Over the past five years, the direct evaluation of eyes in order to make a diagnosis of dry eye disease (DED) has gotten much easier. In fact, we are very fortunate to be able to directly visualize all of the structures we are examining when diagnosing eye care problems. Specifically, imaging of the meibomian oil glands has become a critical part of the diagnosis of dry eye disease.
Dry eye disease is one of the most common conditions affecting people, but it often goes under-diagnosed. There is no one single test that makes the diagnosis, and every dry eye patient has a different presentation.
Do You Have Dry Eye?
Signs and symptoms will vary with sufferers of dry eye. Signs are measurements and observations pertaining to a medical problem. Symptoms are what patients experience, their observations, sensations, and feelings. People with high blood pressure most often have no outward symptoms of their diseases. Blood pressure just has to be measured. Similarly, dry eye symptoms often are not present in the early stages of the condition. In this way, it is better to make as many measurements and observations for dry eye to derive a firm diagnosis. Imaging tests are key to making this diagnosis.
Who Is Affected By Dry Eye?
Among patients over 40 years old, the prevalence of meibomian gland dysfunction (MGD) is between 38% and 68%, according to the Dry Eye Workshop II Report. Hundreds of millions of people in the world visit eye doctors every year to address dry eye issues. This is a problem of global proportion and represents a range of concerns from minor to life-altering.
Meibomian glands can be viewed at the slit lamp biomicroscope by every doctor who knows the technique of transillumination. Direct imaging of the glands is best done using infrared sources of observation. This is called meibography, of which there are several methods.
The Lipiview II Ocular Surface Interferometer is the best device to measure many aspects of tearfilm function. This device measures the sub-micron lipid layer thickness, the amount of partial vs full blinks, it also captures videos of blinking dynamics, eyelid closure, and high definition infrared images of the meibomian glands in the eyelids. These characteristics are invaluable in making a diagnosis of the quality of tearfilm.
Check out the videos below to see examples of partial vs. full blinks.
While conventional wisdom would make us believe that older patients are the most likely candidates for DED, actual analyses show that patients in their twenties suffer much more than expected when surveyed and observed. This has been hypothesized to be due to the extensive amount of digital display use the younger generations are accustomed to. The excessive screen use is associated with incomplete blinking activities. When the upper and lower lids do not meet and contact each other, the muscles of Riolan lose their ability to function and squeeze out a measure of liquid meibum oil the consistency of olive oil.
The Real Test – Do You Have Dry Eye?
With the amount of symptoms that dry eye causes and the impact of MGD on society, you would think that most eye care practitioners would routinely screen for this condition. Studies of eye care practitioners show that the routine screening for DED and MGD is not being done. Dry eye disease is implicated in taking a toll on the psychological welfare of patients, even leading to suicide in some post-refractive surgery patients. Visual acuity and stability varies greatly with those suffering from dry eye. There is a natural tendency for patients to start blinking whenever blurry vision ensues. That is how the tearfilm is re-established, in spite of an unstable tearfilm mix of aqueous, lipid and mucin components. Screening with vital dyes like fluorescein and lissamine green do not take very much time to do. The results are easy to analyze and explain to patients.
While imaging technology is a more sophisticated method of examination and has some cost considerations, the impact on patient education cannot be underestimated. Patients like to know the “score” of their evaluation, and the visual representation of MGD can be dramatic. Someone who has poor glandular structure may still have good meibomian gland function and vice versa. A healthy lipid layer depends on minimizing inflammation to maintain homeostasis of the lacrimal function unit. The ability to manually express meibomian glands and receive a release of clear oil is very rewarding to the doctor and patient. The impact of blocked meibomian glands is known to lead to atrophy and a furthering of the vicious cycle of inflammation involved in dry eye.
The role of the health of meibomian glands is undeniable to maintain a healthy ocular surface in everyday life. A thorough understanding of the interplay between blinking and the ocular surface is crucial. Manual expression of the glands can be done as part of a routine slit lamp evaluation. Studies show that 60% of patients show significant meibographic evidence of disease in spite of having what is referred to as NOMGD, or non-obvious meibomian gland dysfunction.
The Brill Dry Eye Experience
The Brill Eye Center Difference includes making an accurate diagnosis of DED and MGD on an individual patient-by-patient basis. All of the test results are explained thoroughly to patients. The results impact and direct the plan of action for treatment. Various options are explained in terms of pros and cons and effectiveness of treatment, always weighing the cost-to-benefit ratio to the patient. The advanced technology available at Dry Eye Spa in Brill Eye Center is central to the success and relief patient receive after so much suffering for so long.
Looking for an eye care professional in Kansas City to help relieve you of your symptoms of dry eye? Schedule your evaluation at Brill Eye Center today!