Asymptomatic Meibomian Gland Dysfunction in Refractive Surgery Candidates

PURPOSE: To investigate the association between asymptomatic meibomian gland dysfunction (MGD) and preoperative clinical parameters in candidates for refractive surgery. METHODS: This retrospective case-control study was conducted at Care Vision Laser Center, Tel Aviv, Israel. A total of 3,472 eyes that underwent evaluation and subsequently proceeded to keratorefractive surgery between January 2019 and December 2024 were included. All eyes had normal tear break-up time (TBUT) and no dry eye symptoms. MGD severity was graded clinically (0 to 3) by a single examiner and categorized as low (grades 0 to 1) or high (grades 2 to 3). Preoperative parameters were compared using univariate analyses, and variables reaching significance were evaluated using multivariate logistic regression to identify independent associations with high MGD. A subgroup analysis of eyes with available low-contrast acuity (CA6%) measurements was performed to assess functional visual differences. RESULTS: = .022). CONCLUSIONS: Asymptomatic MGD in refractive surgery candidates is independently associated with older age, contact lens wear, higher myopia, thinner corneas, and reduced visual performance. Routine MGD screening is recommended even in asymptomatic patients undergoing preoperative refractive evaluation.