Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery Evaluation

Purpose: To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation. Methods: Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and 3-point scale for gland tortuosity (0-2). Lipid layer thickness and partial blinks were also recorded. Results: One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 +/- 9.2 years) were reviewed. The mean meiboscale was 1.1 +/- 1.0 and the mean tortuosity score was 1.0 +/- 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale >0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade >= 1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 +/- 0.79 and 1.38 +/- 1.07 for those <35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman's rho 0.3829, p<0.001). Conclusion: Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.