Andrew D. Pucker, OD, PhD is an Assistant Professor at the School of Optometry, University of Alabama at Birmingham.
Association Between Meibomian Gland Health and Soft Contact Lens Dropout
Andrew D. Pucker, OD, PhD, Lisa A. Jones-Jordan, PhD, Sruthi Srinivasan PhD, BS Optom, Daniel R. Powell, OD, PhD, Justin T. Kwan, OD, Sebastian Marx, M.S., Dipl.-Ing. (FH) AO, Wolfgang Sickenberger, M.Sc. Optom, Dipl.-Ing. (FH) AO, Lyndon Jones, PhD FCOptom
Purpose: There is virtually no growth in the global contact lens (CL) market because there are as many CL dropouts as new CL wearers. The purpose of this study was to determine if meibomian gland (MG) atrophy has an impact on successful CL wear.
Methods: This five-site study recruited subjects between the ages of 18 and 45 years who had discontinued CL use within the past 6-12 months due to discomfort. CL dropout subjects (cases) were compared to age- and sex-matched successful CL wearing controls (≥8 hours/day for ≥5 days/week). Each subject was administered a study-specific CL questionnaire and a standard SPEED questionnaire. Clinical testing included non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), meibomian gland function (expression and plugging), and meibography (OCULUS Keratograph 5M). MG atrophy was graded subjectively on a 0 to 3 scale by eyelid for each eye; atrophy was categorized as significant if the upper or lower eyelid grade was ≥ 2 or the total grade for both upper and lower eyelids was ≥ 4. Subjects were considered to have diagnosed dry eye if they had a SPEED score > 5.0 and a positive NITBUT (< 10 s) or TMH (< 0.2 mm) test. Worse eye comparisons were made with paired t-tests (means) or McNemar’s test (frequencies).
Results: 56 matched-pairs were recruited across sites. The mean ± SD age of the cases (28.5 ± 7.1 years) and controls (28.6 ± 7.0 years) were similar (p = 0.66). Cases had significantly higher SPEED scores than controls (6.4 ± 5.0 vs. 2.6 ± 2.7; p < 0.0001). Diagnosed dry eye was significantly associated with CL dropout (p < 0.001). NITBUT, TMH, and significant upper, lower and total MG atrophy was not different between groups (all p ≥ 0.16). Upper (p < 0.001) and lower (p = 0.002) MG plugging and upper (p < 0.001) but not lower (p = 0.11) meibum quality were associated with CL dropout. Neither upper nor lower MG atrophy were associated with upper or lower MG plugging or upper or lower meibum quality (all p ≥ 0.35).
Conclusions: CL dropout may be precipitated by underlying dry eye, though most dry eye signs, with the exception of MG function, have minimal predictive value for CL dropout. Nevertheless, evidence from this study suggests that practitioners should screen for and educate CL patients about the importance of eyelid hygiene in order to maintain comfortable CL use.