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Aubrey Schachter, Scott Schachter, Milton M Hom; Asymptomatic Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5672.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular Surface Disease Index (OSDI) and Subjective Evaluation of Symptom of Dryness (SESoD) are questionnaires used to evaluate ocular discomfort due to dry eye disease. Typically, OSDI scores of 0-12 are considered normal, 13-22 mild, 23-32 moderate, and 33-100 severe. SESoD scores of 0-1 are considered normal, and scores of 2-4 indicate dry eye.
Images of lower lid meibomian glands were captured with an Oculus keratograph in consecutive patients in a private optometry practice in October and November 2015. Eighty-three percent of these patients had some degree of meibomian gland atrophy, as rated with the Pult scale Area of Loss method (0-4, with scores >0 indicating a degree of atrophy). These 45 patients (ages 14-85, mean age=44, 16 males) completed an OSDI and SESoD questionnaire.
Of patients with meibomian gland atrophy graded 1-4, 60% of patients were asymptomatic as indicated by their OSDI score (<13). In addition, 57.8% of these patients were asymptomatic as indicated by their SESoD score (<2).
OSDI and SESoD do not predict atrophy of meibomian glands. MGD is asymptomatic in the majority of patients, as evaluated by these two questionnaires. This asymptomatic condition presents a challenge to practitioners who prescribe lid therapy and other treatments for atrophy, as patients often resist treatment for non-symptomatic conditions. As with dry eye, the signs and symptoms of meibomian gland atrophy don’t match, which means that we must treat regardless of symptoms. It is important to keep this in mind when discussing treatment options with patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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