Study Reviews Meibomian Gland Visibility Metrics in Diagnosis

Asian male optometrist examining patient
These new metrics for diagnosing meibomian gland dysfunction are recommended by the researchers for use in clinical settings.

Meibomian gland visibility metrics can serve as a complementary tool for supporting the diagnosis of meibomian gland dysfunction (MGD), and they are more powerful than current single metrics, according to findings published in Optometry and Vision Science.

Researchers conducted a study to evaluate the metric’s use in diagnosing MGD. It included 112 healthy volunteers whose ocular surface parameters were measured using the Oculus Keratograph® 5M (Oculus GmbH), and subsequently were classified based on absence or presence of MGD. Researchers then calculated the visibility of the meibomian glands using new metrics and compared them between the 2 groups. Through receiver operating characteristic curves, the team quantified the diagnostic ability of ocular surface parameters and gland visibility metrics, as well as the combined curve of the metrics with the best diagnostic ability, using logistic regression.

The study found statistically significant differences between new gland visibility metrics and all ocular surface parameters, with the exception of the first noninvasive keratograph breakup time and gland expressibility. Higher sensitivity and specificity were shown via the new metrics compared with current single metrics when diagnostic ability was assessed without any combination. When gland visibility metrics were incorporated into the logistic regression analysis together with gland dropout percentage, tear meniscus height, dry eye symptoms, and lid margin abnormality score (P <.001), the diagnostic capability increased. The highest area under the curve (AUC) (0.99), as well as excellent sensitivity (1.00) and specificity (0.93) was achieved by the combination of median pixel intensity of meibography gray values and the ocular surface metrics.

“These results suggest that gland visibility metrics are suitable to be incorporated into meibomian gland dysfunction diagnosis assessment,” according to investigators.

The researchers point out some limitations. First, since there is no current diagnostic criterion to define MGD, assessing the diagnostic ability of metrics and establishing cutoff values is difficult. Additionally, there were statistically significant age differences between the MGD group and the no-MGD group, and gland visibility was correlated with age, which is a possible confounding factor. Finally, only the upper eyelid was evaluated in the current study. The researchers recommend further investigation that includes both eyelids and that establishes cutoff values based on the age of the participants.


García-Marqués J, García-Lázaro S, Talens-Estarelles C, Martínez-Albert N, Cerviño A. Diagnostic capability of a new objective method to assess meibomian gland visibility. Optom Vis Sci. 2021;98(9):1045-1055. doi:10.1097/OPX.0000000000001764