Compliance with Lid Hygiene in Patients with Meibomian Gland Dysfunction

Figures & data

Table 1 Seven-Item Questionnaire Lid Hygiene Compliance Scale

No	Question	Answer
		Yes	No
1	Have you ever forgotten to perform lid hygiene?
2	Did you perform lid hygiene over the past 3 days?
3	When your symptoms settled, have you continued performing lid hygiene?
4	When you did not feel better, have you stopped performing lid hygiene?
5	Have you performed lid hygiene every day for 7 consecutive days?
6	When you traveled, did you still perform lid hygiene regularly?
7	Do you think the lid hygiene regimen recommended by the hospital is simple and practical?
Total scores

Table 2 Patient Demographic and Baseline Characteristics of the Study Population (N = 77)

Parameters	Results
Age (years) (mean ± SD)	66.7 ± 8.2
Sex (male: female)	14 (18.2%): 63 (81.8%)
Education
- No education or primary	11 (14.3%)
- Secondary or higher	66 (85.7%)
Occupation
- Retirees or the unemployed	32 (41.6%)
- Government/state enterprise officers	21 (27.3%)
- The self - employed, retail merchants, or company heads	12 (15.6%)
- Company employees	5 (6.5%)
- Agriculturists	3 (3.9%)
- Others	4 (5.2%)
Number of systemic drugs used (mean ± SD)	4.1 ± 3.5
Number of topical ophthalmic drugs used (mean ± SD)	2.0 ± 0.9
Fluorescein tear breakup time (seconds) (mean ± SD)	5.0 ± 2.7
Ocular surface fluorescein staining (Oxford scale)
- Grade 0 - II (absent to mild staining)	63(81.7%)
- Grade III–V (moderate to severe staining)	14(18.3%)
Meibum quality*
- Grade 1: cloudy	15 (19.5%)
- Grade 2: cloudy with debris (granular)	41 (53.3%)
- Grade 3: thick, like toothpaste	21 (27.3%)
Meibum expressibility* (number of glands expressible from five glands)
- Grade 1: three to four glands	33 (42.9%)
- Grade 2: one to two glands	40 (52.0%)
- Grade 3: no glands	4 (5.2%)

Note: *No patient with meibum quality and expressibility of grade 0.

Table 3 Univariate and Multivariate Analysis of Patient Demographic and Baseline Characteristics Comparing Between Good and Poor Compliance Measured by the Newly Developed Questionnaire

Variables	Good Compliance (N=42)	Poor Compliance (N=35)	Univariate Analysis	Multivariate Analysis
			P-value	P-value
Mean age (years)	67.5 ± 1.3	65.7 ± 1.4	0.345^a
Female sex	35 (83.3%)	28 (80.0%)	0.706^b
Secondary or higher education	36 (85.7%)	30 (85.7%)	1.00^c
Retirees or the unemployed	15(35.7%)	17(48.5%)	0.473^b
Mean number of oral drugs	4.7 ± 3.5	3.4 ± 3.4	0.068^d	0.198
Mean number of topical ophthalmic drugs	2.2 ± 0.2	1.8 ± 0.1	0.095^a	0.478
History of glaucoma	4 (9.5%)	4 (11.4%)	1.00^c
Mean fluorescein TBUT (seconds)	4.8 ± 2.9	5.2 ± 2.5	0.414^d
Ocular surface staining (≥3; moderate to severe)	13(30.9%)	1(2.8%)	0.001^b	0.015
Meibum quality scores of ≥2	33 (78.6%)	29 (82.9%)	0.636^b
Meibum expressibility scores of ≥2	31 (73.8%)	13 (37.1%)	0.001^b	0.474

Note: ^aTwo-sided t-test, ^bChi-square test, ^cFisher exact test, ^dTwo-sample Wilcoxon rank-sum test.

Abbreviation: TBUT, tear breakup time.

Table 4 Reasons of Poor Compliance with Lid Hygiene (N = 35)

Reasons	N (%)
Patient-Centered Factor	25 (71.5%)
Lack of time	18 (51.4)
Do not comprehend the disease and the necessity of the recommended treatment	2 (5.7)
Too many concerns about other systemic conditions	2 (5.7)
Simply forget to do lid hygiene	2 (5.7)
Intermittent shoulder pain	1 (2.9)
Procedure-related factor	10 (28.5%)
Complexity of the regimen	4 (11.4)
Inconvenience of preparing things required for lid hygiene	3 (8.6)
Difficulty in remembering the steps of the regimen	2 (5.7)
Feel discomfort after lid hygiene	1 (2.9)

Table 5 Sensitivity, Specificity, Positive Likelihood Ratio, and Negative Likelihood Ratio of Each Questionnaire Item

Questions	Sensitivity (95% CI*)	Specificity (95% CI*)	Positive Likelihood Ratio (95% CI*)	Negative Likelihood Ratio (95% CI*)
Q1	28.57% (15.72, 44.58)	100% (90.00, 100)	∞	0.71 (0.60, 0.87)
Q2	92.85% (80.51, 98.50)	57.14% (39.35, 73.67)	2.17 (1.46, 3.21)	0.13 (0.04, 0.39)
Q3	95.24% (83.84, 99.42)	28.57% (14.64, 46.30)	1.33 (1.07, 1.66)	0.17 (0.39, 0.71)
Q4	97.62% (87.43, 99.94)	54.29% (36.65, 71.17)	2.14 (1.48, 3.07)	0.04 (0.01, 0.31)
Q5	85.71% (71.46, 94.57)	88.57% (73.26, 96.78)	7.50 (2.96, 19.00)	0.16 (0.08, 0.34)
Q6	45.24% (29.85, 61.33)	85.71% (69.74, 95.19)	3.17 (1.32, 7.61)	0.64 (0.47, 0.87)
Q7	95.23% (83.84, 99.42)	31.43% (16.85, 49.29)	1.39 (1.1, 1.76)	0.15 (0.04, 0.64)

Abbreviation: CI*, confidence interval.