Prevalence of Meibomian Gland Dysfunction and Its Determinants in a Deprived Rural Population of Iran: A Population-Based Cross-Sectional Study
-
Hassan Hashemi
,
Reza Pakzad
,
Amir Asharlous
,
Abbasali Yekta
,
Mohammad Mehdi Sadoughi
,
Hadi Ostadimoghaddam
,
Mehdi Khabazkhoob
Abstract
To investigate the prevalence of Meibomian gland dysfunction (MGD) and its relationship with some determinants in underserved villages of Iran. This population-based cross-sectional study was conducted on 3850 subjects that were randomly selected from the villages of two underserved districts in the north and southwest of Iran using multistage cluster sampling. All participants underwent complete ophthalmic examinations, including visual acuity and refraction measurement. Then, slit-lamp biomicroscopy was done by an ophthalmologist to investigate MGD. Of 3850 subjects that were invited, 3314 participated in the study (participation rate=86.07%), of whom 1834 (55.34%) were women. The mean age of the participants was 37.7±21.4 years (range=2-93 years). The prevalence (95% CI) of MGD in at least one eye was 29.20% (27.35 to 31.06). According to the results of multiple regression analysis, MGD had a positive association with the male sex (OR: 1.75; CI 95%: 1.44 to 2.13), age 61-70 years (OR: 7.15; CI 95%: 3.65 to 14.01), and living in southern villages (OR: 1.82; CI 95%: 1.48 to 2.22) and an inverse association with education level (OR: 0.89; CI 95%: 0.80 to 0.98). The results of this study showed a lower prevalence of MGD even in Iranian rural regions compared to other Asian countries. This study found that older age, male sex, and low education level served as MGD risk factors. It seems that improved health conditions are an important factor in preventing MGD.
1. Schaumberg DA, Dana R, Buring JE, Sullivan DA. Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. Arch Ophthalmol 2009;127:763-8.
2. Foulks GN, Bron AJ. Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading. Ocul Surf 2003;1:107-26.
3. Siak JJ, Tong L, Wong WL, Cajucom-Uy H, Rosman M, Saw SM, et al. Prevalence and risk factors of meibomian gland dysfunction: the Singapore Malay eye study. Cornea 2012;31:1223-8.
4. Yaylali V, Ozyurt C. Comparison of tear function tests and impression cytology with the ocular findings in acne rosacea. Eur J Ophthalmol 2002;12:11-7.
5. Goto E, Endo K, Suzuki A, Fujikura Y, Matsumoto Y, Tsubota K. Tear evaporation dynamics in normal subjects and subjects with obstructive meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2003;44:533-9.
6. Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011;52:1994-2005.
7. Hashemi H, Rastad H, Emamian MH, Fotouhi A. Meibomian gland dysfunction and its determinants in Iranian adults: A population-based study. Cont Lens Anterior Eye 2017;40:213-6.
8. Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf 2004;2:149-65.
9. Chan TCY, Chow SSW, Wan KHN, Yuen HKL. Update on the association between dry eye disease and meibomian gland dysfunction. Hong Kong Med J 2019;25:38-47.
10. Damasceno RW, Osaki MH, Dantas PE, Belfort R Jr. Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population. Ophthalmic Plast Reconstr Surg 2011;27:317-20.
11. Schein OD, Muñoz B, Tielsch JM, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am J Ophthalmol 1997;124:723-8.
12. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 1998;105:1114-9.
13. Lin PY, Tsai SY, Cheng CY, Liu JH, Chou P, Hsu WM. Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 2003;110:1096-101.
14. Uchino M, Dogru M, Yagi Y, Goto E, Tomita M, Kon T, et al. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci 2006;83:797-802.
15. Jie Y, Xu L, Wu YY, Jonas JB. Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye (Lond) 2009;23:688-93.
16. Lekhanont K, Rojanaporn D, Chuck RS, Vongthongsri A. Prevalence of dry eye in Bangkok, Thailand. Cornea. 2006;25:1162-7.
17. Chhadva P, Goldhardt R, Galor A. Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease. Ophthalmology 2017;124:S20-6.
18. Mitchell P, Hinchcliffe P, Wang JJ, Rochtchina E, Foran S. Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol 2001;29:108-10.
19. Hashemi H, Pakzad R, Yekta A, Khabazkhoob M. The Prevalence of Corneal Opacity in Rural Areas in Iran: A Population-based Study. Ophthalmic Epidemiol 2018;25:21-6.
20. Hashemi H, Pakzad R, Yekta A, Asharlous A, Aghamirsalim M, Ostadimoghaddam H, et al. The distribution of near point of convergence in an Iranian rural population: A population-based cross-sectional study. Saudi J Ophthalmol 2019;33:148-52.
21. Hom MM, Martinson JR, Knapp LL, Paugh JR. Prevalence of Meibomian gland dysfunction. Optom Vis Sci 1990;67:710-2.
22. Ong BL, Larke JR. Meibomian gland dysfunction: some clinical, biochemical and physical observations. Ophthalmic Physiol Opt 1990;10:144-8.
23. Shimazaki J, Sakata M, Tsubota K. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol 1995;113:1266-70.
24. Ong BL. Relation between contact lens wear and Meibomian gland dysfunction. Optom Vis Sci 1996;73:208-10.
25. Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology 1998;105:1485-8.
26. Horwath-Winter J, Berghold A, Schmut O, Floegel I, Solhdju V, Bodner E, et al. Evaluation of the clinical course of dry eye syndrome. Arch Ophthalmol 2003;121:1364-8.
27. Zhang M, Chen JQ, Liu ZG, Lou LH, Xiao QG, Yao Y, et al. [Clinical characteristics of patients with dry eye syndrome]. Zhonghua Yan Ke Za Zhi 2003;39:5-9.
28. Den S, Shimizu K, Ikeda T, Tsubota K, Shimmura S, Shimazaki J. Association between meibomian gland changes and aging, sex, or tear function. Cornea 2006;25:651-5.
29. Sullivan DA, Sullivan BD, Evans JE, Schirra F, Yamagami H, Liu M, et al. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci 2002;966:211-22.
30. Hykin PG, Bron AJ. Age-related morphological changes in lid margin and meibomian gland anatomy. Cornea 1992;11:334-42.
31. Sullivan BD, Evans JE, Dana MR, Sullivan DA. Influence of aging on the polar and neutral lipid profiles in human meibomian gland secretions. Arch Ophthalmol 2006;124:1286-92.
32. Nemet AY, Vinker S, Kaiserman I. Associated morbidity of blepharitis. Ophthalmology 2011;118:1062-8.
33. Baudouin C, Messmer EM, Aragona P, Geerling G, Akova YA, Benítez-del-Castillo J, et al. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol 2016;100:300-6.
2. Foulks GN, Bron AJ. Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading. Ocul Surf 2003;1:107-26.
3. Siak JJ, Tong L, Wong WL, Cajucom-Uy H, Rosman M, Saw SM, et al. Prevalence and risk factors of meibomian gland dysfunction: the Singapore Malay eye study. Cornea 2012;31:1223-8.
4. Yaylali V, Ozyurt C. Comparison of tear function tests and impression cytology with the ocular findings in acne rosacea. Eur J Ophthalmol 2002;12:11-7.
5. Goto E, Endo K, Suzuki A, Fujikura Y, Matsumoto Y, Tsubota K. Tear evaporation dynamics in normal subjects and subjects with obstructive meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2003;44:533-9.
6. Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011;52:1994-2005.
7. Hashemi H, Rastad H, Emamian MH, Fotouhi A. Meibomian gland dysfunction and its determinants in Iranian adults: A population-based study. Cont Lens Anterior Eye 2017;40:213-6.
8. Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf 2004;2:149-65.
9. Chan TCY, Chow SSW, Wan KHN, Yuen HKL. Update on the association between dry eye disease and meibomian gland dysfunction. Hong Kong Med J 2019;25:38-47.
10. Damasceno RW, Osaki MH, Dantas PE, Belfort R Jr. Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population. Ophthalmic Plast Reconstr Surg 2011;27:317-20.
11. Schein OD, Muñoz B, Tielsch JM, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am J Ophthalmol 1997;124:723-8.
12. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 1998;105:1114-9.
13. Lin PY, Tsai SY, Cheng CY, Liu JH, Chou P, Hsu WM. Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 2003;110:1096-101.
14. Uchino M, Dogru M, Yagi Y, Goto E, Tomita M, Kon T, et al. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci 2006;83:797-802.
15. Jie Y, Xu L, Wu YY, Jonas JB. Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye (Lond) 2009;23:688-93.
16. Lekhanont K, Rojanaporn D, Chuck RS, Vongthongsri A. Prevalence of dry eye in Bangkok, Thailand. Cornea. 2006;25:1162-7.
17. Chhadva P, Goldhardt R, Galor A. Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease. Ophthalmology 2017;124:S20-6.
18. Mitchell P, Hinchcliffe P, Wang JJ, Rochtchina E, Foran S. Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol 2001;29:108-10.
19. Hashemi H, Pakzad R, Yekta A, Khabazkhoob M. The Prevalence of Corneal Opacity in Rural Areas in Iran: A Population-based Study. Ophthalmic Epidemiol 2018;25:21-6.
20. Hashemi H, Pakzad R, Yekta A, Asharlous A, Aghamirsalim M, Ostadimoghaddam H, et al. The distribution of near point of convergence in an Iranian rural population: A population-based cross-sectional study. Saudi J Ophthalmol 2019;33:148-52.
21. Hom MM, Martinson JR, Knapp LL, Paugh JR. Prevalence of Meibomian gland dysfunction. Optom Vis Sci 1990;67:710-2.
22. Ong BL, Larke JR. Meibomian gland dysfunction: some clinical, biochemical and physical observations. Ophthalmic Physiol Opt 1990;10:144-8.
23. Shimazaki J, Sakata M, Tsubota K. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol 1995;113:1266-70.
24. Ong BL. Relation between contact lens wear and Meibomian gland dysfunction. Optom Vis Sci 1996;73:208-10.
25. Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology 1998;105:1485-8.
26. Horwath-Winter J, Berghold A, Schmut O, Floegel I, Solhdju V, Bodner E, et al. Evaluation of the clinical course of dry eye syndrome. Arch Ophthalmol 2003;121:1364-8.
27. Zhang M, Chen JQ, Liu ZG, Lou LH, Xiao QG, Yao Y, et al. [Clinical characteristics of patients with dry eye syndrome]. Zhonghua Yan Ke Za Zhi 2003;39:5-9.
28. Den S, Shimizu K, Ikeda T, Tsubota K, Shimmura S, Shimazaki J. Association between meibomian gland changes and aging, sex, or tear function. Cornea 2006;25:651-5.
29. Sullivan DA, Sullivan BD, Evans JE, Schirra F, Yamagami H, Liu M, et al. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci 2002;966:211-22.
30. Hykin PG, Bron AJ. Age-related morphological changes in lid margin and meibomian gland anatomy. Cornea 1992;11:334-42.
31. Sullivan BD, Evans JE, Dana MR, Sullivan DA. Influence of aging on the polar and neutral lipid profiles in human meibomian gland secretions. Arch Ophthalmol 2006;124:1286-92.
32. Nemet AY, Vinker S, Kaiserman I. Associated morbidity of blepharitis. Ophthalmology 2011;118:1062-8.
33. Baudouin C, Messmer EM, Aragona P, Geerling G, Akova YA, Benítez-del-Castillo J, et al. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol 2016;100:300-6.
| Files | ||
| Issue | Vol 60 No 11 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i11.11653 | |
| Keywords | ||
| Meibomian gland dysfunction Prevalence Cross-sectional study Determinants | ||
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How to Cite
1.
Hashemi H, Pakzad R, Asharlous A, Yekta A, Sadoughi MM, Ostadimoghaddam H, Khabazkhoob M. Prevalence of Meibomian Gland Dysfunction and Its Determinants in a Deprived Rural Population of Iran: A Population-Based Cross-Sectional Study. Acta Med Iran. 2023;60(11):688-694.
