The Experts below are selected from a list of 1587 Experts worldwide ranked by ideXlab platform
Reiko Arita - One of the best experts on this subject based on the ideXlab platform.
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Relationship between serum lipid level and Meibomian Gland Dysfunction subtype in Korea using propensity score matching
'Springer Science and Business Media LLC', 2021Co-Authors: Jiyun Song, Ho Sik Hwang, Sunkyoung Park, Kyungdo Han, Hyun-seung Kim, Reiko AritaAbstract:Abstract To analyze the relationship between systemic lipid profile levels and Meibomian Gland Dysfunction (MGD) subtype in Korea. The ophthalmic data of 95 eyes and the serum lipid profiles of 95 patients were reviewed. These factors were compared with those of the general population using data from the Korean National Health and Nutrition Examination Survey (KNHANES), which evaluated 2,917 subjects. Of these, the comparison group (1:5 ratio; n = 475) was selected using propensity score matching according to age and sex. In addition, we analyzed the relationship between serum lipid profile levels and MGD subtypes in MGD patients. The mean high-density lipoprotein (HDL) value of the MGD patients was significantly higher than that of the general population (P
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proposed algorithm for management of Meibomian Gland Dysfunction based on noninvasive meibography
Journal of Clinical Medicine, 2020Co-Authors: Reiko Arita, Shima Fukuoka, Motoko KawashimaAbstract:Although the pathophysiology of Meibomian Gland Dysfunction (MGD) remains incompletely understood, many treatment options have recently become available. According to an international workshop report, treatment selection for MGD should be based on a comprehensive stage classification dependent on ocular symptoms, lid margin abnormalities, meibum grade, and ocular surface staining. However, it is often difficult to evaluate all parameters required for such classification in routine clinical practice. We have now retrospectively evaluated therapeutic efficacy in MGD patients who received five types of treatment in the clinic setting: (1) meibocare (application of a warm compress and practice of lid hygiene), (2) meibum expression plus meibocare, (3) azithromycin eyedrops plus meibocare, (4) thermal pulsation therapy plus meibocare, or (5) intense pulsed light (IPL) therapy plus meibocare. Patients in each treatment group were classified into three subsets according to the meiboscore determined by noncontact meibography at baseline. Eyes in the IPL group showed improvement even if the meiboscore was high (5 or 6), whereas meibocare tended to be effective only if the meiboscore was low (1 or 2). The meiboscore may thus serve to guide selection of the most appropriate treatment in MGD patients. Prospective studies are warranted to confirm these outcomes.
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therapeutic efficacy of intense pulsed light in patients with refractory Meibomian Gland Dysfunction
Ocular Surface, 2019Co-Authors: Reiko Arita, Shima Fukuoka, Naoyuki MorishigeAbstract:Abstract Purpose To evaluate the efficacy and safety of intense pulsed light (IPL) combined with Meibomian Gland expression (MGX) for treatment of refractory Meibomian Gland Dysfunction (MGD). Methods Ninety eyes of 45 patients were randomly assigned to receive either the combination of IPL and MGX or MGX alone (control). Each eye underwent eight treatment sessions at 3-week intervals. Parameters were evaluated before and during treatment as well as at 3–11 weeks after the last treatment session. Measured parameters included the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score, noninvasive breakup time (NIBUT), fluorescein breakup time (BUT), lipid layer grade, lipid layer thickness (LLT), lid margin abnormalities, corneal and conjunctival fluorescein staining (CFS) score, meibum grade, and meiboscore. Results A significant improvement in lipid layer grade was apparent in the IPL-MGX group from 6 to 32 weeks after treatment onset (adjusted P Conclusions The combination of IPL and MGX improved homeostasis of the tear film and ameliorated ocular symptoms in patients with refractory MGD and is thus a promising modality for treatment of this condition.
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Meibomian Gland Dysfunction and contact lens discomfort
Eye & Contact Lens-science and Clinical Practice, 2017Co-Authors: Reiko Arita, Shima Fukuoka, Naoyuki MorishigeAbstract:Meibomian Glands are located in the eyelids and secrete meibum, which gives rise to the lipid layer of the tear film. Changes to these Glands can lead to the development of Meibomian Gland Dysfunction (MGD), which is associated with various ocular symptoms such as fatigue, dryness, burning sensation, and heavy sensation. The diagnosis of MGD thus relies on evaluation of ocular symptoms, meibum condition, and lid margin abnormalities. The recent development of noninvasive meibography and tear interferometry has provided important insight into Meibomian Gland structure and function, respectively. Wearers of contact lenses complain of ocular symptoms that are thought to be attributable to a variety of causes, such as a diminished aqueous or mucin layer of the tear film, changes in tear protein concentration, and altered Meibomian Gland structure or function. Many studies have examined the relation between contact lens wear and Meibomian Gland changes. Such studies have found that lens wear is associated with adverse changes in Meibomian Gland morphology and in the condition of the lid margin and meibum, suggesting that contact lenses negatively affect Meibomian Glands. Meibomian Gland Dysfunction-like changes in Meibomian Glands induced by contact lens wear may thus be responsible for at least some of the ocular symptoms in lens wearers.
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topical diquafosol for patients with obstructive Meibomian Gland Dysfunction
British Journal of Ophthalmology, 2013Co-Authors: Tsuyoshi Haraguchi, Shuji Maeda, Koshi Maeda, Hideaki Tokoro, Jun Suehiro, Reiko Arita, Shiro AmanoAbstract:Aims To evaluate the effect of topical diquafosol in patients with Meibomian Gland Dysfunction (MGD) using tear film parameters and quantitatively analyse the Meibomian Gland morphology. Subjects and Methods The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the Meibomian Glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmer’s test. Quantitative image analysis of the Meibomian Glands was performed using the original software. Results 10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the Meibomian Gland area was significantly increased after treatment (p<0.0001). Conclusions Quantitative image analysis was useful for evaluating the morphological changes of the Meibomian Glands. Topical diquafosol therapy was effective for patients with obstructive MGD.
David A. Sullivan - One of the best experts on this subject based on the ideXlab platform.
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Meibomian Gland Dysfunction in primary and secondary sjogren syndrome
Ophthalmic Research, 2018Co-Authors: David A. Sullivan, R M Sullivan, Kathleen L Krenzer, Afsun Sahin, Beril Arica, Reza Dana, Athena PapasAbstract:Purpose We hypothesized that women with primary (pSS) and secondary Sjogren syndrome (sSS; with systemic lupus erythematosus [SLE] or rheumatoid arthritis [RA]) have Meibomian Gland Dysfunction (MGD). We sought to test our hypothesis. Methods Subjects with pSS, sSS + SLE, sSS + RA, and non-SS-related MGD were recruited from the Sjogren's Syndrome Foundation or outpatient clinics at Tufts University School of Dental Medicine or Brigham and Women's Hospital. The control population was recruited from the Greater Boston area. After providing written informed consent, the subjects underwent an eye examination and/or completed two questionnaires that assess symptoms of dry eye disease (DED). Results Our results demonstrate that pSS and sSS patients have MGD. These subjects had Meibomian Gland orifice metaplasia, an increased number of occluded Meibomian Gland orifices, and a reduced quality of Meibomian Gland secretions. Further, patients with pSS, sSS + SLE, sSS + RA, and MGD had significant alterations in their tear film, lid margin, cornea, and conjunctiva. Symptoms of DED were increased ∼10-fold in all pSS, sSS, and MGD groups relative to controls. Conclusions Our findings support our hypothesis and show that individuals with pSS, sSS + SLE, and sSS + RA have MGD. In addition, our study indicates that patients with pSS and sSS have both aqueous-deficient and evaporative DED.
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changes in gene expression in human Meibomian Gland Dysfunction
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Stephen M Richards, Mark P Hatton, Kristine Lo, David A. SullivanAbstract:Purpose. Meibomian Gland Dysfunction (MGD) may be the leading cause of dry eye syndrome throughout the world. However, the precise mechanism(s) underlying the pathogenesis of this disease is unclear. This study was conducted to identify Meibomian Gland genes that may promote the development and/or progression of human MGD.
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the international workshop on Meibomian Gland Dysfunction executive summary
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Kelly K Nichols, Gary N. Foulks, Kazuo Tsubota, Anthony J Bron, Ben J Glasgow, Murat Dogru, David A. SullivanAbstract:DOI:10.1167/iovs.10-6997a Investigative Ophthalmology & Visual Science, Special Issue 2011, Vol. 52, No. 4 Copyright 2011 The Association for Research in Vision and Ophthalmology, Inc. 1922 ドライアイ疾患の原因としては、マイボーム腺機能不全 (MGD)がおそらく最も多い。この疾患によって数百万人 もの健康と幸福が損なわれているにもかかわらず、MGD の定 義、分類、診断、治療について世界的なコンセンサスはない。 そうしたコンセンサスに達する目的で、非営利団体である Tear Film and Ocular Surface Society( TFOS; http://www. tearfilm.org)が International Workshop on Meibomian Gland Dysfunction(国際マイボーム腺機能不全ワークショップ、 www.tearfilm.org/mgdworkshop/index.html)を起ち上げた。こ のワークショップの目的は以下の通りである:
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androgen deficiency Meibomian Gland Dysfunction and evaporative dry eye
Annals of the New York Academy of Sciences, 2002Co-Authors: David A. Sullivan, James E. Evans, Benjamin D Sullivan, F Schirra, Hideki Yamagami, Stephen M Richards, Debra A Schaumberg, Tomo Suzuki, R M SullivanAbstract:Abstract: Objective. We have recently discovered that women with primary and secondary Sjogren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the Meibomian Gland Dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate Meibomian Gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjogren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to Meibomian Gland Dysfunction and evaporative dry eye. The following studies were designed to test these predictions. Methods. Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques. Results. Our results demonstrate that: (1) androgens regulate the Meibomian Gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5α-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit Meibomian Glands; and (2) androgen deficiency may lead to Meibomian Gland Dysfunction, altered lipid profiles in Meibomian Gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with Meibomian Gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor Dysfunction in women with CAIS is associated with Meibomian Gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human Meibomian Gland secretions. Conclusions. Our findings show that the Meibomian Gland is an androgen target organ and that androgen deficiency may promote Meibomian Gland Dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjogren's syndrome.
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androgen deficiency Meibomian Gland Dysfunction and evaporative dry eye
Annals of the New York Academy of Sciences, 2002Co-Authors: David A. Sullivan, James E. Evans, Benjamin D Sullivan, F Schirra, Hideki Yamagami, Stephen M Richards, Debra A Schaumberg, Tomo Suzuki, R M SullivanAbstract:Abstract: Objective. We have recently discovered that women with primary and secondary Sjogren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the Meibomian Gland Dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate Meibomian Gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjogren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to Meibomian Gland Dysfunction and evaporative dry eye. The following studies were designed to test these predictions. Methods. Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques. Results. Our results demonstrate that: (1) androgens regulate the Meibomian Gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5α-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit Meibomian Glands; and (2) androgen deficiency may lead to Meibomian Gland Dysfunction, altered lipid profiles in Meibomian Gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with Meibomian Gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor Dysfunction in women with CAIS is associated with Meibomian Gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human Meibomian Gland secretions. Conclusions. Our findings show that the Meibomian Gland is an androgen target organ and that androgen deficiency may promote Meibomian Gland Dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjogren's syndrome.
Shiro Amano - One of the best experts on this subject based on the ideXlab platform.
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clinic based study on Meibomian Gland Dysfunction in japan
Investigative Ophthalmology & Visual Science, 2017Co-Authors: Shiro Amano, Kenji InoueAbstract:Purpose To estimate the prevalence of Meibomian Gland Dysfunction (MGD) in the Japanese population. Methods We undertook a clinical study on the prevalence of MGD in Japan using the same diagnostic criteria as a previous population-based study conducted in Spanish Caucasians. The participants were consecutive patients scheduled for cataract surgery at Inouye Eye Hospital. All participants were aged 50 years or older. Patients completed a symptoms questionnaire and underwent a comprehensive slit-lamp examination. Meibomian Gland Dysfunction was diagnosed when one or more of the following was present in at least in one eye: absent, viscous, or waxy white secretion upon digital expression; presence of two or more lid margin telangiectases; and/or plugging of two or more Gland orifices. Results The study included 510 patients (205 men and 305 women). Mean participant age was 71.1 ± 8.5 years (range, 50-93 years). The prevalences of symptomatic and total MGD (symptomatic MGD + asymptomatic MGD) were 11.2% and 74.5%, respectively. The prevalence of total MGD increased significantly as participant age increased (P < 0.0001). The ratio of males to females and the prevalence of any systemic disease did not differ between patients who were positive or negative for MGD. For the total MGD group, all slit-lamp findings were more frequent, fluorescein score was higher, tear film breakup time was shorter, and meibo-score was larger, compared to non-MGD patients. Conclusions Based on the present diagnostic criteria, prevalence of MGD is higher in Tokyo, compared to the Spanish population.
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topical diquafosol for patients with obstructive Meibomian Gland Dysfunction
British Journal of Ophthalmology, 2013Co-Authors: Tsuyoshi Haraguchi, Shuji Maeda, Koshi Maeda, Hideaki Tokoro, Jun Suehiro, Reiko Arita, Shiro AmanoAbstract:Aims To evaluate the effect of topical diquafosol in patients with Meibomian Gland Dysfunction (MGD) using tear film parameters and quantitatively analyse the Meibomian Gland morphology. Subjects and Methods The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the Meibomian Glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmer’s test. Quantitative image analysis of the Meibomian Glands was performed using the original software. Results 10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the Meibomian Gland area was significantly increased after treatment (p<0.0001). Conclusions Quantitative image analysis was useful for evaluating the morphological changes of the Meibomian Glands. Topical diquafosol therapy was effective for patients with obstructive MGD.
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the international workshop on Meibomian Gland Dysfunction report of the diagnosis subcommittee
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Alan Tomlinson, Donald R. Korb, Reiko Arita, Shiro Amano, Norihiko Yokoi, Anthony J Bron, Jerry R Paugh, Ian E Pearce, Murat DogruAbstract:Diagnostic tests of Meibomian Gland Dysfunction (MGD) and of MGD-related disorders are based on the demonstration of abnormal anatomy and physiology of the Glands and the detection of specific pathologic events. For this reason, this subcommittee report is divided into two sections. In part I, those aspects of Meibomian anatomy and physiology that are relevant to currently available tests are described; a fuller account of the anatomy and physiology is provided in the report of the Anatomy Subcommittee of this workshop. In part II, each test and its performance is described in detail. In part III, the practical application of selected tests is summarized and recommendations for future approaches are made. Additional recommendations and a summary of pertinent literature and concepts are presented in Appendices 1 to 17.
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efficacy of diagnostic criteria for the differential diagnosis between obstructive Meibomian Gland Dysfunction and aqueous deficiency dry eye
Japanese Journal of Ophthalmology, 2010Co-Authors: Reiko Arita, Koshi Maeda, Kouzo Itoh, Atsuo Tomidokoro, Syuji Maeda, Shiro AmanoAbstract:Purpose To evaluate diagnostic criteria for obstructive Meibomian Gland Dysfunction (MGD) using three parameters (symptom score, lid margin abnormality score, and Meibomian Gland morphologic change scores) for differentiating obstructive MGD from aqueous deficiency dry eye (ADDE).
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proposed diagnostic criteria for seborrheic Meibomian Gland Dysfunction
Cornea, 2010Co-Authors: Reiko Arita, Shuji Maeda, Koshi Maeda, Kouzo Itoh, Ayumu Furuta, Atsuo Tomidokoro, Shiro AmanoAbstract:Purpose:To compare clinical findings between patients with seborrheic Meibomian Gland Dysfunction (MGD) and normal controls and to propose diagnostic criteria for seborrheic MGD.Methods:Thirty eyes of 30 patients [13 men and 17 women; age (mean ± SD) 73.9 ± 9.9 years] diagnosed with seborrheic MGD a
Gary N. Foulks - One of the best experts on this subject based on the ideXlab platform.
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efficacy of an artificial tear emulsion in patients with dry eye associated with Meibomian Gland Dysfunction
Clinical Ophthalmology, 2013Co-Authors: Christine W Sindt, Gary N. FoulksAbstract:Objectives The aim of the study reported here was to assess the efficacy of an artificial tear emulsion for the treatment of dry eye associated with Meibomian Gland Dysfunction (MGD).
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improving awareness identification and management of Meibomian Gland Dysfunction
Ophthalmology, 2012Co-Authors: Gary N. Foulks, Kelly K Nichols, Edward J Holland, Anthony J Bron, Marguerite B Mcdonald, Daniel J NelsonAbstract:Ocular surface disorders—and dry eye, in particular—is a leading reason for visits to eye care professionals. It has been generally accepted that Meibomian Gland Dysfunction (MGD) is a leading cause of evaporative dry eye, as well as being associated with aqueous-deficient dry eye. Yet, researchers and clinicians have lacked a global consensus on the definition of MGD, its epidemiology, pathophysiology, and management. Various systemic diseases and medications have been associated with the progression of both dry eye and MGD, as have several ocular disorders beyond those directly affecting the surface. It is in the best interest of patients for clinicians to be able to better identify and diagnose MGD, differentiating it from other ocular surface disorders, and to recognize the effects of MGD on the ocular surface, and thus initiate appropriate therapy. This CME activity provides expert insight into the Tear Film and Ocular Surface Society's International Workshop on MGD consensus report, offering practical application of its findings to better manage MGD patient care, particularly for those patients facing or undergoing ocular surgery.
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human meibum lipid conformation and thermodynamic changes with Meibomian Gland Dysfunction
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Douglas Borchman, Gary N. Foulks, Marta C Yappert, Jim Bell, Emily Wells, Shantanu Neravetla, Victoria GreenstoneAbstract:PURPOSE. Instability of the tear film with rapid tear break-up time is a common feature of aqueous-deficient and evaporative dry eye diseases, suggesting that there may be a shared structural abnormality of the tear film that is responsible for the instability. It may be that a change in the normal meibum lipid composition and conformation causes this abnormality. Principle component analyses of infrared spectra of human meibum indicate that human meibum collected from normal donors (Mn) is less ordered than meibum from donors with Meibomian Gland Dysfunction (Md). In this study the conformation of Md was quantified to test this finding. METHODS. Changes in lipid conformation with temperature were measured by infrared spectroscopy. There were two phases to our study. In phase 1, the phase transitions of human samples, Mn and Md, were measured. In phase 2, the phase transitions of model lipid standards composed of different waxes and cholesterol esters were measured. RESULTS. The phase-transition temperature was significantly higher (4°C) for the Md compared with the Mn of age-matched donors with no history of dry-eye symptoms. Most (82%) of the phase-transition temperatures measured for Md were above the values for Mn. The small change in the transition temperature was amplified in the average lipid order (stiffness) at 33.4°C. The average lipid order at 33.4°C for Md was significantly higher (30%, P 0.004) than for Mn. The strength of lipid‐ lipid interactions was 72% higher for Md than for Mn. The ability of one lipid to influence the melting of adjacent lipids is termed cooperativity. There were no significant differences between Mn and Md in phase-transition cooperativity, nor was there a difference between Mn and Md in the minimum order or maximum order that Mn and Md achieved at very low and very high temperatures, respectively. The model wax studies showed that the phase transition of complex mixtures of natural lipids was set by the level of unsaturation. A double bond decreased the phase-transition temperature by approximately 40°C. The addition of a second CHACH moiety decreased the phase-transition temperature by approximately 19°C. Unsaturated waxes were miscible with saturated waxes. When a saturated wax was mixed with an unsaturated one, the saturated wax disproportionately increased the phase transition of the mixture by approximately 30°C compared with the saturated wax alone. Cholesterol ester had little effect on the phase-transition temperature of the waxes. Model studies indicated that changes in the amount of lipid saturation, rather than the amount of cholesterol esters, could be a factor in the observed conformational changes. CONCLUSIONS. Meibum lipid compositional changes with Meibomian Gland Dysfunction reflect changes in hydrocarbon chain conformation and lipid‐lipid interaction strength. Spectroscopic techniques are useful in studying the lipid‐lipid interactions and conformation of lipid from individual patients. (ClinicalTrials.gov number, NCT00803452.) (Invest Ophthalmol Vis Sci. 2011;52:3805‐3817) DOI:10.1167/iovs.10-6514
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the international workshop on Meibomian Gland Dysfunction report of the definition and classification subcommittee
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Daniel J Nelson, Jennifer P Craig, Jun Shimazaki, J M Benitezdelcastillo, James P Mcculley, Gary N. FoulksAbstract:Recommended definition of MGD: Meibomian Gland Dysfunction (MGD) is a chronic, diffuse abnormality of the Meibomian Glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the Glandular secretion. This may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease. Previous definitions and criteria of MGD: There is no firmly established definition of MGD published in the literature. Most researchers have used a criterion-based approach to describe the condition, with combinations of objective findings and measurements. Anatomic changes of the lid margin, expressibility of Meibomian lipids, Gland dropout by meibography, evaporimetry, and meibometry are most commonly used (Table 1). Table 1. Criteria of Meibomian Gland Dysfunction Used in Previous Works
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the international workshop on Meibomian Gland Dysfunction executive summary
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Kelly K Nichols, Gary N. Foulks, Kazuo Tsubota, Anthony J Bron, Ben J Glasgow, Murat Dogru, David A. SullivanAbstract:DOI:10.1167/iovs.10-6997a Investigative Ophthalmology & Visual Science, Special Issue 2011, Vol. 52, No. 4 Copyright 2011 The Association for Research in Vision and Ophthalmology, Inc. 1922 ドライアイ疾患の原因としては、マイボーム腺機能不全 (MGD)がおそらく最も多い。この疾患によって数百万人 もの健康と幸福が損なわれているにもかかわらず、MGD の定 義、分類、診断、治療について世界的なコンセンサスはない。 そうしたコンセンサスに達する目的で、非営利団体である Tear Film and Ocular Surface Society( TFOS; http://www. tearfilm.org)が International Workshop on Meibomian Gland Dysfunction(国際マイボーム腺機能不全ワークショップ、 www.tearfilm.org/mgdworkshop/index.html)を起ち上げた。こ のワークショップの目的は以下の通りである:
R M Sullivan - One of the best experts on this subject based on the ideXlab platform.
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Meibomian Gland Dysfunction in primary and secondary sjogren syndrome
Ophthalmic Research, 2018Co-Authors: David A. Sullivan, R M Sullivan, Kathleen L Krenzer, Afsun Sahin, Beril Arica, Reza Dana, Athena PapasAbstract:Purpose We hypothesized that women with primary (pSS) and secondary Sjogren syndrome (sSS; with systemic lupus erythematosus [SLE] or rheumatoid arthritis [RA]) have Meibomian Gland Dysfunction (MGD). We sought to test our hypothesis. Methods Subjects with pSS, sSS + SLE, sSS + RA, and non-SS-related MGD were recruited from the Sjogren's Syndrome Foundation or outpatient clinics at Tufts University School of Dental Medicine or Brigham and Women's Hospital. The control population was recruited from the Greater Boston area. After providing written informed consent, the subjects underwent an eye examination and/or completed two questionnaires that assess symptoms of dry eye disease (DED). Results Our results demonstrate that pSS and sSS patients have MGD. These subjects had Meibomian Gland orifice metaplasia, an increased number of occluded Meibomian Gland orifices, and a reduced quality of Meibomian Gland secretions. Further, patients with pSS, sSS + SLE, sSS + RA, and MGD had significant alterations in their tear film, lid margin, cornea, and conjunctiva. Symptoms of DED were increased ∼10-fold in all pSS, sSS, and MGD groups relative to controls. Conclusions Our findings support our hypothesis and show that individuals with pSS, sSS + SLE, and sSS + RA have MGD. In addition, our study indicates that patients with pSS and sSS have both aqueous-deficient and evaporative DED.
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androgen deficiency Meibomian Gland Dysfunction and evaporative dry eye
Annals of the New York Academy of Sciences, 2002Co-Authors: David A. Sullivan, James E. Evans, Benjamin D Sullivan, F Schirra, Hideki Yamagami, Stephen M Richards, Debra A Schaumberg, Tomo Suzuki, R M SullivanAbstract:Abstract: Objective. We have recently discovered that women with primary and secondary Sjogren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the Meibomian Gland Dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate Meibomian Gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjogren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to Meibomian Gland Dysfunction and evaporative dry eye. The following studies were designed to test these predictions. Methods. Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques. Results. Our results demonstrate that: (1) androgens regulate the Meibomian Gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5α-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit Meibomian Glands; and (2) androgen deficiency may lead to Meibomian Gland Dysfunction, altered lipid profiles in Meibomian Gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with Meibomian Gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor Dysfunction in women with CAIS is associated with Meibomian Gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human Meibomian Gland secretions. Conclusions. Our findings show that the Meibomian Gland is an androgen target organ and that androgen deficiency may promote Meibomian Gland Dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjogren's syndrome.
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androgen deficiency Meibomian Gland Dysfunction and evaporative dry eye
Annals of the New York Academy of Sciences, 2002Co-Authors: David A. Sullivan, James E. Evans, Benjamin D Sullivan, F Schirra, Hideki Yamagami, Stephen M Richards, Debra A Schaumberg, Tomo Suzuki, R M SullivanAbstract:Abstract: Objective. We have recently discovered that women with primary and secondary Sjogren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the Meibomian Gland Dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate Meibomian Gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjogren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to Meibomian Gland Dysfunction and evaporative dry eye. The following studies were designed to test these predictions. Methods. Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques. Results. Our results demonstrate that: (1) androgens regulate the Meibomian Gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5α-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit Meibomian Glands; and (2) androgen deficiency may lead to Meibomian Gland Dysfunction, altered lipid profiles in Meibomian Gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with Meibomian Gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor Dysfunction in women with CAIS is associated with Meibomian Gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human Meibomian Gland secretions. Conclusions. Our findings show that the Meibomian Gland is an androgen target organ and that androgen deficiency may promote Meibomian Gland Dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjogren's syndrome.