Meibography Isolates Morphological Differences by Age, Ethnicity

Clinicians should be able to recognize the varying patterns of meibomian gland anatomy and be able to discern which indicate dysfunction that may be improved by various medical interventions. These images from the study show upper (A) and lower  (B) meibography examples of the distinctions noted by the researchers. Photo: Graham AD, et al. Transl Vis Sci Technol. 2025;14(8):36. Click image to enlarge. Meibomian gland dysfunction (MGD) has become increasingly prevalent in recent years and is the primary cause of evaporative dry eye. Given its pervasiveness, researchers are interested in elucidating possible characteristics of the glands that hint toward dysfunction. In a new study published in Translational Vision Science & Technology, investigators input a large dataset of meibography images into a machine learning model to quantify different gland characteristics.Of the 2,233 images compiled from 560 subjects, photos were assessed for quantification of gland length, width, tortuosity, contrast, atrophy, density and number. It was found that age was significantly linked with shorter glands, greater atrophy and lower gland density. By ethnicity, Asian participants exhibited the longest and densest glands, while Black patients displayed the most gland atrophy. Contact lens wearers were also found to have longer glands than non-wearers by around 4% to 5%, but this was the only contact lens parameter found to have significance in relation with MG morphological features. That is, lens type, replacement schedule, lens wear history (years), frequency (days/week), duration (hours/day) and comfortable duration (hours/day) all had no significant impact on MG characteristics. Wearers of rigid gas permeable lenses in this study exhibited the shortest glands in the lower eyelid, but simultaneously had the longest glands in the upper eyelid.Interestingly, no differences in morphology were seen based on the sex of the patient.In general, the authors of the study relay that their findings indicate “what constitutes ‘normal-looking’ meibomian glands in a meibography image depends on the age and ethnicity of the patient.”The finding of age’s effect on glands in this study reflect previous reports, with MGs showing decreased size and/or displaying reduced acini numbers. What’s more, shorter glands are documented as more common among patients over 30, while more studies show greater age is linked with gland dropout, loss, area of atrophy and meiboscore.Related to this, the authors highlight the finding of gland contrast in meibography images not showing distinctions by age. This, they say, is because gland contrast results from reflectivity properties of the acini, with the most popular theory for age-related MGD being that hyperkeratinization causes secretory duct obstruction and static meibum within glands, thus leading to gland atrophy via backpressure. Given this pathophysiology, decreased gland contrast would be implied, as the glands changing composition would result in being less elastic and reflective. However, no relationship was seen with age and gland contrast, indicating lipid composition—a function seen via reflectivity of intact glands—doesn’t change with age in the absence of obstruction.In the paper, the authors concluded that “the important next steps, which are currently underway, are to determine what alterations to any of these detailed MG morphological features are related to differences in downstream gland function, lipid layer thickness and uniformity, tear film stability, and ultimately the symptoms associated with MGD and dry eye.”Click here for the journal source. Graham AD, Yeh CH, Lin MC. Morphological characteristics of the meibomian glands: impact of demographics and contact lens wear. Transl Vis Sci Technol. 2025;14(8):36.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.