Eyeworld

meibography summit: Better understanding of meibomian gland dysfunction and how to integrate meibography in diagnosis and treatment planning 6 | SUPPLEMENT TO EYEWORLD | SEPTEMBER 2019 Incorporating meibography into your practice ative patients and those with only one positive symptom on the dry eye questionnaire have tear osmolarity and MMP-9 testing before her Device helps clinicians view the meibomian gland structure M eibography is a valu- able tool in assessing the structure of the meibomian glands and the severity of meibomian gland dysfunction (MGD), and experts have developed protocols to integrate it into their examinations (Figure 1). 1 Valuable tool "I find meibography to be one of those tests that routine- ly changes how I manage patients," said Preeya Gupta, MD. "As much as we think that we are excellent clinicians, we do not have x-ray vision. We can see the function of the gland by exerting pressure on it, looking at the flow, but we cannot assess the architecture without meibography." "Meibography helps as an educational tool to show patients the extent of their MGD. It serves as an im- portant tool for preoperative evaluation when you need to delay cataract surgery and treat this problem," said W. Barry Lee, MD. "Enabling the patient to visualize the extent of their disease is powerful," said Frank Bowden, MD. "It allows you to set a measure of urgency in the patient that this is a problem that needs to be dealt with and not ignored or dismissed." Meibography is also advantageous for evaluating contact lens wearers, said Paul Karpecki, OD. "That is a major part of optometric practices where it can assist in selecting the type of lens or modality that is likely to be most successful," he said. Incorporating meibography Although 44% of Meibogra- phy Summit participants think meibography should be per- formed at the point of care for cataract patients before surgery if they are suspected of having ocular surface dis- ease (Figure 2), approximately 80% of respondents to the 2018 ASCRS Clinical Survey do not use meibography. Ninety-four percent of Sum- mit participants do not delay meibomian gland assessment in patients without symptoms. In his practice, mei- bography is used for every patient evaluated for dry eye or having a cataract surgery evaluation, said Douglas Devries, OD. "On routine patients, we are looking for a SPEED score greater than 6; then they would receive point-of-care tests including meibography," he said. They also perform meibography if technicians suspect tear film instability based on imaging or refraction. Technicians often per- form testing before the pa- tient sees the clinician. In her practice, Marguerite Mc- Donald, MD, said all preoper- Figure 1. Progressive meibomian gland atrophy; top, normal meibomian glands; middle, moderate meibomian gland dropout; bottom, advanced atrophy Source: Alice Epitropoulos, MD

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