A Picture Is Worth a Thousand Words: The Utility of Meibography
The old saying is true: One picture is worth a thousand words.
It certainly applies when it comes to treating patients with Meibomian Gland Dysfunction (MGD), a major contributor to dry eye, and convincing those patients to comply with recommended cleansing treatments, whether at home or in office.
In recent decades, advances in technology have produced Meibography, a non-invasive diagnostic study that, in just a few moments and with minimal patient discomfort, produces detailed images of the Meibomian glands. In our practice, we use the LipiScan system, made by TearScience, a division of Johnson & Johnson, as well as the Keratograph 5M, from OCULUS USA. With these two systems, we get accurate and detailed images that reveal the structure and condition of the Meibomian glands.
These imaging systems were designed with the intent of aiding physicians in diagnosis and planning an appropriate course of treatment, and they succeed at that. But for any Dry Eye Center of Excellence, they can serve an additional, and crucial role: encouraging patient compliance with lid-cleaning regimens.
If one picture is worth a thousand words, then three pictures depicting MGD are three times more valuable.
Most patients have no idea what a normal Meibomian gland should look like – they usually do not even know that they have eyelid glands. So, merely showing them images of their diseased glands will have little impact because patients have no frame of reference.
That’s why we always present three images side-by-side to our dry-eye patients with MGD:
• Normal Meibomian glands
• Glands with moderate disease
• End-stage disease where there are just a couple of truncated glands left
A physician can recommend treatments, lecture patients, and even try to frighten them with descriptions of future damage. All that may be helpful. It may also be useful to explain to dry-eye patients that Meibomian glands play a key role in tear production by contributing lipids to the tear film, and that MGD is a major cause of the abnormalities in the tear-film lipid layer that cause evaporative dry eye.
But when patients can see for themselves photos clearly showing not only damage that has already occurred, but damage that may occur – and that they may prevent or lessen further damage with proper and consistent treatment – those images speak volumes and patients are much more motivated to follow those recommendations.
In our practice, presenting these dramatic images to patients produces a substantial increase in patient compliance with both at-home and in-office treatment regimens.
Once you’ve presented those images, and you have the patient’s attention, it’s time to go over – or repeat if necessary – treatment options, including cleansing regimens that can be performed at home or in the office, such as BlephEx (microblepharoexfoliation) treatments, LipiFlow (computer controlled pulsation therapy) treatments, and professional lid cleaning (using OCUSOFT Swabstix, sold only to professionals). At this point, it may be worth reminding patients that it’s important to keep Meibomian glands alive, because those glands will have to work for many years to come.
Marguerite McDonald, MD, FACS, with OCLI on Long Island, NY, is clinical professor of Ophthalmology at NYU Langone Medical Center, NY, and clinical professor of Ophthalmology at Tulane University Health Sciences Center, New Orleans, Louisiana.