title: Interexaminer Reliability of Meibography: Upper or Lower Eyelid?
abstract: OBJECTIVE
  To investigate the interexaminer reliability of meibography evaluation and the impact of eyelid selection for the procedure.
  
  
  METHODS
  Meibography images of 30 subjects' right eye, including both lids, were evaluated by three clinicians. Meibomian gland (MG) dropout was noted with respect to both percentage and grading (0-4). The examiners' (E1, E2, and E3) consistency was assessed by the intraclass correlation coefficient for MG loss percent and weighted kappa for grading. Correlations between the meibography findings and the fluorescein tear break-up time (FBUT), ocular surface disease index (OSDI) questionnaire, and noninvasive tear break-up time (NIBUT) data were also analyzed.
  
  
  RESULTS
  The patients' mean age was 49.2±13.4 years, and the male/female ratio distribution was 15/15. Mean FBUT was 9.6±3.1 sec. OSDI and NIBUT were not correlated with meibography findings. FBUT measurements were correlated with the MG loss assessments of all examiners for the upper lid (Spearman correlation test, E1: r=-0.617, P<0.001; E2: r=-0.428, P<0.018; E3: r=-0.429, P=0.018) but not for the lower lid. Weighted kappa statistics based on MG dropout grading revealed moderate-to-good agreement for the upper lid (E1-E2: κ=0.516, P<0.001; E1-E3: κ=0.621, P<0.001; E2-E3: κ=0.650, P<0.001) and fair-to-moderate agreement for the lower lid (E1-E2: κ=0.212; E1-E3: κ=0.272; E2-E3: κ=0.530).
  
  
  CONCLUSIONS
  Meibography is an objective tool for the detection of MG loss. Because of the correlation with FBUT and better interexaminer agreement on dropout by grading, the upper lid might be the preferred lid to make an evaluation.
authors.affiliation: Department of Ophthalmology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
authors.forename: Aysun Sanal
authors.initials: AS
authors.lastname: Dogan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kosker
authors.forename: Nese
authors.initials: N
authors.lastname: Arslan
authors.forename: Canan
authors.initials: C
authors.lastname: Gurdal
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003941:Diagnostic Techniques, Ophthalmological; D005141:Eyelid Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results