'Review targets meibomian gland dysfunction

April 15, 2011
Peter J. McDonnell, MD

He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

The author discusses how MGD is a major source of morbidity and decreased quality of life for patients.

"Sell the sizzle, not the steak."-Elmer Wheeler

"In advertising, sex sells. But only if you're selling sex."-Jef I. Richards

New cataract surgical technology for many ophthalmologists is what catnip is for felines, what free tequila shots are for college kids, what bevacizumab is for retina specialists, and what hardtop convertibles are for very manly men. It's sexy. It irresistibly draws its audience. It sizzles!

Meibomian gland dysfunction (MGD)? Not so much.

MGD's subtle appeal

MGD clearly excites somewhat less interest; it does not pack the audience halls of our major meetings. This is regrettable, because MGD is a major source of morbidity and decreased quality of life for our patients. A recent exhaustive review and evidence assessment1 points out that it is extremely common, perhaps afflicting half of all adults in certain racial groups, and the authors assert it may be the most common single cause of the constellations of disorders that we call "dry eye." But for a number of reasons it fails to engender interest proportionate to its prevalence, and my belief is that those reasons are probably so obvious to my readers that they need not be enumerated here.

Historically, dry eye in general has been among the topics whose perceived excitement has been inversely proportional to its impact upon the population. But as science advances and treatments become available, that is changing. This year, a little birdie tells me, topical cyclosporine will be the number one (in terms of dollars) prescribed topical ophthalmic medication. Throughout most of my career, that would have been an unthinkable occurrence.

A significant compilation of our knowledge (and the gaps therein) about MGD has recently been published, and I commend this to your reading. (Full disclosure: One of my faculty members worked on this.) It nicely summarizes, from an evidence-based perspective, our current understanding of this vexatious condition. Some of you may consider it to be more than you ever wanted to know, but I believe most ophthalmologists will be glad to spend the time to become fully caught up on this topic. For the closed-minded among you, this issue of Ophthalmology Times summarizes some of the information from the report on Page 1.

Maybe Elmer Wheeler could whip up a frenzy of popular interest in this important and relatively neglected disease. As science identifies more definitive diagnostic tests and cost-effective therapeutic interventions, the enthusiasm of ophthalmologists for focusing on MGD will probably correspondingly increase. But unless Jennifer Aniston develops this problem tomorrow and becomes the spokesperson for the National Meibomian Gland Dysfunction Network ("Blink for the Cure?"), this will be a gradual process.

By Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building 600 N. Wolfe St. Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu

Reference

1. http://www.iovs.org/content/52/4.toc

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