TY - JOUR
T1 - Association of Dry Eye Tests With Extraocular Signs Among 3514 Participants in the Sjögren's Syndrome International Registry
AU - Bunya, Vatinee Y.
AU - Bhosai, Satasuk Joy
AU - Heidenreich, Ana Maria
AU - Kitagawa, Kazuko
AU - Larkin, Genevieve B.
AU - Lietman, Thomas M.
AU - Gaynor, Bruce D.
AU - Akpek, Esen K.
AU - Massaro-Giordano, Mina
AU - Srinivasan, M.
AU - Porco, Travis C.
AU - Whitcher, John P.
AU - Shiboski, Stephen C.
AU - Criswell, Lindsey A.
AU - Shiboski, Caroline H.
N1 - Funding Information:
Funding/Support: The SICCA Study Group is supported by the National Institutes of Health (International Research Registry Network for Sjögren's syndrome contract N01-DE-32636 from the National Institute of Dental and Craniofacial Research, National Eye Institute, and Office of Research on Women's Health, 2003–2013). Vatinee Y. Bunya is supported by the National Eye Institute (K12-EY-015398) and Research to Prevent Blindness (New York, New York). Mina Massaro-Giordano receives support from Research to Prevent Blindness. Financial disclosures: The following authors have no financial disclosures: Vatinee Y. Bunya, Satasuk Joy Bhosai, Ana Maria Heidenreich, Kazuko Kitagawa, Genevieve B. Larkin, Thomas M. Lietman, Bruce D. Gaynor, Esen K. Akpek, Mina Massaro-Giordano, M. Srinivasan, Travis C. Porco, John P. Whitcher, Stephen C. Shiboski, Lindsey A. Criswell, and Caroline H. Shiboski. All authors attest that they meet the current ICMJE criteria for authorship.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Purpose To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. Design Multicenter cross-sectional study. Methods The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0–6 points) and conjunctiva (0–6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology. Results The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05–1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39–1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08–1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09–1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43–1.58, P < .001). Conclusions In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
AB - Purpose To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. Design Multicenter cross-sectional study. Methods The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0–6 points) and conjunctiva (0–6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology. Results The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05–1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39–1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08–1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09–1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43–1.58, P < .001). Conclusions In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
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U2 - 10.1016/j.ajo.2016.09.013
DO - 10.1016/j.ajo.2016.09.013
M3 - Article
C2 - 27644591
AN - SCOPUS:84995933264
SN - 0002-9394
VL - 172
SP - 87
EP - 93
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
ER -