Imaging technology advances meibomian gland visualization

Take-Home

Advances to an imaging technology may assist clinicians in improving a diagnosis of meibomian gland dysfunction with objective examination of patients’ tear film lipid layer, blink profile, and meibomian gland structure and function.

By Lynda Charters; Reviewed by Eric D. Donnenfeld, MD

Rockville Centre, NY-A new iteration of an imaging technology is in the pipeline to provide more accurate visualization of the meibomian gland structure. 

The device (LipiView II with Dynamic Meibomian Imaging, TearScience) includes two novel imaging technologies (Dynamic Illumination and Adaptive Transillumination). Both technologies independently generate images of the glands that then are processed, displayed, and combined for improved visualization and more accurate diagnosis.

“Eye-care providers must examine both gland function and structure when diagnosing meibomian gland dysfunction,” said Eric D. Donnenfeld, MD, founding partner of Ophthalmic Consultants of Long Island and Connecticut, clinical professor of ophthalmology, New York University Medical Center, New York, and a trustee of Dartmouth Medical School.

“The [technology] helps clinicians evaluate gland structure, measure lipid layer thickness, and determine if partial blinking plays a role in the disease,” Dr. Donnenfeld said.

The images are also helpful in patient education. Individuals with dry eye can see the effect of the disease on the glands and understand the importance of instituting treatment before the disease progresses, he said.

In patients with dry eye disease, he explained, the subsequent morphologic changes are secondary to obstruction of the meibomian glands. Early obstruction is characterized by decreased gland function with dilation of the central duct. Prolonged gland obstruction results in further duct dilation and the onset of atrophy of acini and shrinkage. In advanced obstruction, gland drop out can be seen.

Central dilation, gland truncation, and gland drop out can be clearly visualized in contrast to normal meibomian gland structure.

About the technology

The technology works through the use of surface lighting (Dynamic Illumination) that originates from multiple sources. The multiple light sources eliminate glare. This result is in contrast to traditional meibography in which only one light source is used and glare almost always results.

Another component of the technology (Adaptive Transillumination) changes the intensity of the light across the surface of the illuminator to compensate for variations in the lid thicknesses among patients.

The clinician can obtain the images through the use of the keyboard at the top of the device. A lid everter that emits multi-angle light helps ensures that all of the meibomian glands are visualized.

A comparison of images obtained from the new device with those obtained using a traditional meibographer showed the traditional technology may not accurately reflect the status of the meibomian glands-possibly resulting in confusion or misdiagnosis of gland dropout and visible glare. Meibomian glands that appear to be dropped out in traditional, static meibography can be seen with dual-mode Dynamic Meibomian Imaging, according to Dr. Donnenfeld.

The technology is intended to be used with other products from the manufacturer-i.e., its Korb Meibomian Gland Evaluator and LipiFlow treatment for the ocular surface that helps restore meibomian gland function.

Eric D. Donnenfeld, MD

E: ericdonnenfeld@gmail.com

Dr. Donnenfeld is a consultant to TearScience. The LipiView II is expected to become commercially available in early 2015 with upgrade options available for owners of the current technology.