Morphological Characteristics of the Meibomian Glands: Impact of Demographics and Contact Lens Wear

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Purpose: To determine the impact of age, sex, ethnicity, and contact lens wear on the detailed morphology of the Meibomian glands as quantified by a deep learning segmentation model. Methods: A large dataset of meibography images (n = 2233) from 560 subjects was compiled and input to a supervised machine learning model to quantify gland length, width, tortuosity, contrast, atrophy, density, and number of glands. These morphology outcomes were modeled as functions of age, sex, ethnicity, and contact lens wear parameters. Results: Age was significantly associated with shorter glands, more atrophy, and lower gland density (all p < 0.001). No Meibomian gland morphological characteristics were related to sex. Asian subjects exhibited the longest and densest glands, and black subjects exhibited the most gland atrophy. Although contact lens wearers overall had significantly longer glands (∼4%-5%; p < 0.001) than non-wearers, no other contact lens wear parameter was significantly related to any Meibomian gland morphological feature. Conclusions: What constitutes "normal-looking" Meibomian glands in a meibography image depends on the age and ethnicity of the patient. There appear to be no significant female/male Meibomian gland morphological differences. Meibomian gland morphology is robust to contact lens wear based on a large-sample analysis of younger, successful contact lens wearers. Now that the impact of these external factors has been established, work is ongoing to determine exactly what alterations in Meibomian gland morphology contribute to downstream pathology. Translational Relevance: This study used artificial intelligence to provide clinicians with novel insights into normal versus abnormal Meibomian gland morphological features in their patients.

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