Grading and baseline characteristics of meibomian glands in meibography images and their clinical associations in the Dry Eye Assessment and Management (DREAM) study

Abstract

Purpose: To describe and evaluate a comprehensive grading system for meibomian gland (MG) digital infrared images developed for the Dry Eye Assessment and Management (DREAM) Study.

Methods: Cross-sectional study. Reading Center (RC) certified readers independently evaluated MG features of both lids from meibography images of dry eye disease subjects. Dropout areas were measured using planimetry software. Inter-reader and grade-regrade agreement and comparison of meiboscale scores (Meiboscale©; Pult) from clinical centers to RC percent dropout and of MG features with clinical parameters were evaluated.

Results: Among 551 eyes of 277 patients at baseline, 62 (11%) upper lid and 5 (1%) lower lid images were missing. Lid eversion was poor in 63 (13%) of upper lids compared to 15 (3%) of lower lids. Intraclass correlation for inter-reader and grade-regrade agreement was moderate to substantial for most MG features. MG features were more frequent in the upper lid (p < 0.001), except for dropout glands, gaps, fluffy gland areas and dropout areas. Clinic meiboscale score was associated with RC percent dropout (p < 0.001), a clinic score of 0% having a mean RC score of 19%, and a clinic score of >75% having a mean RC score of 66%. MG plugging was associated with ghost glands (p = 0.009), dropout glands (p < 0.001) and a composite severity score (p = 0.02); turbid and absent secretions were associated with ghost glands (p = 0.046).

Conclusion: RC readers identified MG features with good reproducibility. Upper lids had more MG features. RC dropout areas correlated well with clinic meiboscale scores. Ghost glands were associated with paste like and absent meibomian secretions.

Keywords: Dry eye disease; Meibography; Meibomian glands; Morphology; Reading center.

Conflict of interest statement

Conflict of Interest:

Dr. Asbell:consultant for Sun Pharma, Dompe, Novaliq, Senju, Santen, Shire, Alcon, Kala, CLAO, Allakon, Medscape and Regeneron. Dr Bunya: Grant recipient from Bausch &Lomb/Immco Diagnostics and consultant for Celularity. Dr Massaro-giordano is consultant for GSK, Celularity and PRN. Ebenezer Daniel, Maureen Maguire, Maxwell Pistilli, Giacomina Massaro-giordano, Eli Smith and Pooja Kadakia have no conflicts of interest

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure A.

Meibography image of the lower lid in which a large fold of conjunctiva covers the meibomian glands (A) and only a close inspection reveals the meibomian glands seen near the lid margin. Meibography image of the upper lid with a representative example of almost complete meibomian gland atrophy throughout the tarsal region (B). Conjunctival folds (A) can be mistaken for complete atrophy (B).

Figure 1.

Definitions and representative examples of various meibomian gland features observed in the lids of subjects with moderate to severe dry eye disease.

Figure 2.

Quality of lid eversion in subjects with meibography images in the DREAM study

Figure 3.

Comparison of Reading Center percentage of drop out areas vs the clinic estimated meiboscale (Pult) scores. A – Drop out area includes fluffy areas and ghost glands. B – Drop out area does not include fluffy areas and ghost glands.