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Max J Blumberg,1 Amy E Millen,2 Sangita P Patel1,3 1Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA; 2Department of Epidemiology and Environmental Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA; 3Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, Buffalo, NY, USACorrespondence: Sangita P PatelRoss Eye Institute, 1176 Main Street, Buffalo, NY 14209, USATel +1 716 862 6577Fax +1 716 881 4349Email sppatel@buffalo.eduPurpose: To determine whether reliance on eyelid margin vascularization as a diagnostic criterion for meibomian gland dysfunction (MGD) results in underdiagnosis of MGD in individuals with dark skin pigmentation.Patients and Methods: This cross-sectional study enrolled consecutive cornea clinic patients in Buffalo, New York. Eyelid margin vascularization was graded qualitatively from slit-lamp photos. Skin pigmentation was quantified from digital photos using red/green/blue (RGB) pixel analysis and dichotomized using the RGB median. MGD was defined as abnormal quantity or quality of meibum or increased pressure required to express meibum. Additional testing included infrared meibography, Schirmer’s testing, and a dry eye questionnaire. Sensitivity of MGD diagnosis by visualization of vascularization, compared to diagnosis by expression of meibum, was estimated with and without stratification by skin pigmentation.Results: Among 47 participants, 15–79 years old, meibomian gland truncation/dropout, abnormal tear production, and dry eye symptoms affected individuals of all skin pigmentations. Eyelid margin vascularization was less common in subjects with dark (n=21%) compared to light pigmentation (65%; p=0.002), although the prevalence of MGD assessed via clinical evaluation did not vary significantly between those groups. Use of eyelid margin vascularization alone was not sensitive (33%) for MGD diagnosis. The sensitivity was 17% when limited to those with dark pigmentation.Conclusion: Our findings highlight the importance of gland expression and suggest limiting reliance on eyelid margin vascularization for MGD diagnosis, especially in those with dark eyelid skin pigmentation.Keywords: meibomian glands, dry eye syndromes, skin pigmentation

Vitamin D is hypothesized to prevent periodontal disease progression through its immune-modulating properties and its role in maintaining systemic calcium concentrations. The authors investigated associations between plasma 25-hydroxyvitamin D [25(OH)D] (collected 1997 to 2000) and the 5-year change in periodontal disease measures from baseline (1997 to 2000) to follow-up (2002 to 2005) among 655 postmenopausal women in a Women's Health Initiative Observational Study ancillary study. Exploratory analyses were conducted in 628 women who also had 25(OH)D measures at follow-up.Four continuous measures of the 5-year change in periodontal disease were assessed using alveolar crest height (ACH), clinical attachment level (CAL), probing depth (PD), and percentage of gingival sites that bled on assessment. Linear regression was used to estimate β-coefficients, standard errors, and P values corresponding to change in periodontal disease (a 1-mm change in ACH, CAL, or PD or a 1-unit change in the percentage of gingival sites that bled) for a 10-nmol/L difference in 25(OH)D. Models were adjusted for age, education, dental visit frequency, smoking, diabetes status, current medications affecting bone health, baseline measures of periodontal disease, body mass index, and recreational physical activity.No statistically significant associations were observed between baseline 25(OH)D and change in periodontal disease measures, overall or in a subset (n = 442) of women with stable 25(OH)D concentrations [25(OH)D change20 nmol/L from baseline to follow-up]. RESULTS also did not vary significantly in analyses that were stratified by baseline periodontal disease status.No association between baseline 25(OH)D and the subsequent 5-year change in periodontal disease measures was observed. Vitamin D status may not influence periodontal disease progression. More studies are needed to confirm these results.

Few detailed data are available on the wide range of determinants of vitamin D status among postmenopausal women, and it is also unclear whether there may be undiscovered determinants. The objective of this study was to comprehensively evaluate determinants of serum 25-hydroxyvitamin D [25(OH)D] concentrations in a large cohort of postmenopausal women. Data from a subset of the Women's Health Initiative Observational Study were analyzed (50-79 y; n = 3345). Information on diet, lifestyle behaviors, secondhand smoke, use of dietary supplements and medication, chronic diseases, and anthropometry was collected at baseline (1993-1998) and on sun exposure at year 4 follow-up. Linear regression was performed to estimate regression coefficients (β). Significant determinants were total vitamin D intake (food plus supplements per 100 IU/d, β = 2.08), years of supplemental vitamin D use (β = 0.15), total fat intake (grams per day, β = -0.03), smoking status (β = -2.64, current vs. never), regional solar irradiance (β = 6.26, 475-500 vs. 300-325 Langleys), daylight time spent outdoors in summer (β = 5.15, >2 h vs.

Vitamin D deficiency {defined by the blood concentration of 25-hydroxyvitamin D [25(OH)D]} has been associated with many adverse health outcomes. Genetic and nongenetic factors account for variation in 25(OH)D, but the role of interactions between these factors is unknown. To assess this, we examined 1204 women of European descent from the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women’s Health Initiative Observational Study. Twenty-nine single nucleotide polymorphisms (SNPs) in 4 genes, GC, CYP2R1, DHCR7, and CYP24A1, from recent meta-analyses of 25(OH)D genome-wide association studies were genotyped. Associations between these SNPs and 25(OH)D were tested using generalized linear regression under an additive genetic model adjusted for age, blood draw month, and ancestry. Results were stratified by season of blood draw and, separately, vitamin D intake for the 6 SNPs showing a significant association with 25(OH)D at the P < 0.01 level. Two nonsynonymous SNPs in GC and 4 SNPs in CYP2R1 were strongly associated with 25(OH)D in individuals whose blood was drawn in summer (P ≤ 0.002) but not winter months and, independently, in individuals with vitamin D intakes ≥400 (P ≤ 0.004) but not