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BMC Ophthalmology
Published in: BMC Ophthalmology 1/2018

Open Access 01-12-2018 | Research article

Assessment of meibomian glands using a custom–made meibographer in dry eye patients in Ghana

Authors: Eugene Appenteng Osae, Reynolds Kwame Ablorddepey, Jens Horstmann, David Ben Kumah, Philipp Steven

Published in: BMC Ophthalmology | Issue 1/2018

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Abstract

Background

Meibomian Gland Dysfunction (MGD) is a leading cause of evaporative Dry Eye Disease (DED). This makes non-invasive meibography an important procedure in the clinical evaluation of DED patients. Our purpose was to conduct a lead-off investigation focused on the practicality of performing meibography in a developing country, with limited access to complex ophthalmic imaging systems, using a custom meibographer, as a step to future comparative studies on meibomian glands and DED in Africa.

Methods

Meibomian glands(MG) in 76 upper eyelids (UL) and 49 lower eyelids (LL) in 1 eye each of 125 patients randomly selected from a patient population presenting with subjective DED symptoms at a clinic were photographed using a custom meibographer. Single frames were captured, and the MG area determined by intensity threshold segmentation and area calculation using Image J software. MG loss (MGL) was quantified by outlining its area and expressing it as a percentage of the total MG per Pult’s grading scheme. Dry eye measures included Tear Film Break Up - Time (TUBT), Schirmer’s test and Ocular Surface Staining (OSS). Symptoms were evaluated using the SPEED II questionnaire. Correlations between MGL and age, ocular signs and symptoms were analyzed by Pearson’s. Differences between comparable groups were analyzed by Mann - Whitney test; p < 0.05 was considered significant.

Results

Overall mean MGL was 32.10% ± 25.0% (26.25% ± 22.40% for UL and 40.33% ± 26.70% for LL). MGL correlated significantly with age [r = 0.91, p = 0.001], SPEED scores [r = 0.90, p = 0.001], OSS [r = 0.75, p = 0.001] and TBUT [r = − 0.81, p = 0.001]. MGL scores were significantly higher in the UL than LL [U = 1293.5 p = 0.004].

Conclusion

This study for the first time presents data on the status of Meibomian glands in Africa. It furthermore suggests that it is feasible to examine Meibomian glands using a custom meibographer in developing countries with limited access to complex imaging systems. It also demonstrates the benefit and cost-effectiveness of a simple device by the observed significant relations between meibomian gland loss and DED in these patients.
Literature
1.
2.
Nelson JD, Shimazaki J, Benitez-del-Castillo JM, Craig JP, McCulley JP, Den S, et al. The international workshop on Meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930–7.CrossRefPubMedPubMedCentral
3.
4.
Phadatare SP, Momin M, Nighojkar P, Askarkar S, Singh KK. A comprehensive review on dry eye disease: diagnosis, medical management, recent developments, and future challenges. Adv Pharm. 2015;2015
5.
Knop E, Knop N, Millar T, Obata H, Sullivan DA. The international workshop on Meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the Meibomian gland. Invest Ophthalmol Vis Sci. 2011;52(4):1938–78.CrossRefPubMedPubMedCentral
6.
Bron A, Tiffany J, Gouveia S, Yokoi N, Voon L. Functional aspects of the tear film lipid layer. Exp Eye Res. 2004;78(3):347–60.CrossRefPubMed
7.
Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI, et al. The international workshop on Meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):2006–49.CrossRefPubMedPubMedCentral
8.
West KP. Extent of vitamin a deficiency among preschool children and women of reproductive age. J Nutr. 2002;132(9):2857S–66S.CrossRefPubMed
9.
Moore DB, Shirefaw W, Tomkins-Netzer O, Eshete Z, Netzer-Tomkins H, Ben-Zion I. Prevalence of xerophthalmia among malnourished children in rural Ethiopia. Int Ophthalmol. 2013;33(5):455–9.CrossRefPubMed
10.
Schémann J-F, Malvy D, Sacko D, Traore L. Trachoma and vitamin a deficiency. Lancet. 2001;357(9269):1676.CrossRefPubMed
11.
Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol. 2000;118(9):1264–8.CrossRefPubMed
12.
Abrahams C, Ballard R, Sutter E. The pathology of trachoma in a black south African population. Light microscopical, histochemical and electron microscopical findings. South Afr Med J. 1979;55(27):1115–8.
13.
Osae A, Gehlsen U, Horstmann J, Siebelmann S, Stern M, Kumah D, et al. Epidemiology of dry eye disease in Africa: the sparse information, gaps and opportunities. Ocular Surface. 2017;15(2):159-68.
14.
Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR. A simple system for the assessment of trachoma and its complications. Bull World Health Organ. 1987;65(4):477.PubMedPubMedCentral
15.
Dawson CR, Jones BR, Tarizzo ML. Guide to trachoma control in programmes for the prevention of blindness. Geneva: The World Health Organization; 1981.
16.
Negrel A, Mariotti S. WHO alliance for the global elimination of blinding trachoma and the potential use of azithromycin. Int J Antimicrob Agents. 1998;10(4):259–62.CrossRefPubMed
17.
Stevens GA, Bennett JE, Hennocq Q, Lu Y, De-Regil LM, Rogers L, et al. Trends and mortality effects of vitamin a deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys. Lancet Glob Health. 2015;3(9):e528–e36.CrossRefPubMed
18.
Mayo-Wilson E, Imdad A, Herzer K, Yakoob MY, Bhutta ZA. Vitamin a supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. BMJ. 2011;343:d5094.CrossRefPubMedPubMedCentral
19.
20.
Fund. TUNCs. In: Vitamin A Supplementation; a Statistical Snapshot; 2016.
21.
Bureau TPR. World population data sheet and press release. 2015.
22.
Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, et al. The international workshop on Meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922–9.CrossRefPubMedPubMedCentral
23.
Wise RJ, Sobel RK, Allen RC. Meibography: a review of techniques and technologies. Saudi J Ophthal. 2012;26(4):349–56.CrossRef
24.
Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology. 2008;115(5):911–5.CrossRefPubMed
25.
Arita R. Validity of noninvasive meibography systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph. Cornea. 2013;32:S65–70.CrossRefPubMed
26.
Pult H, Riede-Pult B. Non-contact meibography: keep it simple but effective. Contact Lens Anterior Eye. 2012;35(2):77–80.CrossRefPubMed
27.
Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003;22(7):640–50.CrossRefPubMed
28.
Moy A, McNamara NA, Lin MC. Effects of isotretinoin on meibomian glands. Optom Vis Sci. 2015;92(9):925–30.CrossRefPubMed
29.
Abràmoff MD, Magalhães PJ, Ram SJ. Image processing with ImageJ. Biophoton Int. 2004;11(7):36–42.
30.
Jie Y, Xu L, Wu Y, Jonas J. Prevalence of dry eye among adult Chinese in the Beijing eye study. Eye. 2009;23(3):688.CrossRefPubMed
31.
Uchino M, Dogru M, Yagi Y, Goto E, Tomita M, Kon T, et al. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci. 2006;83(11):797–802.CrossRefPubMed
32.
Schein OD, MUÑO B, Tielsch JM, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am J Ophthalmol. 1997;124(6):723–8.CrossRefPubMed
33.
Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on Meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994–2005.CrossRefPubMedPubMedCentral
34.
McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia 1. Ophthalmology. 1998;105(6):1114–9.CrossRefPubMed
35.
Viso E, Gude F, Rodríguez-Ares MT. The association of meibomian gland dysfunction and other common ocular diseases with dry eye: a population-based study in Spain. Cornea. 2011;30(1):1–6.CrossRefPubMed
36.
McCulley JP, Shine WE. Meibomian gland function and the tear lipid layer. Ocular Surface. 2003;1(3):97–106.CrossRefPubMed
37.
38.
Mathers WD, Shields WJ, Sachdev MS, Petroll WM, Jester JV. Meibomian gland dysfunction in chronic blepharitis. Cornea. 1991;10(4):277–85.CrossRefPubMed
39.
Nien CJ, Massei S, Lin G, Nabavi C, Tao J, Brown DJ, et al. Effects of age and dysfunction on human meibomian glands. Arch Ophthalmol. 2011;129(4):462–9.CrossRefPubMedPubMedCentral
40.
41.
Braich PS, Howard MK, Singh JS. Dyslipidemia and its association with meibomian gland dysfunction. Int Ophthalmol. 2016;36(4):469–76.CrossRefPubMed
42.
Bron AJ, Yokoi N, Gaffney EA, Tiffany JM. A solute gradient in the tear meniscus. II. Implications for lid margin disease, including meibomian gland dysfunction. Ocular Surface. 2011;9(2):92–7.CrossRefPubMed
43.
Chia EM, Mitchell P, Rochtchina E, Lee AJ, Maroun R, Wang JJ. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains eye study. Clin Exp Ophthalmol. 2003;31(3):229–32.CrossRefPubMed
44.
Villani E, Ceresara G, Beretta S, Magnani F, Viola F, Ratiglia R. In vivo confocal microscopy of meibomian glands in contact lens wearers. Invest Ophthalmol Vis Sci. 2011;52(8):5215–9.CrossRefPubMed
45.
Fenga C, Aragona P, Cacciola A, Spinella R, Di Nola C, Ferreri F, et al. Meibomian gland dysfunction and ocular discomfort in video display terminal workers. Eye. 2008;22(1):91–5.CrossRefPubMed
46.
Rooney MS, Arku RE, Dionisio KL, Paciorek C, Friedman AB, Carmichael H, et al. Spatial and temporal patterns of particulate matter sources and pollution in four communities in Accra. Ghana Sci Total Env. 2012;435:107–14.CrossRef
47.
Pult H, Riede-Pult BH, Nichols JJ. Relation between upper and lower lids' meibomian gland morphology, tear film, and dry eye. Optom Vis Sci. 2012;89(3):E310–E5.CrossRefPubMed
48.
Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009;116(3):379–84.CrossRefPubMed
49.
Green-Church KB, Butovich I, Willcox M, Borchman D, Paulsen F, Barabino S, et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on tear film lipids and lipid–protein interactions in health and disease. Invest Ophthalmol Vis Sci. 2011;52(4):1979–93.CrossRefPubMedPubMedCentral
50.
Sullivan DA, Jensen RV, Suzuki T, Richards SM. Do sex steroids exert sex-specific and/or opposite effects on gene expression in lacrimal and meibomian glands? Mol Vision. 2009;15:1553–72.
51.
Sullivan DA, Sullivan BD, Evans JE, Schirra F, Yamagami H, Liu M, et al. Androgen deficiency, meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci. 2002;966(1):211–22.CrossRefPubMed
52.
Tiffany JM. The normal tear film. In: Surgery for the Dry Eye. 41: Karger Publishers; 2008. p. 1–20.
53.
Abelson MB, Ousler GW, Nally LA, Welch D, Krenzer K. Alternative reference values for tear film break up time in normal and dry eye populations. In: Lacrimal Gland, Tear Film, and Dry Eye Syndromes 3: Springer; 2002. p. 1121–5.
54.
McCulley JP, Shine WE. The lipid layer of tears: dependent on meibomian gland function. Exp Eye Res. 2004;78(3):361–5.CrossRefPubMed
55.
Solomon A, Dursun D, Liu Z, Xie Y, Macri A, Pflugfelder SC. Pro-and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001;42(10):2283–92.PubMed
56.
Goto E, Yagi Y, Matsumoto Y, Tsubota K. Impaired functional visual acuity of dry eye patients. Am J Ophthalmol. 2002;133(2):181–6.CrossRefPubMed
57.
Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004;23(8):762–70.CrossRefPubMed
58.
Begley CG, Chalmers RL, Abetz L, Venkataraman K, Mertzanis P, Caffery BA, et al. The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity. Invest Ophthalmol Vis Sci. 2003;44(11):4753–61.CrossRefPubMed
59.
Asiedu K, Kyei S, Mensah SN, Ocansey S, Abu LS, Kyere EA. Ocular surface disease index (OSDI) versus the standard patient evaluation of eye dryness (SPEED): a study of a nonclinical sample. Cornea. 2016;35(2):175–80.CrossRefPubMed
60.
Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W. Utility assessment among patients with dry eye disease. Ophthalmology. 2003;110(7):1412–9.CrossRefPubMed
Metadata
Title
Assessment of meibomian glands using a custom–made meibographer in dry eye patients in Ghana
Authors
Eugene Appenteng Osae
Reynolds Kwame Ablorddepey
Jens Horstmann
David Ben Kumah
Philipp Steven
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2018
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-018-0869-0

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