Effect of Eyelid Hygiene on Functional Visual Acuity After Cataract Surgery: A Randomized Controlled Study

Figures & data

Table 1 Baseline Characteristics of Participants

Clinical Characteristics	Control Group^a	Eyelid Hygiene Group^a
Sex (male/female)	10/15	13/12
Age, mean (SD), y	74.4 (6.4)	73.8 (6.5)
Patients with a history of eye disease^b	3 (12%)	5 (20%)
Patients with diabetes mellitus	4 (16%)	4 (16%)
Patients with other systemic disorders^c	12 (48%)	16 (64%)

Notes: ^an (%) unless indicated otherwise. ^bDry eye, trichiasis, epiretinal membrane, glaucoma and branch retinal vein occlusion. ^cHypertension, Meniere disease, anemia, osteoporosis, insomnia, gastric ulcer, breast cancer, stroke, Graves’ disease, epilepsy, myasthenia gravis, gout, atrial fibrillation and hepatitis C.

Abbreviation: SD, standard deviation.

Table 2 Preoperative Clinical Measurements of Eyelid Hygiene Group and Control Group

Variables	Control^a	Lid Hygiene Group^a	p-value
UDVA (logMAR)	0.52 (0.39)	0.68 (0.45)	0.21
CDVA (logMAR)	0.19 (0.22)	0.20 (0.23)	0.94
Mean VA (logMAR)	0.45 (0.24)	0.46 (0.28)	1.0
Visual maintenance ratio	0.91 (0.069)	0.88 (0.083)	0.26
Maximal VA (logMAR)	0.28 (0.25)	0.29 (0.28)	0.99
Minimal VA (logMAR)	0.65 (0.27)	0.67 (0.30)	0.76
Average response time (s)	1.4 (0.14)	1.4 (0.19)	0.49
Tear meniscus height (1-low, 2-normal, 3-high)	2.2 (0.57)	1.9 (0.29)	0.056
BUT (s)	5.5 (2.8)	3.8 (2.5)	0.075
SPK score	0.33 (0.82)	0.48 (0.85)	0.34
Lid margin findings (out of 3)
Telangiectasia	0.63 (0.77)	0.39 (0.58)	0.22
Irregularity	0.21 (0.42)	0.30 (0.47)	0.75
Plugging	0.96 (0.91)	0.70 (0.70)	0.21
Foaming	0.0 (0.0)	0.0 (0.0)	1.0
MCJ abnormalities	0.71 (0.81)	0.70 (0.77)	0.98
Meibomian gland evaluation
Meibo score (out of 3)	1.2 (0.83)	0.74 (0.86)	0.047
Flexion (0, absent; 1, present)	0.33 (0.48)	0.26 (0.45)	0.83
Dilatation (0, absent; 1, present)	0.080 (0.28)	0.040 (0.21)	0.32
Contraction (0, absent; 1, present)	0.46 (0.51)	0.35 (0.49)	0.45
Dropout (0, absent; 1, present)	0.50 (0.51)	0.13 (0.34)	0.004
Meibum grade (out of 3)	0.83 (1.0)	0.57 (0.84)	0.25
SPEED score	2.8 (2.7)	4.4 (4.2)	0.47
Preoperative CCT (µm)	543.8 (28.05)	546.8 (27.49)	0.68
AL (mm)	23.7 (1.09)	24.5 (1.65)	0.056
Higher order aberrations
3rd order (µm)	0.38 (0.36)	0.36 (0.23)	0.80
4th order (µm)	0.15 (0.13)	0.10 (0.059)	0.27
3rd + 4th order (µm)	0.42 (0.37)	0.39 (0.22)	0.62
3rd + 5th order (µm)	0.40 (0.38)	0.39 (0.23)	0.67
4th + 6th order (µm)	0.17 (0.16)	0.12 (0.065)	0.15
Total HOAs (µm)	0.45 (0.40)	0.41 (0.22)	0.60

Notes: ^aData are presented as mean (standard deviation) or number of patients (% of patients). Bold font indicates p<0.05.

Abbreviations: AL, axial length of the eye; BUT, tear film break-up time; CCT, central corneal thickness; CDVA, corrected distant visual acuity; HOA, higher order aberration; MCJ, mucocutaneous junction; SPEED, Standard Patient Evaluation of Eye Dryness; SPK, superficial punctate keratopathy; UDVA, uncorrected distant visual acuity; VA, visual acuity.

Table 3 Postoperative Clinical Measurements of Eyelid Hygiene Group and Control Group

Variables	Control^a	Lid Hygiene Group^a	p-value
UDVA (logMAR)	0.15 (0.23)	0.24 (0.30)	0.15
CDVA (logMAR)	−0.016 (0.10)	−0.043 (0.080)	0.27
Mean VA (logMAR)	0.24 (0.22)	0.16 (0.22)	0.12
Visual maintenance ratio	0.91 (0.068)	0.93 (0.064)	0.13
Maximal VA (logMAR)	0.084 (0.18)	0.035 (0.20)	0.18
Minimal VA (logMAR)	0.45 (0.29)	0.32 (0.24)	0.080
Average response time (s)	1.4 (0.13)	1.4 (0.15)	0.62
Tear meniscus height (1-low, 2-normal, 3-high)	1.8 (0.57)	1.8 (0.64)	0.93
BUT (s)	5.4 (2.8)	3.7 (2.7)	0.034
SPK score	0.17 (0.48)	0.21 (0.42)	0.45
Lid margin findings (out of 3)
Telangiectasia	0.42 (0.58)	0.63 (0.58)	0.14
Irregularity	0.33 (0.64)	0.21 (0.51)	0.51
Plugging	0.79 (0.72)	0.67 (0.76)	0.60
Foaming	0.21 (0.59)	0.13 (0.34)	0.96
MCJ abnormalities	0.83 (0.76)	0.83 (0.82)	0.93
Meibomian gland evaluation
Meibo score (out of 3)	1.0 (0.96)	0.79 (0.88)	0.33
Flexion (0, absent; 1, present)	0.25 (0.44)	0.38 (0.50)	0.48
Dilatation (0, absent; 1, present)	0.040 (0.20)	0.0 (0.0)	0.33
Contraction (0, absent; 1, present)	0.46 (0.51)	0.25 (0.44)	0.17
Dropout (0, absent; 1, present)	0.38 (0.50)	0.21 (0.42)	0.25
Meibum grade (out of 3)	0.83 (0.82)	0.88 (1.1)	0.68
SPEED score	2.2 (2.5)	2.8 (2.7)	0.38
Postoperative CCT (µm)	552.8 (27.02)	555.9 (31.93)	0.85
Rate of satisfaction (VAS) (%)	84.1 (19.1)	90.1 (12.1)	0.66
Higher order aberrations
3rd order (µm)	0.99 (2.9)	0.40 (0.46)	0.98
4th order (µm)	0.93 (3.6)	0.30 (0.39)	0.47
3rd + 4th order (µm)	1.4 (4.6)	0.51 (0.59)	0.69
3rd + 5th order (µm)	1.3 (4.3)	0.50 (0.63)	0.98
4th + 6th order (µm)	1.1 (4.1)	0.36 (0.49)	0.35
Total HOAs (µm)	1.7 (5.9)	0.63 (0.79)	0.86

Notes: ^aData are presented as mean (standard deviation) or number of patients (% of patients). Bold font indicates p<0.05.

Abbreviations: AL, axial length of the eye; BUT, tear film break-up time; CCT, central corneal thickness; CDVA, corrected distant visual acuity; HOA, higher order aberration; MCJ, mucocutaneous junction; SPEED, Standard Patient Evaluation of Eye Dryness; SPK, superficial punctate keratopathy; UDVA, uncorrected distant visual acuity; VA, visual acuity; VAS, visual analogue scale.

Table 4 Changes in Clinical Measurements in Eyelid Hygiene and Control Groups

Variables	Control^a	Lid Hygiene Group^a	p-value
UDVA (logMAR)	−0.35 (0.44)	−0.37 (0.46)	0.67
CDVA (logMAR)	−0.20 (0.26)	−0.27 (0.25)	0.71
Mean VA (logMAR)	−0.20 (0.31)	−0.33 (0.31)	0.13
Visual maintenance ratio	0.0042 (0.085)	0.039 (0.091)	0.048
Maximal VA (logMAR)	−0.20 (0.33)	−0.29 (0.31)	0.28
Minimal VA (logMAR)	−0.18 (0.27)	−0.37 (0.37)	0.084
Average response time (s)	0.035 (0.16)	0.062 (0.15)	0.63
BUT (s)	0.46 (2.9)	−0.16 (2.6)	0.26
SPK score	−0.050 (0.62)	−0.32 (0.82)	0.53
Meibum grade (out of 3)	0.0 (1.2)	0.21 (0.86)	0.81
Higher order aberrations
3rd order (µm)	0.61 (2.8)	0.040 (0.58)	0.63
4th order (µm)	0.78 (3.5)	0.19 (0.37)	0.062
3rd + 4th order (µm)	0.98 (4.4)	0.12 (0.69)	0.92
3rd + 5th order (µm)	0.93 (4.1)	0.12 (0.74)	0.63
4th + 6th order (µm)	0.88 (3.9)	0.24 (0.48)	0.027
Total HOAs (µm)	1.3 (5.7)	0.22 (0.88)	0.92

Notes: ^aData are presented as mean (standard deviation) or number of patients (% of patients). Bold font indicates p<0.05.

Abbreviations: AL, axial length of the eye; BUT, tear film break-up time; CCT, central corneal thickness; CDVA, corrected distant visual acuity; HOA, higher order aberration; SPK, superficial punctate keratopathy; UDVA, uncorrected distant visual acuity; VA, visual acuity.

Table 5 Comparison of Changes in Lid Margin Findings and Meibo Score Between Lid Hygiene and Control Groups

Lid Margin Findings		Exacerbated^a	Stable^a	Improved^a	χ^2	p-value
Telangiectasia	Control	0	23	2	2.1	0.15
	Lid hygiene	0	25	0
Irregularity	Control	1	24	0	1.0	0.31
	Lid hygiene	0	25	0
Plugging	Control	0	22	3	2.1	0.35
	Lid hygiene	2	20	3
Foaming	Control	2	23	0	2.1	0.15
	Lid hygiene	0	25	0
MCJ abnormality	Control	1	24	0	0.36	0.55
	Lid hygiene	2	23	0
Meibo score	Control	0	23	2	2.1	0.15
	Lid hygiene	0	25	0

Note: ^aData are presented as the number of patients.

Abbreviation: MCJ, mucocutaneous junction.

Table 6 Factors Associated with Changes in Visual Maintenance Ratio

Variables	Univariate Estimate	Multivariate Estimate
	p-value	β	p-value
Lid hygiene	0.056^a	0.041	0.048
Sex (male/female)	0.49
Age (y)	0.76
History of eye diseases (0: negative; 1: positive)	0.18^a	−0.064	0.029
IOL power (D)	0.59
Changes in CDVA (logMAR)	0.35
Changes in SPEED score	0.52
Changes in BUT	0.58
Changes in SPK score	0.17^a	−0.040	0.007
Rate of satisfaction (VAS) (%)	0.008^a	0.0020	0.003
Corneal incision	0.98
Scleral incision	0.55
Corneoscleral incision	0.76
Temporal incision	0.78
AL (mm)	0.55
Changes in ECD	0.63
Changes in CCT (µm)	0.15^a		0.17
Changes in 3rd order (µm)	0.075^a		0.65
Changes in 4th order (µm)	0.47
Changes in 3rd + 4th order (µm)	0.13^a		0.75
Changes in 3rd + 5th order (µm)	0.067^a		0.70
Changes in 4th + 6th order (µm)	0.53
Changes in total HOAs (µm)	0.12^a		0.76

Notes: ^aMultivariate estimate was performed if variables had p-values less than 0.20 in univariate estimate. Bold font indicates p<0.05.

Abbreviations: AL, axial length of the eye; BUT, tear film break-up time; CCT, central corneal thickness; CDVA, corrected distant visual acuity; ECD, endothelial cell density; HOA, higher order aberration; IOL, intraocular lens; SPEED, Standard Patient Evaluation of Eye Dryness; SPK, superficial punctate keratopathy; VAS, visual analogue scale.