Yeh Thao N, Lin Meng C
Clinical Research Center, and Vision Science Group, School of Optometry, University of California, Berkeley, Berkeley, California.
Optom Vis Sci. 2021 Feb 1;98(2):121-126. doi: 10.1097/OPX.0000000000001636.
Lipid deficiency due to meibomian gland (MG) dysfunction is believed to account for the vast majority of patients with dry eye compared with aqueous deficiency. Clinicians commonly evaluate MG length to determine a disease, but our research with isotretinoin users suggests that MG contrast is also an important characteristic to consider.
This study aimed to determine the sensitivity and specificity of MG contrast for the diagnosis of lipid-deficient dry eye (LDDE).
This case-control study used demographic data, Standard Patient Evaluation of Eye Dryness (SPEED) scores, average tear lipid layer thickness (TLLT), fluorescein tear breakup time (FTBUT), upper eyelid meibography images, and meibum quality and quantity scores for individuals with LDDE (SPEED score ≥10 and TLLT ≤35 interferometric color units) and normal individuals (SPEED ≤2 and TLLT ≥80 interferometric color units).
Thirty-one eyes of 22 controls (mean ± SD age, 22.7 ± 5.5 years) and 13 eyes of 12 cases (mean ± SD age, 43.9 ± 17.2 years) were included. Normalized MG contrast was significantly correlated with FTBUT (r = 0.35, P = .02), percent MG atrophy (r = -0.50, P < .001), and SPEED scores (r = -0.49, P < .001). The receiver operating characteristic curve for LDDE diagnosis classifiers MG contrast, MG atrophy, and meibum quantity score had areas under the curve of 0.83, 0.64, and 0.73, respectively. Meibomian gland contrast cutoff at 28.3 intensity units yielded optimal correct classification of subjects (84.1%; sensitivity, 0.69; specificity, 0.90). Cases had shorter FTBUT (P < .001), worse meibum quality (P = .02) and quantity (P = .02) scores, and lower MG contrast (P < .001) compared with controls. Subjects with low MG contrast (≤28.3) had 14.9 higher odds of having LDDE (95% confidence interval, 2.84 to 78.4) compared with subjects with high MG contrast (>28.3).
Meibomian gland contrast correlates well with clinical parameters and symptoms, shows good sensitivity and excellent specificity for diagnosing LDDE, and can be a useful diagnostic parameter for monitoring MG changes due to age, disease, or intervention.
与泪液分泌不足相比，睑板腺（MG）功能障碍导致的脂质缺乏被认为是绝大多数干眼患者的病因。临床医生通常通过评估睑板腺长度来诊断疾病，但我们针对异维甲酸使用者的研究表明，睑板腺对比度也是一个需要考虑的重要特征。
本研究旨在确定睑板腺对比度对脂质缺乏性干眼（LDDE）诊断的敏感性和特异性。
本病例对照研究使用了人口统计学数据、干眼标准患者评估（SPEED）评分、平均泪液脂质层厚度（TLLT）、荧光素泪膜破裂时间（FTBUT）、上睑睑板腺造影图像，以及LDDE患者（SPEED评分≥10且TLLT≤35干涉色单位）和正常个体（SPEED≤2且TLLT≥80干涉色单位）的睑脂质量和数量评分。
纳入了22名对照组患者的31只眼（平均±标准差年龄，22.7±5.5岁）和12例患者的13只眼（平均±标准差年龄，43.9±17.2岁）。标准化睑板腺对比度与FTBUT显著相关（r = 0.35，P = 0.02）、睑板腺萎缩百分比（r = -0.50，P < 0.001）和SPEED评分（r = -0.49，P < 0.001）。用于LDDE诊断分类的睑板腺对比度、睑板腺萎缩和睑脂数量评分的受试者工作特征曲线下面积分别为0.83、0.64和0.73。睑板腺对比度截断值为28.3强度单位时，受试者的正确分类最佳（84.1%；敏感性，0.69；特异性，0.90）。与对照组相比，病例组的FTBUT更短（P < 0.001），睑脂质量（P = 0.02）和数量（P = 0.02）评分更差，睑板腺对比度更低（P < 0.001）。与睑板腺对比度高（>28.3）的受试者相比，睑板腺对比度低（≤28.）的受试者患LDDE的几率高14.9倍（95%置信区间，2.84至78.4）。
睑板腺对比度与临床参数和症状相关性良好，对LDDE诊断具有良好的敏感性和出色的特异性，并且可以作为监测因年龄、疾病或干预导致的睑板腺变化的有用诊断参数。
