A simple novel technique of infrared meibography by means of spectral-domain optical coherence tomography: A cross-sectional clinical study

Purpose To compare a novel spectral-domain optical coherence tomography (SD-OCT) technique with traditional lid transillumination for evaluation of meibomian glands (MGs) and to assess the relation of MG morphologic changes to the glandular atrophy. Design Evaluation of diagnostic technology. Participants Sixty-one patients with obstructive MGD (30 men, 31 women; age [mean ± standard deviation] 45.1 ± 12.1 years), and 75 control subjects (32 men, 43 women; 44.1 ± 12.5 years) were recruited in order to have a balanced distribution of glandular features. Methods Agreement between SD-OCT and lid transillumination examination for the detection of drop-out (partial or complete loss of MGs) and microscopic changes (i.e. shortening, distor-tion, segmentation and entanglement), as well as the relationship between morphological features and MG atrophy were evaluated. Main Outcome Measures Agreement between the two meibographic techniques, bias in symmetry of classification, and association analysis between microscopic changes and MG dropout. Results Overall agreement for all morphological features was substantial (Cohen kappa coefficient = 0.77; p<0.001), even if, the majority of disagreement occurred for cases with segmentation, where agreement was present in only 108 (81.82%) of 132 eyes with adequate images for interpretation, and where SD-OCT tended to diagnose more cases not detected by traditional lid transillumination (McNemar test, p<0.001). Moreover, segmentation and distortion pattern negatively correlated with the degree of drop-out, whereas shortening and entanglement pattern demonstrated only a weak correlation (Spearman's ñ was -0.691, -0.491, -0.359, -0.385, respectively). Conclusions Each method has its advantages but in general there was close agreement between these meibographic techniques, particularly for MG dropout, which supports the reliability of our novel, simple and patient-friendly SD-OCT approach.