ARVO 2024: Trial design and increased accuracy of meibomian gland morphology measurements

At this year's ARVO meeting, the Eye Care Network spoke with Andrew D. Pucker, OD, PhD, executive director of clinical and medical science at Lexitas Pharma Services Inc. He shared key takeaways from a recent study regarding meibomobian gland morphology, comparing data measured with a Visante OCT versus an OCULUS Keratograph 5M. The study was also published in Contact Lens and Anterior Eye.

Editor's note: The below transcript has been lightly edited for clarity.

Andrew D. Pucker, OD, PhD: Hello, my name is Andrew Pucker. I am the executive director of clinical and medical sciences at Lexitas Pharma services, and today I'm excited to talk about my recent paper that was published in Contact Lens and Anterior Eye.

In this study, what we did was we compared people who were analysed with a Visante OCT, which has a long wavelength of light, which is around 310 nanometers, to people who were analysed with an OCULUS Keratograph 5M, which has an 880 nanometer wavelength. So with these two instruments, what we did is we looked at their eyelids, we looked at their meibomian gland morphology, and what we found was that with the OCT, they had longer eyelid glands compared to the chronograph.

So why is that important? So about 3 or 4 years ago, I was reading in the literature, and I found that post-treatment, the meibomian glands got longer, which doesn't really make sense. Typically, we think of a gland once it's gone. It's atrophied. You can't get it back. But what happened is, there's several studies that found it was longer post-treatment. So what I think my data suggests is that on OCT, you can just image deeper into the eyelid and see these glands that are always there that are probably being missed with the Keratograph. So post-treatment, what might be happening is that the glands are becoming healthier, thicker, and become more visible on meibography, which is why there's being shown as longer post-treatments. So really, I think the glands are there. They're just not healthy. And what we can do now is use this technology to hopefully better design trials to see how treatment changes occur over time.

So the next step is, I think, to potentially optimise our existing meibographers. So the Keratograph 5M is just one example. That's what we used, but it has this shorter wavelength than the Vistante OCT, which is not used typically for analyzing the meibomian glands. So what we can potentially do is have manufacturers take this information, optimise the wavelengths, so maybe you're catching all the glands instead of just more the superficial gland.