Eyeworld

5 point-of-care exam gives us an abundance of information. It helps to identify the disease and educate our patients and guides the discussion about the disease." Various practices use dif- ferent tests to prompt meibog- raphy. "In our clinic, any time a patient has tested positively for either increased osmolarity or increased inflammation, that will trigger the dry eye work- up," said Douglas Devries, OD. "During the dry eye workup, every OSD suspect will have meibography performed on them." One step further "One of the limitations of point-of-care testing such as osmolarity or MMP-9 is that it does not differentiate between MGD and aqueous-deficient dry eye, so meibography gives you a good basis for deciding what form of dry eye you should be treating," Dr. Donnenfeld said. "Meibography has been a game changer," said Terry Kim, MD. "It finally allows us to link the structural components of the disease process to the func- tional component of the disease process via an imaging modality that is easily interpreted by the eye care provider and easily explainable to the patient." D. Rex Hamilton, MD, suggested that it may be important to look at younger patients more closely and on a routine basis. 3 "I saw a 31-year- old patient who had previous LASIK and had intractable dry eye symptoms. Typically we consider this to be a very unusual demographic to have that problem. We looked at his meibomian glands and he clear- ly had issues," he said. Advancing patient education Meibography and tear breakup time devices allow clinicians to educate patients about MGD. "When you show patients the images of their glands and they can see firsthand that they have obstructed glands and you compare that with a normal image, it is a tremen- dous educational tool and the patient's understanding of the disease progresses much faster," said Edward Holland, MD. "This education drastically speeds up the conversation on the significance of MGD and allows the discussion to go on to treatments." "Any time you can perform an objective test, including imaging, that educates patients on their specific eye condition, it will result in a call to action and the patient electing to be treated more aggressively," Dr. Devries said. Meibography also helps clinicians monitor treatment response and set expectations. 4 "Once they have a single ther- mal pulsation treatment, they will likely need another at some future date due to the chronic, progressive nature of MGD," said Frank Bowden III, MD. "It is important to use metrics such as meibography and tear film lipid layer thickness to help patients understand and see the value of procedures to address meibomian gland obstruction." Looking ahead "My advice to my colleagues in optometry and ophthalmology is that if MGD is not being diag- nosed in your office, you need to incorporate this," Dr. Don- nenfeld said. "This is a great place for bringing ODs into MD practices to work together to manage this disease." In the future, Dr. Farid expects to see multifunctional meibography devices with add-on point-of-care testing. "I think that is when we will see a huge increase in usage. Practices will be able to invest in a com - prehensive system to evaluate multiple components of the tear film and ocular surface," she said. References 1. Tomlinson A, et al. The Internation- al Workshop on Meibomian Gland Dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52:2006–49. 2. Arita R. Validity of noninvasive meibography systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph. Cornea. 2013;32(suppl 1):S65–70. 3. Mizoguchi T, et al. Morphology and function of meibomian glands and other tear film parameters in junior high school students. Cornea. 2017;36:922– 926. 4. Zhao Y, et al. Clinical trial of thermal pulsation (LipiFlow) in meibomian gland dysfunction with pretreatment meibography. Eye Contact Lens. 2016;42:339–346. Figure 2. Most participants think meibography should be performed on a routine basis if a patient has OSD symptoms. Do you think that meibography should routinely be performed on patients presenting with OSD symptoms? Meibography Summit Figure 1. Dynamic illumination shows truncation. " It is important to use metrics such as meibography and tear film lipid layer thickness to help patients understand and see the value of procedures to address meibomian gland obstruction. " —Frank Bowden III, MD

• Cover