In this video from Interventional Mindset, Marjan Farid, MD, discusses how meibography has positively impacted her diagnosis and management of dry eye disease (DED).
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The value of meibography
Meibography has changed my clinical decision-making and how I approach the entire management scheme for my ocular surface disease patients. This imaging technology evaluates meibomian gland morphology and can reveal gland distortion, dropout, atrophy, and duct dilation.
Having a structural picture of meibomian glands, along with corresponding information, allows me to categorize the dry eye, formulate the optimal treatment plan, and better educate my patients.
Patient selection for meibography
As a general rule in my clinic, all new dry eye patients and all pre-surgical (cataract and refractive) patients receive meibography imaging. During the initial visit for a patient presenting with dry eye disease, I perform a full evaluation, which includes meibography.
Imaging the glands assists me in identifying how best to categorize the type of DED—whether it be aqueous deficient, evaporative, or a combination of the two. In fact, the majority of patients tend to have components of each of these processes and an element of meibomian gland dysfunction (MGD). Patient age does not exclude meibography, as more and more young patients are demonstrating meibomian gland dysfunction.
As is outlined in the American Society of Cataract and Refractive Surgery (ASCRS) algorithm, meibography is recommended for all pre-surgical patients, both cataract and refractive, to assess their need for ocular surface treatment preoperatively. Early DED and MGD diagnosis and treatment preoperatively improves postoperative satisfaction and lends to better outcomes in general.
Whether patients are prescribed simple at-home treatments or a procedural treatment for their meibomian gland disease, there is typically increased surgical success when these issues have been addressed prior.
LipiView as a tool
The LipiView system, which I have utilized at my main practice for a decade, provides not only meibography but also supplies information on lipid layer thickness and deficiency while quantifying blink rate.
The combination of these data points help to determine the degree and severity of the MGD.
A change in tack for MGD therapy
In the past, we only offered procedural therapies to patients with very severe DED. We have since discovered this is inappropriate for patient selection when considering first-time procedural therapies—the more severe cases typically respond the least.
Now we take a proactive approach where meibography guides us to appreciate the presence of structural glands with early meibomian gland dropout and/or poor secretion (i.e., sludgy to toothpaste-like consistency), we immediately prescribe a procedural therapy. Go-to therapies include LipiFlow thermal pulsation, the TearCare system, and intense pulsed light therapy (IPL).
In more severe patients with complete dropout of the oil glands, meibography is an important tool to demonstrate why they are not rapidly improving symptomatically. This, again, encourages them to fully get on board with their treatment regimen.
Post-procedural imaging for MGD
Often patients request a post-procedure meibography to gauge changes. However, since structural changes of the meibomian glands can take years, turn your focus to the physiological changes of the oil gland secretion.
During a slit lamp exam, push on the patient’s oil glands at the slit lamp to demonstrate the rapidity of the secretion and the quality of the meibum composition. Inform the patient that the aim is for an olive oil texture, as opposed to “toothpaste” consistency, and that these findings will influence treatment accordingly.
Educational benefits of meibography
As they say, a picture is worth a thousand words. When educating patients in regards to their ocular surface disease—and meibomian gland disease, in particular—having a visual reference is invaluable. A tangible image allows the patient to see and appreciate the chronicity of the structural changes that have occurred in their meibomian glands as a result of concomitant dry eye disease and lid inflammation.
This educational approach can lead to improved patient compliance with preexisting eyelid health management and the willingness to buy-in based on the value proposition to treat their disease when they can actually see it. I have found that, after viewing their meibography, individuals are more likely to adhere to the recommended treatment plan, be it an in-office procedure or simple, at-home hot compresses.
In closing, I strongly suggest incorporating meibography into your practices to aid in categorization, guide treatment plans, and enhance understanding of MGD for your DED patients.
