Meibographers Comparable in Meibomian Gland Dropout Monitoring

An ophthalmologist shines light into the eye of a tense young female patient who has a piece of foreign object (metal shard) stuck in her cornea. Real injury and examination. A slit lamp instrument for closer examination is in the foreground and lights the doctor’s hand.
Technologies are giving ophthalmologists objective, and in some cases interchangeable, tools for evaluating dry eye.

Few prior investigations have compared meibography devices but a novel study has now performed side-by-side evaluations of 2 instruments and found they yield similar calculations of meibomian gland (MG) dropout percentage in patients with dry eye, according to the paper published in Eye & Contact Lens. The finding suggests the tool can be used interchangeably.

The investigation compares MG measurements using the Antares corneal topographer (Costruzione Strumenti Oftalmici) with a Cobra HD fundus camera (Costruzione Strumenti Oftalmici) for 80 participants: 26 patients with evaporative dry eye, and a control group of 54 individuals with no dry eye, but displaying refractive errors. Participants answered Ocular Surface Disease Index (OSDI) questions before undergoing a complete ophthalmic examination. Noninvasive tear break-up time (NIBUT) and meibography of upper and lower eyelids were conducted using Cobra HD and Antares.

The results demonstrated statistically significant differences between devices for the percentage of MG loss in upper eyelids of those without dry eye, but “measurements were similar in patients with dry eye (upper and lower lids), suggesting that the 2 instruments can be interchanged.” 

More specifically, the mean percentage of MG dropout in upper eyelids of participants without dry eye was 17.62% using Antares, and 16.22% with Cobra (P =.009). MG loss in upper eyelids of patients with dry eye was gauged at 21.78% by Antares, and 21.35% using Cobra (P =.36). The analysis suggests that any inter-device differences in upper lid measurements were less than 2% and not clinically meaningful. Lower lids of both groups showed no significant difference in MG loss when quantified by the 2 devices (P =.65).

No significant correlation was found comparing the percentage of MG loss in either group with objective ocular signs, such as quality of meibum, ocular surface fluorescein staining, or number of meibomian glands yielding liquid secretion (MGYLS). Other findings included a younger mean age of participants without dry eye, 30.87 years of age, compared with those exhibiting dry eye, 49.50 years of age (P =.0002). Also, MGYLS and NIBUT — both the first break in tear film and average break-up time in all regions — were considerably reduced in those with dry eye (P ≤.006).

The study did not have enough information to calculate statistical sample size needed, and the dry eye group was relatively small, indicating a limitation of this analysis. Also, the order of tests was not randomized. However, the sample examined was twice that of similar research, the study explains.

Investigators speculate that differences in upper lid dropout rate measurements may have resulted from several factors such as image quality, different infrared wavelengths of the Antares and Cobra HD, or “more ghost glands in the UL than LL, resulting in a greater impact of different image acquisition methods.”

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Garduño F, Salinas A, Contreras K, et al. Comparative study of two infrared meibographers in evaporative dry eye versus non-dry eye patients. Eye & Contact Lens. 2021;47(6):335–340. doi:10.1097/ICL.0000000000000762