Meibomian Gland Dysfunction in Pre- and Post-Menopausal Women Jennifer S. Harthan, OD, FAAO, FSLS, Justin T. Kwan, OD, FAAO, Dominick L. Opitz, OD, FAAO, Milton M. Hom, OD, FAAO, FACAAI (Sc) 1
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Illinois College of Optometry, Chicago, IL, Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, CA, Private Practice, Azusa, CA
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3241 South Michigan Avenue, Chicago, Illinois 60616
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AAO 2015 Poster
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Results: • 56 females older than 40 years of age were enrolled. • None of the clinical tests nor symptom surveys showed a • 42 females younger than 40 years of age were enrolled. significance between the two cohorts for OSDI • None of the clinical tests nor symptom surveys showed a statistical statistical significance between (p=0.146). the two cohorts for MGD expression grade (p=0.285). Figures 2-‐4 • 56 females older than 40 years age were • None of the ofclinical tests nenrolled. or symptom surveys showed • a In statistical significance the younger thanbetween 40 group, 23 out of 42 subjects had • 42 females younger than offor age were enrolled. the t40 wo years cohorts OSDI (p=0.146). AAO 2015 Poster MGD (54.8%) and in the older than 40 group, 34 out of the In the younger than 4surveys 0 group, showed 23 out of 4a2 subjects had MGD (54.8%) and in the 2o015 lder AAO Poster • None of the clinical• tests nor symptom 56Fsubjects than 40 group, 34 out of the 56 subjects had MGD (60.7%). igure 5 had MGD (60.7%). Figure 5 statistical significance between the two cohorts for MGD • 4The over 40 reported constant Figure : Gorade othan f wM GD ifemales n Pre-‐ and Post-‐ Mmore enopausal Women • The over than 40 females reported more constant frequency f their orst symptom expression grade (p=0.285). Figures 2-4 to bright light compared to the under 40 females. Figures 2: Meibography in a Patient Older than 40 and higher sensitivity frequency of their worst symptom and higher sensitivity to Grade of compared MGD in Pre-‐ nd under Post-‐Menopausal bright light to athe 40 females. Women Figures 2: Meibography in a Patient Younger than 40 35
RESULTS
Meibomian Gland Dysfunction (MGD) is commonly associated with the signs and symptoms of ocular surface disease in dry eye patients (up to 86%). In 2010, the International Workshop on Meibomian Gland Dysfunction developed a recommended definition for MGD : “Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/ quantitative changes in the glandular secretions. This may result in alterations of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.” 1
Number of Women
INTRODUCTION
Figure 2: Meibography in a Patient Confidential AAO 2015 Poster Younger than The production of lipids and meibum from the meibomian Meibomian Gland Dvascular, ysfunction iand n Pre-‐ and Post-‐Menopausal Women glands is controlled by neuronal, hormonal 40
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25 Figure 3: 20 Meibography in15 a Patient 10 Older than 40
Younger than 40 Older than 40
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factors. Common perception among practitioners is that Authors: Jennifer S. Harthan, OD, FAAO, FSLS,1 Justin T. Kwan, OD, FAAO,2 Dominick L. Opitz, females may be particularly affected in O periandFACAAI post-(Sc)3 M. Hom, D, FAAO, OD, FAAO,1 Milton
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menopausal years secondary AAO 2015 Poster 1 to these hormonal regulatory 2 Affiliations: Illinois College of Optometry, Chicago, IL, Southern California College of controls. This study lookedato differences forFMGD Optometry t Mcompare arshall B. Ketchum University, ullerton, CA, 3Private Practice, Azusa, CA patients of pre- and post-menopausal ages.
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Grade of MGD
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CONCLUSIONS Past perceptions of dry eye patient demographics may age bias clinicians to under diagnose Meibomian Gland Confidential Confidential Dysfuction (MGD). No significant differences found between the two cohorts suggest that hormonal controls might play a more minor role in MGD than as previously thought. As MGD is one of the most common causes for the development of ocular surface disease symptoms (specifically those associated with dry eye conditions), younger women with dry eye symptoms need careful ocular surface evaluation, just like their older cohort.
DISCLOSURES J Harthan: Bausch +Lomb, Contamac, Metro Optics J Kwan: Johnson & Johnson Vision Care, Inc. D Opitz: Allergan, Bausch + Lomb, Glaucox, NiCox M Hom: Abbott Medical Optics , Alcon, Allergan, Bausch + Lomb, Shire, Valeant
Figure 4: Grade o f MGD in Pre-‐ and Post-‐ Menopausal WFigure omen Figure 4: Grade of MGD in Pre-‐ and Post-‐ Menopausal Women 5: Presence of MGD in Females by Age Introduction: Figure 4: Grade of MGD in Pre- and Figure 5: Presence of MGD in Females by Age PostMenopausal Women Grade o f M in Pre-‐ and Post-‐Menopausal Women Presence of MGD in Females by Age Meibomian Gland Dysfunction (MGD) is commonly associated with the signs and symptoms of GD 60 ocular surface disease in dry eye patients (up to 86%). The production of lipids and meibum 1. Nelson JD, Shimazaki J, Benitz-de-Castillo JM, et al. The from the meibomian glands is controlled by neuronal, vascular, and hormonal factors. Common international workshop on meibomian gland dysfunction: 50 perception among pAAO ractitioners i s t hat f emales m ay b e p articularly a ffected i n p eri-‐ a nd p ost-‐ • Subjects over age 18 were enrolled. 2015 Poster Confidential 35 report of the definition and classification subcommittee. Invest menopausal years secondary to these hormonal regulatory controls. This study looked to • Subjects were administered the Ocular Surface Disease 40 Ophthalmol Vis Sci. 2011;52:1930-7. compare differences for MGD patients of pre-‐ and post-‐menopausal ages. 30 70.00% 2015 oster Symptom Score (TOSS), and a 9 Confidential Index AAO (OSDI), TotalPOcular Older 2. tBhan ron40 AJ, Tiffany JM. The meibomian gland and tear film lipids: 30 Methods: 60.00% structure, symptom questionnaire that asked both4: frequency and Figure G rade o f M GD i n P re-‐ a nd P ost-‐ M enopausal W omen 25 Younger than 40 function and control. Adv Exp Med Biol. 1998;438:281-95. 3. Foulks GN, Bron AJ. Meibomian gland dysfunction: a clinical 50.00% intensity of dry eye. 20 Subjects over age 18 were enrolled and administered the Ocular Surface Disease Index (OSDI), scheme for description, diagnosis, classification, and grading. Ocul 20 Figure 4 : G rade o f M GD i n P re-‐ a nd P ost-‐ M enopausal W omen Total classified Ocular Symptom Score and a 9 symptom questionnaire that asked both frequency 40.00% • Subjects were then based on(TOSS), Meibomian Gland Grade of MGD in Pre-‐ and Post-‐Menopausal Women Surf. 2003 Jul;1(3):107-126. 10 and intensity of dry eye. Subjects were then classified based on Meibomian Gland (MG) Younger 15 30.00% than 40 (MG) expressionexpression grade (1.0 or worse). 4. Foulks GN, Nichols KK, Bron AJ, et al. Improving awareness, grade (1.0 or worse). The worst eye results were taken. identification, and management of meibomian gland dysfunction. f MGD in Pre-‐ and Post-‐Menopausal Women 0 20.00% Grade • The worst eye results were otaken. Older t han 4 0 10 1 2 3 4 Ophthalmology. 2012;119(10):S1-11. Figure 1: Meibomian Gland D35 ysfunction Grade 1 10.00% 5. K orb DR, Greiner JV. Increase in tear film lipid layer thickness 5 0.00% 30 following treatment of meibomian gland dysfunction. Adv Exp 35 than 40 Younger Older than 40 Med Biol. 1994; 350: 293-298. 0 25 30 6. Korb DR, Blackie CA. Meibomian gland diagnostic expressibility: 1 2 3 4 correlation with dry eye symptoms and gland location. Cornea. 20 25 Grade of MGD 2008 Dec;27(10):1142-7. Figure 1:
REFERENCES
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Past perceptions of dry eye patient demographics may age bias clinicians to under diagnose CONTACT Meibomian Gland Dysfuction (MGD). No significant differences found between the two cohorts INFORMATION suggest that hormonal controls might play a more minor role in MGD than aJennifer s previously S. Harthan, OD, FAAO, FSLS thought. As MGD is one of the most common causes for the development
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Figure 5: Presence of MGD in Females by Age 1
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