In a retrospective analysis, 95% of patients seeking cataract surgery at a single center in the US were found to have some level of meibomian gland atrophy. As this condition impacts tear film and ocular surface integrity, preoperative meibography could help with surgical planning and managing patient expectations.
Study design
This was a retrospective study evaluating meibomian gland architecture in 391 patients ≥50 years of age who presented for cataract surgery evaluation at a high-volume cataract surgery practice in the US. One eye per patient was evaluated. All patients underwent meibography with the Johnson & Johnson Lipiscan. The primary outcome was the proportion of patients with meibomian gland atrophy graded using a predetermined scale: grade 0 (no atrophy), grade 1 (1–33% atrophy), grade 2 (34–66% atrophy), and grade 3 (>66% atrophy). The association of meibomian gland atrophy with factors such as age, other ocular comorbidities, and prior dry eye disease diagnosis was also evaluated.
Outcomes
Ninety-five percent of patients in this study had some evidence of meibomian gland atrophy (≥grade 1). There was no significant difference in the prevalence of meibomian gland atrophy in patients with a history of glaucoma, hypertension, autoimmune disease, smoking, or diabetes mellitus compared with those without such comorbidities. The severity of meibomian gland atrophy was slightly higher in patients with a previous dry eye disease diagnosis than in those without one.
Limitations
Potential limitations of this study include that it is retrospective and only involved a single center. Larger studies that include multiple sites could help obtain more data to strengthen the findings.
Clinical significance
Meibomian gland atrophy is common in the cataract surgery population. Meibomian gland morphology and function can have relevance in cataract surgery decision-making, particularly in patients interested in premium lens technologies. Implementation of routine meibography as part of cataract surgery evaluations can help surgeons determine if patients need lid margin treatment, such as thermal pulsation, prior to cataract surgery to improve the quality of preoperative measurements as well as postoperative stability of the tear film. In extreme cases where meibomian gland function cannot be improved, patients may need to be counseled on their poorer candidacy for certain lens technologies, as they may have a more unstable or unhealthy ocular surface that could impact their resulting quality of vision.
Financial Disclosures: Dr. Nandini Venkateswaran discloses financial relationships with Alcon Laboratories (Consultant/Advisor, Grant Support); Allergan, BVI Medical, Carl Zeiss Meditec, CorneaGen, Dompé, Johnson & Johnson Vision, Sight Sciences, Tarsus Pharmaceuticals (Consultant/Advisor).