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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nPatients with high meibomian gland dysfunction were older and more myopic.<\/li>\n Asymptomatic MGD can affect structural measurements and functional vision.<\/li>\n<\/ul>\nScreening for asymptomatic meibomian gland dysfunction in candidates for refractive surgery is recommended due to a high prevalence of the condition, according to a study published in Journal of Refractive Surgery<\/i>.<\/p>\n
Shawn Sapir, MD,<\/b> of the department of ophthalmology, Barzilai University Medical Center, Israel, and colleagues wrote that irregularities in the tear film, including those caused by meibomian gland dysfunction (MGD), can change baseline measurements critical to the success of refractive surgery.<\/p>\n
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J Refract Surg<\/em>. 2026;doi:10.3928\/1081597X-20260112-08. Image: Adobe Stock<\/em>
\u201cAlthough previous investigations have examined MGD in dry eye cohorts, few have systematically evaluated preoperative clinical, biometric and functional parameters in asymptomatic individuals presenting for refractive correction,\u201d they wrote. \u201cThe extent to which MGD severity relates to age, myopia, corneal morphology, contact lens habits or contrast acuity remains insufficiently characterized.\u201d<\/p>\n
Sapir and colleagues conducted a retrospective case-control study of 3,472 eyes that underwent evaluation for refractive surgery at a single center between 2019 and 2024. After reviewing electronic health records, they included patients who had a complete MGD evaluation, were eligible for laser vision correction and achieved stable refraction for at least 12 months before surgery, according to the study.<\/p>\n
Eyes were classified based on MGD grading determined by the \u201cexpressibility and quality of secretions\u201d during a standardized digital expression of the central third of each eyelid. The group classified as high MGD included 1,731 eyes (49.9%) with MGD grades of 2 to 3. The group classified as low MGD included 1,741 eyes (50.1%) with MGD grades of 0 to 1, according to the study.<\/p>\n
\u201cPatients with high MGD were significantly older than those with low MGD (27.4 years \u00b1 8.2 years vs. 24.5 years \u00b1 6.4 years; P <\/i>< .001),\u201d the authors wrote. \u201cThe high MGD group was also more myopic (\u20134.3 D \u00b1 2.73 D vs. \u20133.5 D \u00b1 2.25 D; P <\/i>< .001), a finding confirmed by cycloplegic autorefraction.\u201d<\/p>\n
Sapir and colleagues wrote that high MGD was also associated with worse uncorrected and corrected distance visual acuity as well as reduced contrast acuity even though all eyes had normal tear breakup time and no dry eye symptoms. The authors wrote that this demonstrates that asymptomatic MGD can lead to issues with functional vision in addition to problems measuring structural elements.<\/p>\n
\u201cThese findings establish asymptomatic MGD as a significant and often overlooked variable in refractive surgery planning and highlight the importance of incorporating routine gland evaluation into the preoperative assessment,\u201d Sapir and colleagues wrote. \u201cFurther prospective studies using objective gland imaging, detailed tear film metrics and long-term postoperative follow-up are warranted to refine screening protocols and optimize refractive outcomes.\u201d<\/p>\n
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Perspective<\/h2>\n Back to Top
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In the April 2026 issue of Journal of Refractive Surgery<\/default:i>, Sapir and colleagues address an issue that refractive surgeons may underestimate: clinically significant meibomian gland dysfunction (MGD) in patients without dry eye symptoms.<\/default:p>In this large retrospective series, nearly half of the candidates were classified as having high-grade asymptomatic MGD. Importantly, MGD severity was assessed clinically by a single examiner using standardized digital expression and secretion grading rather than by objective meibography or imaging-based gland metrics. Nevertheless, MGD was independently associated with older age, contact lens wear, greater myopia, thinner pachymetry and reduced visual performance.<\/default:p>In a subgroup with available low-contrast testing, contrast acuity was worse in eyes with higher MGD severity. Although postoperative safety was similar between groups, eyes with high MGD showed slightly lower efficacy, more residual refractive cylinder and slightly worse postoperative visual acuity.<\/default:p>These findings reinforce a fundamental principle in refractive surgery: A stable tear film is essential not only for reliable preoperative measurements but also for the quality of vision, consistency of visual outcomes and patient satisfaction. In an elective procedure with high expectations, symptom screening alone is not enough. A patient may feel comfortable and still have ocular surface disease significant enough to affect planning precision and postoperative visual quality.<\/default:p>At the same time, the findings should be interpreted in light of the retrospective design and the reliance on examiner-based clinical grading rather than objective gland imaging for MGD classification. Future studies are relevant in this field.<\/default:p><\/p>\n\n
Renato Ambr\u00f3sio Jr., MD, PhD<\/p>\n
Instituto de Olhos Renato Ambr\u00f3sio & Rio Vision Hospital, Rio De Janeiro<\/p>\n<\/p><\/div>\n
Disclosures: <\/strong> Ambr\u00f3sio reports no relevant financial disclosures.
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