Eyeworld

Moderator: Eric Donnenfeld, MD, practices with Ophthalmic Consultants of Long Island and Connecticut, and is clinical professor of ophthalmology, New York University, and trustee, Dartmouth Medical School. Supplement to EyeWorld October 2018 continued on page 2 Meibography Summit: Translating knowledge into practice Supported by an unrestricted educational grant from Johnson & Johnson Vision medially, and that is a cleaning mechanism. It is a pumping mechanism for the oil glands, too," said Paul Karpecki, OD. Patel et al. showed that people blink 4.5 times when using video display devices compared with 18 times in other situa- tions. 3 "So they are not getting that cleaning or meibomian gland expression," he said. Preeya Gupta, MD, and her colleagues reported that 42% of children ages 4–17 had gland atrophy. 4 "There were children who even had moder- ate to severe meibomian gland atrophy, and all these children were asymptomatic. The key for us as clinicians is to try to figure out when these patients are going to become symptomatic A s ophthalmologists observe the impact of meibomian gland dysfunction (MGD) in clinical practice, understanding of the condition continues to advance. 1 "MGD is the number one reason patients come into our office," said Eric Donnenfeld, MD, moderating the Meibog- raphy Summit during the 2018 ASCRS•ASOA Annual Meeting. "It is either a primary or a secondary complaint in about 40–50% of our patients." Defining MGD "The International Workshop on Meibomian Gland Dysfunc- tion described MGD as a chron- ic, diffuse abnormality of the meibomian glands commonly characterized by terminal duct Click to read and claim CME credit Frank Bowden, III, MD, is founder of Bowden Eye and Associates, Jacksonville, Florida. Alan Carlson, MD, is professor, Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina. Douglas Devries, OD, is co-founder, Eye Care Associates of Nevada, adjunct clinical professor of optometry and residency director, Pacific University College of Optometry, Alice Epitropoulos, MD, is clinical assistant professor, Ohio State University Wexner Medical Center, Columbus, co-founder, Eye Center of Columbus, and partner, Ophthalmic Surgeons & Consultants of Ohio. Terry Kim, MD, is professor of ophthalmol- ogy, chief, cornea and ex- ternal disease division, and director, refractive surgery service, Duke University Eye Center, Durham, North Carolina. Preeya Gupta, MD, is associate professor of ophthalmology, Duke Uni- versity Eye Center, Durham, North Carolina. D. Rex Hamilton, MD, is director, University of California, Los Angeles, Laser Refractive Center, and clinical professor, cataract and refractive surgery division, Stein Eye Institute, Los Angeles. Edward Holland, MD, is professor of ophthal- mology, University of Cincinnati. Paul Karpecki, OD, is director of corneal services, Advanced Ocular Surface Disease Center and Research, Kentucky Eye Institute, Lexington, Kentucky, and practices in the ocular surface disease clinic, Gaddie Eye Centers, Louisville, Kentucky. William Trattler, MD, is in practice at the Center for Excellence in Eye Care, Miami. Donald Korb, OD, is president, Korb Associ- ates and Korb Research, and affiliated professor, University of California Berkeley School of Optom- etry. He is a co-founder of TearScience, which was purchased by Johnson & Johnson Vision. W. Barry Lee, MD, practices with Eye Consultants of Atlanta. Marguerite McDonald, MD, practices with Ophthalmic Consultants of Long Island, is clinical professor of Ophthalmology, NYU Lan- gone Medical Center, New York, and clinical professor of ophthalmology, Tulane University Health Sciences Center, New Orleans. John Sheppard, MD, is professor of ophthal- mology, microbiology and molecular biology, Eastern Virginia Medical School, medical director, Lions Eye Bank of Eastern Virginia, and president, Virginia Eye Consultants, Norfolk, Virginia. Elizabeth Yeu, MD, is assistant professor of ophthalmology, Eastern Virginia Medical School, and in private practice, Norfolk, Virginia. Faculty Marjan Farid, MD, is director of cornea, cataract, and refractive surgery, vice chair of ophthalmic faculty, and associate professor of ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine. Examining meibomian gland dysfunction and its impact EyeWorld recently gathered 17 experts on ocular surface disease at a special summit to discuss the current thinking on meibography and meibomian gland dysfunction. The Meibography Summit focused on the role of meibography as a diagnostic tool, as well as how best to integrate diagnostic findings into treatment paradigms in clinical practice. Summit participants were asked to try to achieve consensus on a number of key questions. Their responses are featured in graphic form throughout this supplement. obstruction and/or qualita- tive, quantitative changes in the glandular secretions," Dr. Donnenfeld said. 1 "It may result in alterations of the tear film, symptoms of eye irritation, clinically apparent inflamma- tion, and ocular surface disease (OSD)." Respondents to the 2016 ASCRS Clinical Survey indicated that 48% of dry eye patients have MGD. Estimates by the Meibography Summit partici- pants were considerably higher, with approximately 88% thinking that the prevalence of MGD is increasing. Fifty-six percent of Meibography Sum- mit participants reported that 60–75% of their cataract surgery candidates have MGD, and 82% reported that more than 75% of their OSD patients have MGD (Figures 1 and 2). However, some suspect increased awareness accounts for the increase. "If you look at Michael Lemp's publications on the prevalence of MGD, we know it increases with age and we know this is the most com- mon cause of dry eye disease," said Terry Kim, MD. 2 However, he thinks MGD is still underdi- agnosed because many clini- cians are not looking for it. Others contend that addi- tional factors are at work. "There are few sources for it, but modern risk factors are very real," said Elizabeth Yeu, MD. Many people use digital devices more than 5 hours a day, she said, leading to decreased and incomplete blinking. "When people blink, nor- mally the lower eyelid moves

• Cover