{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:05:31Z","timestamp":1789495531578,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2022R1A2C2006109"],"award-info":[{"award-number":["2022R1A2C2006109"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2022NR075312"],"award-info":[{"award-number":["RS-2022NR075312"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Meibomian gland (MG) dysfunction impairs the tear film lipid layer, which is critical for preventing aqueous evaporation and maintaining tear film stability. While a LipiView\u00ae II-reported mean lipid layer thickness (LLT) of \u2265100 nm indicates a high- or ceiling-range device output rather than a calibrated absolute LLT, mean LLT alone may overlook clinically relevant information about the dynamic behavior of the tear film. This study aimed to evaluate whether qualitative variability in 20-s LipiView\u00ae II dynamic LLT traces is associated with MG morphology and ocular surface findings in eyes with device-reported high-range LLT values. In this retrospective, cross-sectional study, we analyzed 20-s dynamic LipiView\u00ae II recordings from eyes that were initially measured to have a mean LLT of \u2265100 nm. Two masked observers classified LLT pattern variability as high or low based on predefined criteria. Clinical and demographic differences between the high- and low-variability groups were assessed statistically. Out of 85 eyes, 58 (68.2%) and 27 (31.8%) exhibited high- and low-variability, respectively. The high-variability group demonstrated markedly elevated meiboscores compared to the low-variability group, indicating a greater degree of MG dropouts (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.042). Besides elevated meiboscores, patients in the high-variability group suffered from substantially worse dry eye disease (DED) symptoms, a trend toward higher corneal and conjunctival staining scores, and significantly increased blinking frequency (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Qualitative evaluation of LLT revealed increased meiboscores, greater severity of DED symptoms, and increased blinking frequency even in eyes with device-reported high-range mean LLT. LLT pattern analysis may warrant evaluation as an adjunctive approach for the early detection and targeted management of MG dysfunction-related evaporative DED.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0357020","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:39:41Z","timestamp":1789493981000},"page":"e0357020","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Qualitative analysis and clinical implications of lipid layer thickness variability: A retrospective, cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4282-6155","authenticated-orcid":true,"given":"Jiyoung 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Chul","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2708-7356","authenticated-orcid":true,"given":"Kyung-Sun","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pone.0357020.ref001","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1167\/iovs.10-6997b","article-title":"The international workshop on Meibomian gland dysfunction: Report of the definition and classification subcommittee","volume":"52","author":"JD Nelson","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0357020.ref002","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1167\/iovs.10-6997g","article-title":"The international workshop on Meibomian gland dysfunction: Report of the subcommittee on management and treatment of Meibomian gland 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