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2018, Cilt 57, Sayı 4, Sayfa(lar) 191-194
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Impact of contact lens wear on ocular surface and Meibomian glands
Özlem Barut Selver, Melis Palamar, Jale Menteş, Ayşe Yağcı
Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
Keywords: Contact lens wear, infrared imaging, Meibomian gland, meibography, optic coherence tomography
Abstract
Aim: To determine the impact of contact lens (CL) wear on the ocular surface and Meibomian glands (MG).

Materials and Methods: 24 silicone hydrogel CL wearers for a minimum of 5 years (Group 1) and 26 healthy volunteers (Group 2) were included in this retrospective study. Best corrected visual acuity, Oxford scoring, tear film break-up time (T-BUT), Schirmer 1 test, Ocular Surface Disease Index (OSDI) scoring and MG evaluation by infrared captures of optic coherence tomography (OCT) were performed. Loss of the MG was scored blindly by a single researcher.

Results: The mean age was 30.00±6.22 in Group 1 and 28.70±4.95 in Group 2 (p=0.300). Male/female ratio was 4/20 in Group 1 and 9/17 in Group 2. The average duration of CL wear was 10.70±2.70 years. The mean T-BUT in Group 1 and 2 were 17.70±76.74 and 24.76±8.06 sec, respectively (p=0.002). The mean Schirmer 1 test in Group 1 and 2 were 29.04±7.67 and 25.50±8.48 mm, respectively (p=0.129). The mean Oxford scale staining in Group 1 and 2 were 0.58±0.94 and 0.15±0.41, respectively (p=0.040). The mean OSDI scores in Group 1 and 2 were 29.36±19.25 and 23.63±21.99, respectively (p=0.334). The average upper, lower eyelid, and total meiboscores in Group 1 and 2 were 0.95±0.87, 0.66±0.73, 1.60±1.40 and 0.67±0.59, 0.67±0.70 and 1.34±1.17, respectively. No statistical significance was detected in any of these scores.

Conclusion: CL wear has a variety of effects on ocular surface. MG has a significant influence on ocular surface. Meiboscoring is an effective and practical way for evaluation of the MG.

  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Disscussion
  • Conclusion
  • References
  • Introduction
    Meibomian glands (MG) are specialized sebaceous glands, which are localized at the tarsal plates of the eyelids. These glands are responsible for lipid secretion, which plays a significant role to build the surface tension and stability of the tear film and prevents evaporation 1-3. Meibomian gland dysfunction (MGD) is a chronic disease, which results with ocular irritation and ocular surface disorders 4. Meibography is a relatively new technique for evaluating MGD. Infrared imaging of MG and scoring systems for MG loss are the leading research subjects on MGD issue recently 5-7.

    Contact lens wearing has various undesired effects on the ocular surface, such as allergic conjunctivitis, infections and dry eye. Dry eye –one of the most common of these complications– is mainly suggested being related to abnormally functioning MG 8-10,13. Herein, it is aimed to determine the effects of contact lens wear on the ocular surface and MG.

  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Disscussion
  • Conclusion
  • References
  • Methods
    In this cross-sectional observational study 24 contact lens wearers (Group 1) and 26 healthy volunteers (Group 2) were evaluated. Inclusion criteria for contact lens wearers were minimum 5 years history of silicone-hydrogel type contact lens wearing. Exclusion criteria for both groups were ocular or systemic chronic disease history, any intra- or extra-ocular surgery history, smoking, and pregnancy or lactation period for female cases. Both eyes of each subject were evaluated for the study, and the mean values of both eyes were assessed for data analysis. All cases underwent a detailed ophthalmological examination and the following tests were performed: corneal and conjunctival fluorescein staining and Oxford scoring, tear film break-up time (T-BUT), Schirmer 1, Ocular Surface Disease Index (OSDI) score assessment, and evaluation of the MG after everting both upper and lower eyelids to reveal infrared captures using the Optic Coherence Tomography (OCT) device (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany). All patients were questioned for daily eyelid hygiene. Partial or complete loss of the MG was scored for each eyelid as grade 0 (no loss of MG), grade 1 (the area characterized by gland dropout was <1/3 of the total MG), grade 2 (the area characterized by gland dropout was 1/3-2/3 of the total MG) and grade 3 (the area characterized by gland dropout was >2/3 of the total MG) (Figure-1). Meiboscore assessment was performed blinded by the same researcher (AY). The meiboscores for the upper and lower eyelids were summed for each eye. This study was adhered to the tenets of the Declaration of Helsinki. The Statistical Package for the Social Sciences version 11.5.0 was used for statistical analysis. The Mann-Whitney U test is used to compare differences between two groups.


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    Figure 1: The infrared captures from Meibography, grade 0 (no loss of Meibomian glands) (a), grade 1 (the area characterized by gland dropout was <1/3 of the total Meibomian glands) (b), grade 2 (the area characterized by gland dropout was 1/3-2/3 of the total Meibomian glands) (c) and grade 3 (the area characterized by gland dropout was >1/3 of the total Meibomian glands) (d).

  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Disscussion
  • Conclusion
  • References
  • Results
    The mean age was 30.0±6.2 (range, 22-42) in Group 1 and 28.7±4.9 (range, 22-38) in Group 2 (p=0.300). Male to female ratio was 4/20 in Group 1 and 9/17 in Group 2 (p=0.080). The average duration of contact lens wear was 10.7±2.7 years (range, 5-16 years). Two cases (8.33%) in Group 1 and one case (3.84%) in Group 2 were performing daily eyelid hygiene. The mean T-BUT in Group 1 and 2 were 17.70±76.74 (range, 8-30) and 24.76±8.06 (range, 8-30) seconds, respectively (p=0.002) (Table-1). The mean Schirmer 1 test results in Group 1 and 2 were 29.04±7.67 (range, 1-35) and 25.50±8.48 (range, 11-35) mm, respectively (p=0.129).

    The mean superficial punctate staining according to Oxford scale in Group 1 and 2 were 0.58±0.94 (range, 0-4) and 0.15±0.41 (range, 0-1.5), respectively (p=0.040). The mean OSDI scores in Group 1 and 2 were 29.36±19.25 (range, 0-70.83) and 23.63±21.99 (range, 0-70.45), respectively (p=0.334). The average upper eyelid, lower eyelid, and total (upper eyelid plus lower eyelid) meiboscores in Group 1 were 0.95 ±0.87 (range, 0-3), 0.66 ±0.73 (range, 0-3) and 1.60±1.40 (range, 0-6), respectively. The average upper eyelid, lower eyelid, and total (upper eyelid plus lower eyelid) meiboscores in Group 2 were 0.67 ± 0.59 (range, 0-2), 0.67 ±0.70 (range, 0-3.5) and (1.34±1.17) (range, 0-4), respectively. Although a noteworthy increase in upper eyelid meiboscore compared to the lower eyelid was noted in contact lens wearer group, the statistical difference could not reach the significance point (p=0.068). No other significant differences were found in the remaining meiboscores of the groups (Table-1).


    Click Here to Zoom
    Table 1: The results of the Corneal And Conjunctival Fluorescein Staining And Oxford Scoring, Tear Film Break-Up Time (T-BUT), Schirmer 1, Ocular Surface Disease Index (OSDI) Score Assessment, and Evaluation of the Meibomian Glands in Group 1 and 2.

  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Disscussion
  • Conclusion
  • References
  • Discussion
    Contact lens use induces a variety of ocular complications, such as allergic conjunctivitis, infections and dry eye. One of the most important complications of prolonged contact lens wear is dry eye 11-12. The prevalence of dry eye and related findings were reported up to 50% in the literature 4. MG plays an important role in structuring the lipid layer of the tear film 13. MGD consequently causes dry eye, mainly of evaporative type. There are several ways to evaluate MG function; slit lamp biomicroscopy for MG appearance, T-BUT measurement, analyzing meibum expressed from the glands 4.

    Meibography is a relatively objective and new technique for evaluating the MG, which images the MG and also advances with the developments in medical imaging. It can be performed in various ways by using contact or noncontact infrared cameras, confocal microscopy, ultrasound and OCT devices 14.

    Currently, it is not clear which device is the most suitable one for this purpose. Besides, grading MGS is still a controversial issue. Most of the researchers defined their own grading systems and scoring the drop out of the gland percentage is the most common system 5,6,15-20. However, some of the researchers also evaluate the morphology of the glands 6,21-26.

    There are only a few studies that investigate the relation of these two parameters, contact lens wear and MG. In most of the published literature, MG evaluation with conventional methods in gas permeable or hydrogel contact lens users was performed 13,25-26. In 2009, Arita et al 13, reported a significant MG loss in rigid gas permeable and hydrogel contact lens wearers with one-year history of lens use. They also reported that meiboscore difference that is demonstrated with their own developed infrared Meibography camera was prominent between upper and lower eyelids of contact lens wearer group. Herein, silicone hydrogel contact lens wearers – at least for 5 years - were included and MG imaging was performed with the infrared acquisition feature of the OCT device, which is widely present in most of the ophthalmology clinics. Contact lens wear is a probable reason of alterations in MG, which may result with MGD 13,27. We found a slight meiboscore difference between upper and lower eyelids in silicone hydrogel contact lens wearer group was detected, however the statistical difference did not reach the significance point.

    In the present study, an increased Oxford scoring and decreased T-BUT in contact lens wearer group compared to the control group were found. The differences were statistically significant which is consistent with the literature – confirming the negative effects of contact lens wear on the ocular surface 8,13.

  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Discussion
  • Conclusion
  • References
  • Conclusion
    In conclusion, contact lens wear has a variety of effects on ocular surface. Meiboscoring of MG is an effective and practical way for the evaluation. There still is need for more detailed and associated randomized controlled prospective studies with larger populations to understand the issue in a better way.
  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Discussion
  • Conclusion
  • References
  • References

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    23) Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 2008;115(5):911-5.

    24) Srinivasan S, Menzies K, Sorbara L, Jones L. Infra-red imaging of meibomian gland structure using a novel keratograph. OptomVis Sci 2012;89(5):788-94.

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  • Top
  • Abstract
  • Introduction
  • Methods
  • Results
  • Discussion
  • Conclusion
  • References
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