IF YOU grew up in the’70’s or ’80’s, you likely remember these public service announcements (PSAs): “This is your brain on drugs,” “Beware of stranger danger” and “The More You Know,” which, incidentally, continues today. I feel that meibomian gland imaging deserves a practitioner service announcement. Here’s my proposal (and, yes, it’s a spinoff of “Stop, Drop and Roll”): “Stop, Look and Image.”

Here, I explain why I feel this PSA is needed.

THE TRUTH LIES UNDERNEATH

Often, doctors mistakenly check the “within normal limits” (WNL) box in their EHR records when the patient doesn’t have anterior blepharitis, a hordeolum or other glaring lid disease. But, is the patient truly “normal?”

Congested glands visualized at the slit lamp can literally be the tip of the iceberg. Superficial inspection does little to establish the severity or steer an effective treatment plan. The slit lamp view shows only what’s at the surface. Meibography, however, enables you to see the threat that lies below.

STRUCTURE = TREATMENT

Whether you transilluminate glands or use high-resolution imaging, visualization is needed to identify gland atrophy, dilation, tortuosity and other anatomical changes. Seeing the gland’s structure within the lids helps you, the doctor, recognize the opportunities and limitations for therapy. It can also help determine how aggressive treatment should be, should you determine the patient’s lids do show signs of MGD.

Without meibography, the warm compresses you prescribe may set up even the most compliant patient for failure, possibly causing him or her to seek a new optometrist. Get treatment “right,” the first time, and you’ll likely have that patient for his or her life, along with several referrals.

So, who requires meibomian gland imaging? You may be surprised. While conventional dry eye demographics would dictate imaging a post-menopausal woman, emerging trends (due in part to digital device use) indicate a shift toward a younger patient base. Gland drop-out has even been identified in pediatric patients. Some practices are electing to image all patients as a screening and catching some unexpected and asymptomatic patients who have significant atrophy. Many other practices are taking a more selective approach.

While there are no hard and fast rules, consider imaging a patient’s meibomian glands if the patient:

• Has an existing dry eye complaint

• Reports digital device use > 2 hours

• Reports vision fluctuations increasing as the day goes on.

MY VISION

I must admit, I hope to see kids submitting colorful artwork to MGD “Stop, Look and Image” poster contests and Kelsey Grammar doing the voiceover for the PSA. So many of my patients tell me that I gave them information they’d never heard before when we discussed their images. After all, The More You Know… OM

DR. HAUSER provides clinical care for patients at TearWell: Advance Dry Eye Treatment Center and the Advanced Care and The Eye Center at Southern College of Optometry. She is a consultant, speaker or board member for: Allergan, Akorn, Paragon Vision Sciences, BioTeck, BlephEx, TearScience, BioTissue, NovaBay, Lumenis, TearLab and Shire. Visit tinyurl.com/OMcomment to comment.