Meibomian gland dysfunction and dry eye symptoms of fitted and over the counter contact lens wearers compared with non-contact lens wearing controls
(English) Meibomian gland dysfunction (MGD) is a chronic and diffuse abnormality of the meibomian glands (MGs) that occurs in 38% of contact lens (CL) wearers, though the influence of CLs on MGD is equivocal. A topical literature review examining the influence of CL wear on MGs found 15 studies repo...
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| Tipo de recurso: | tesis doctoral |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universitat Politècnica de Catalunya (UPC) |
| Repositorio: | UPCommons. Portal del coneixement obert de la UPC |
| Idioma: | inglés |
| OAI Identifier: | oai:upcommons.upc.edu:2117/402156 |
| Acceso en línea: | https://hdl.handle.net/2117/402156 https://dx.doi.org/10.5821/dissertation-2117-402156 |
| Access Level: | acceso abierto |
| Palabra clave: | Meibomian gland dysfunction Dry eye Contact lens Over-the-counter Follow-up After-care Àrees temàtiques de la UPC::Ciències de la visió |
| Sumario: | (English) Meibomian gland dysfunction (MGD) is a chronic and diffuse abnormality of the meibomian glands (MGs) that occurs in 38% of contact lens (CL) wearers, though the influence of CLs on MGD is equivocal. A topical literature review examining the influence of CL wear on MGs found 15 studies reporting an effect of CLs on MGs vs. seven studies who did not. Discrepancies may be due to varying definitions of MGD, types of questionnaires, assessment methods, CL types, and measurement of one vs. both eyelids. The review concluded that the effect of CL wear on MGD should be addressed with a prospective study including non-CL wearing controls and employing an objective assessment of MGs. The Cobra HD meibographer is an objective instrument used in research studies whose inter-session repeatability (ISR), inter-examiner reproducibility (IER) and within-subject variability (WSV) has not been investigated. These measures were evaluated in participants with and without dry eye (DE) symptoms based on their Ocular Surface Disease Index (OSDI) questionnaire. Seventy-two participants (mean age: 23±5 years, 36 asymptomatic) were examined by Examiner 1 in sessions S1 and S2 to calculate the ISR, and seventy-four (mean age: 23±5 years, 37 asymptomatic) were measured on the same day by examiners E1 and E2 to determine the IER. WSV was determined from three consecutive measurements of the same eyelid. Mean MG loss of the upper (S1:13.5±9.5%,S2:12.8±8.5%, E1:12.7±8.2%, E2:13.1±8%) and lower eyelids (S1:7.5±6.9%,S2:7.3±6.3%, E1:7±6.2%, E2:7.4±6.2%) was not significantly different between sessions or examiners for all cohorts for both eyelids. The ISR within-subject standard deviations (Sw) for the upper and lower eyelids were 1.3% and 1.0%; mean difference (md) was 0.7±3.5% [CI:-6.25%- 7.62%] and 0.1±2.1% [CI:-3.94%- 4.17%], respectively. IER ICC values were >0.86 for all conditions, Sw was 1.3% and 1.2% with md of -0.4±3.2% [CI:-6.65%- 5.9%] and -0.4±2.9% [CI:-6.15%- 5.31%], respectively. WSV Sw values were <1.4%, and ICC values were >0.89 for both eyelids, examiners and sessions. Thus, the Cobra meibographer is repeatable, reproducible and has low WSV. The relationship between MGD and CL wear was assessed in 31 fitted CL wearers, 43 over the counter (OTC) CL wearers, and 54 non-CL wearing controls (mean ages: 22.2±3.1, 22.3±3.5, and 23±4.6, respectively). Habitual LogMAR visual acuity (VA), Meibum Quality Score (MQS), Meibum Expressibility Score (MES), MG loss, lid margin abnormalities and DE symptoms of the right eyes of the cohorts were compared using Kruskal-Wallis for ordinal and Pearson Chi-Square test for categorical variables, respectively. Univariate logistic regression examined if CLs are an independent risk factor for MG abnormalities. OTC CL wearers had lower VA than controls (0.82±0.17 vs. 0.93±0.12, p=0.002) and more DE symptoms (3.7±2.4 vs. 2.3±2.1, p=0.002). CL wearers (Fitted:0.6±0.7, p<0.01, OTC:0.8±0.9, p<0.0008) had worse MES than controls (0.2±0.5) and more MG loss (Fitted:16.9%±8.8%, p=0.02, OTC:18.6%±11.3%, p=0.001) than controls (11.2%±6.8%). CL wear was associated with corneal staining (odds ratio(OR)=3.42, 95% confidence interval(CI):1.16–10.11, p=0.03 and OR=5.23, 95%CI: 1.89-14.48, p=0.001, respectively) and MG loss (OR=10.47, 95%CI:1.14-96.29, p=0.04 and OR=16.63, 95%CI:1.96-140.86, p=0.01, respectively). OTC CL wear was also associated with abnormal MQS (OR=12.87, 95%CI:1.12-148.41, p=0.04), conjunctival staining (OR=12.18, 95%CI:3.66-40.51, p=0.0005), and lid margin telangiectasia (OR=3.78, 95%CI:1.55-9.21, p=0.003). CL wearers had significantly more morphological and functional abnormalities than controls. OTC resulted in more DE symptoms, poorer VA, and were an independent predictor for more functional and morphological abnormalities than Fitted CL wearers, emphasizing the importance of proper fitting and aftercare. |
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