact meibography, meibomian gland duct distortion in meibography, tear production by the Schirmer I test, and grading of meibum expression. Results: The frequency of meibomian gland duct distortion was significantly greater in patients with AC (45%) than that in controls (8.5%; P < 0.0001). The meibum (P = 0.049) and superficial punctate keratopathy scores (P = 0.0076) were significantly higher in patients with AC than those in controls. There was no significant difference in meibography score, breakup time, or Schirmer value between the 2 groups. The meibomian expression score was significantly higher in patients with AC with meibomian gland duct distortion than in patients with AC without meibomian gland duct distortion (P = 0.0012). Conclusion: Perennial AC is associated with increased meibomian gland duct distortion.

A Newly Developed Noninvasive and Mobile Pen-shaped Meibography System

Purpose: To examine the usefulness of a newly developed noninvasive mobile pen-shaped meibography system. Methods: This study evaluated a newly developed noninvasive mobile pen-shaped meibography system comprising an infrared light-emitting diode as the light source and a highly sensitive complementary metal oxide semiconductor image camera. The images were recorded digitally. The utility of this system was compared with that of the previously developed noncontact infrared meibography system for examination of the upper and lower eyelids in 20 healthy volunteers (range, 2–91 years) and 23 patients with meibomian gland dysfunction, 17 patients with dry eyes who wore contact lenses, and 14 patients with allergic conjunctivitis accompanied by itching. Results: Using the newly developed noninvasive mobile pen-shaped meibography system, clear images of the meibomian glands were obtained in all age groups. The quality of the images obtained was similar between the two meibography systems. The quantitative analysis of the images obtained showed no statistically significant difference between the two meibography systems. Conclusions: The newly developed noninvasive mobile pen-shaped meibography system is a useful tool that provides meibomian gland images of the same quality and quantity as the noncontact meibography system equipped with a slit lamp. This new system is convenient and applicable for examination of meibomian glands in patients of all ages.

Proposed diagnostic criteria for seborrheic meibomian gland dysfunction.

Purpose: To compare clinical findings between patients with seborrheic meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for seborrheic MGD. Methods: Thirty eyes of 30 patients [13 men and 17 women; age (mean ± SD) 73.9 ± 9.9 years] diagnosed with seborrheic MGD and 60 eyes of 60 healthy volunteers (22 men and 38 women; age: 71.0 ± 9.3 years) as a control group were included in this study. Ocular symptoms were scored from 0 to 14 according to the number of symptoms present. Lid margin abnormality was scored from 0 to 4 depending on the number of abnormalities present. Meibomian gland changes were scored from 0 to 6 on the basis of noncontact meibography (meiboscore). Superficial punctate keratopathy was scored from 0 to 3. Tear film production was evaluated by Schirmer test. Receiver operating characteristic curves with calculations of the area under the curve were used to describe the accuracy of each parameter to differentiate patients with seborrheic MGD from normal eyes. Results: Ocular symptom score and lid margin abnormality score were significantly higher in the seborrheic MGD group than in the control group (P < 0.0001 for both scores). Area under the curve values indicated that the lid margin abnormality score had the highest diagnostic power as a single parameter followed by the ocular symptom score. When the diagnosis for seborrheic MGD was made on the basis of the 2 scores (ocular symptom score and lid margin abnormality score) being abnormal, the sensitivity was 100% and the specificity was 98.3%. Conclusions: On the basis of these findings, we recommend that physicians use ocular symptom score and lid margin abnormality score in the diagnosis of seborrheic MGD. Seborrheic MGD should be considered very likely when both of the 2 scores are abnormal.

Caffeine Increases Tear Volume Depending on Polymorphisms within the Adenosine A2a Receptor Gene and Cytochrome P450 1A2

PURPOSE The primary aim of the present study was to examine the effect of caffeine on tear volume. The secondary aim was to investigate the relation between caffeine-induced changes in tear volume and polymorphisms in ADORA2A and CYP1A2. DESIGN Double-masked, placebo-controlled, crossover study. PARTICIPANTS Seventy-eight healthy volunteers were recruited for the study. METHODS Subjects participated in 2 sessions in which they received capsules containing either placebo or caffeine. The caffeine capsules were given to the subjects to keep the caffeine volume per body weight within 5 to 7 mg/kg. After caffeine intake, tear meniscus height (TMH) was measured. Subjects provided a blood sample for genotyping. MAIN OUTCOME MEASURES Tear meniscus height, single nucleotide polymorphism. RESULTS The tear volume increased after caffeine consumption. The net increase in TMH was 0.08 mm (95% confidence interval, 0.05-0.10) greater when participants were given caffeine than when given placebo (P<0.0001). In ADORA2A, the difference in the net increase in TMH for participants who were heterozygous at rs5751876 and rs2298383 was 0.07 mm (P = 0.001) and who were minor homozygous was 0.08 mm (P = 0.007). In CYP1A2, the net increase in TMH for participants who were minor homozygous at rs2472304 was lower than for those who were major homozygous; the difference was 0.06 mm (P = 0.039). CONCLUSIONS Caffeine intake increases tear volume and polymorphisms within ADORA2A, and CYP1A2 is associated with the tear increase after caffeine intake. Genetic polymorphisms had a significant effect on tear meniscus that was of limited clinical significance.

Noncontact Meibography Detects Changes in Meibomian Glands in the Aging Process in a Normal Population and Patients with Meibomian Gland Dysfunction

Purpose: To examine, using our novel technique of noncontact meibography, morphological changes in meibomian glands associated with aging and sex in a normal population and in patients with obstructive meibomian gland dysfunction (oMGD) and seborrheic meibomian gland dysfunction (sMGD). Participants: Two hundred thirty-six healthy volunteers [M:F, 114:122; mean age (range), 41.2 ± 23.1 (4-98) years] and patients with oMGD or sMGD. Methods: Lid margin and ocular surface were examined by slit lamp. The meibomian glands were observed with noncontact meibography and scored using meiboscore. Partial or complete loss of meibomian glands was scored for each eyelid from grade 0 (no loss of meibomian glands) to grade 3 (lost area more than two thirds total area of meibomian glands). Results: Significant positive correlations were noted between age and meiboscore in total subjects (R = 0.428; P < 0.0001), in men (R = 0.462; P < 0.0001), and in women (R = 0.418; P < 0.0001). There was a significant positive correlation between age and score of lid margin abnormalities (R = 0.538; P < 0.0001). Meiboscore was significantly correlated with the score of lid margin abnormalities (R = 0.359; P < 0.0001). In oMGD, changes in meibomian glands such as dropout and shortening were observed. In sMGD, no change in meibomian glands was detected. Conclusions: Changes in meibomian glands increased with age in a normal population. In oMGD, morphologic changes in meibomian glands were observed. In sMGD, no morphologic changes in meibomian glands were detected.