Qualitative analysis and clinical implications of lipid layer thickness variability: A retrospective, cross-sectional study
5 affiliations
- 1Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 2Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 3Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 4Itoh Clinic, Saitama, Japan
- 5Department of Ophthalmology, Keio University, Tokyo, Japan
Abstract
Meibomian gland (MG) dysfunction impairs the tear film lipid layer, which is critical for preventing aqueous evaporation and maintaining tear film stability. While a LipiView® II-reported mean lipid layer thickness (LLT) of ≥100 nm indicates a high- or ceiling-range device output rather than a calibrated absolute LLT, mean LLT alone may overlook clinically relevant information about the dynamic behavior of the tear film. This study aimed to evaluate whether qualitative variability in 20-s LipiView® II dynamic LLT traces is associated with MG morphology and ocular surface findings in eyes with device-reported high-range LLT values. In this retrospective, cross-sectional study, we analyzed 20-s dynamic LipiView® II recordings from eyes that were initially measured to have a mean LLT of ≥100 nm. Two masked observers classified LLT pattern variability as high or low based on predefined criteria. Clinical and demographic differences between the high- and low-variability groups were assessed statistically. Out of 85 eyes, 58 (68.2%) and 27 (31.8%) exhibited high- and low-variability, respectively. The high-variability group demonstrated markedly elevated meiboscores compared to the low-variability group, indicating a greater degree of MG dropouts (p = 0.042). Besides elevated meiboscores, patients in the high-variability group suffered from substantially worse dry eye disease (DED) symptoms, a trend toward higher corneal and conjunctival staining scores, and significantly increased blinking frequency (p < 0.05). Qualitative evaluation of LLT revealed increased meiboscores, greater severity of DED symptoms, and increased blinking frequency even in eyes with device-reported high-range mean LLT. LLT pattern analysis may warrant evaluation as an adjunctive approach for the early detection and targeted management of MG dysfunction-related evaporative DED.
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BibTeX
@article{lee2026qualitative,
title = {{Qualitative analysis and clinical implications of lipid layer thickness variability: A retrospective, cross-sectional study}},
author = {Jiyoung Emily Lee and Dong-Kyu Kim and Hye Yeon Yoon and Woong-Joo Whang and Ho Sik Hwang and Hyun-Seung Kim and Reiko Arita and Eun Chul Kim and Kyung-Sun Na},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357020},
url = {https://doi.org/10.1371/journal.pone.0357020},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Qualitative analysis and clinical implications of lipid layer thickness variability: A retrospective, cross-sectional study
AU - Jiyoung Emily Lee
AU - Dong-Kyu Kim
AU - Hye Yeon Yoon
AU - Woong-Joo Whang
AU - Ho Sik Hwang
AU - Hyun-Seung Kim
AU - Reiko Arita
AU - Eun Chul Kim
AU - Kyung-Sun Na
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0357020
UR - https://doi.org/10.1371/journal.pone.0357020
AB - Meibomian gland (MG) dysfunction impairs the tear film lipid layer, which is critical for preventing aqueous evaporation and maintaining tear film stability. While a LipiView® II-reported mean lipid layer thickness (LLT) of ≥100 nm indicates a high- or ceiling-range device output rather than a calibrated absolute LLT, mean LLT alone may overlook clinically relevant information about the dynamic behavior of the tear film. This study aimed to evaluate whether qualitative variability in 20-s LipiView® II dynamic LLT traces is associated with MG morphology and ocular surface findings in eyes with device-reported high-range LLT values. In this retrospective, cross-sectional study, we analyzed 20-s dynamic LipiView® II recordings from eyes that were initially measured to have a mean LLT of ≥100 nm. Two masked observers classified LLT pattern variability as high or low based on predefined criteria. Clinical and demographic differences between the high- and low-variability groups were assessed statistically. Out of 85 eyes, 58 (68.2%) and 27 (31.8%) exhibited high- and low-variability, respectively. The high-variability group demonstrated markedly elevated meiboscores compared to the low-variability group, indicating a greater degree of MG dropouts (p = 0.042). Besides elevated meiboscores, patients in the high-variability group suffered from substantially worse dry eye disease (DED) symptoms, a trend toward higher corneal and conjunctival staining scores, and significantly increased blinking frequency (p < 0.05). Qualitative evaluation of LLT revealed increased meiboscores, greater severity of DED symptoms, and increased blinking frequency even in eyes with device-reported high-range mean LLT. LLT pattern analysis may warrant evaluation as an adjunctive approach for the early detection and targeted management of MG dysfunction-related evaporative DED.
SN - 1932-6203
ER -