THE INFLUENCE OF CONTACT lenses on the anatomy of the eye has been discussed since the release of contact lenses (Osae et al, 2022). With the introduction of commercial means to image the meibomian glands, the relationship between changes in meibomian gland morphology and contact lenses has seen renewed research interest.

The thinking is that given the frequency of dry eye, and discomfort symptoms in contact lens wearers, particularly in more long-term wearers, perhaps lens wear itself alters the meibomian glands and thus their secretions, impacting the tear film and ultimately the comfort of lenses while they are being worn (Osae et al, 2022).

Due to mechanical interactions of the contact lenses with the palpebral conjunctiva, it is hypothesized that the meibomian glands underneath this area of the eyelids may become impacted (Osae et al, 2022). A secondary process is thought to occur due to alterations in the blink patterns during contact lens wear, which may lead to stagnation of the meibum within the glands and long-term complications (Wan et al, 2016; Wang et al, 2018).

Most studies have suggested that some observable changes to the meibomian glands are associated with contact lens wear (Alghamdi et al, 2016; Uçakhan and Arslanturk-Eren, 2019; Villani et al, 2011) but a minority show no association (Na et al, 2016). Some studies have also associated symptomatic contact lens wear with this change in meibomian gland structure compared to asymptomatic wear (Pucker et al, 2019; Siddireddy et al, 2018; Wolffsohn et al, 2021). Factors that have been associated with detrimental changes in meibomian gland morphology include longer duration of contact lens wear (Gu et al, 2020), higher modulus of the contact lens used (Iqbal et al, 2021), and the use of rigid contact lenses (Harbiyeli et al, 2022).

There has, however, been some criticism of the investigations of contact lenses and meibomian glands conducted thus far in the literature, as they have for the most part employed relatively small sample sizes and have relied on convenience sampling, which may not represent the entire population of contact lens wearers (Osae et al, 2022). The means of analysis of the meibomian gland features from the imaging have also been varied, with some of the research analyzing data using subjective means, while others have relied on proprietary software and other automated processing tools.

The use of deep learning algorithms in the segmentation of the lid area and the computation of the area of gland atrophy and, thus, a meiboscore has been presented within the literature (Wang et al, 2019). Development of this deep learning model utilized 497 annotated images for training and evaluated them against 209 other images, achieving a greater than 95% meiboscore accuracy, which outperformed similar scores determined by lead investigator and the team of researchers by more than 15% and 40%, respectively (Wang et al, 2019). The processing of images was also fast at approximately 0.29 seconds per image, leading to claims of 1,000 raw images potentially being processed and graded within five minutes (Wang et al, 2019).

Similar techniques have been employed on longitudinal data (Zhai et al, 2023). In a retrospective study of children, the authors concluded that overnight orthokeratology use over time (an average of more than 20 months of follow-up) significantly impacted meibomian gland density, tortuosity, width, density, and vagueness, values that were generated by the artificial intelligence algorithm, which would have been impossible or required significantly greater time if done by a human investigator (Zhai et al, 2023).

This represents the next frontier in the investigations into the potential associations between contact lenses and meibomian glands, potentially paving the way for causal relationships to be thoroughly explored.

REFERENCES

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