TY - JOUR
T1 - Ocular Clinical Signs and Diagnostic Tests Most Compatible with Keratoconjunctivitis Sicca
T2 - A Latent Class Approach
AU - Gonzales, John A.
AU - Shiboski, Stephen C.
AU - Bunya, Vatinee Y.
AU - Akpek, Esen K.
AU - Rose-Nussbaumer, Jennifer
AU - Seitzman, Gerami D.
AU - Criswell, Lindsey A.
AU - Shiboski, Caroline H.
AU - Lietman, Thomas M.
N1 - Funding Information:
J. A. Gonzales is supported by a mentored research career development award from the National Institutes of Health—National Eye Institute (grant no. NEI K23EY026998). V. Y. Bunya is supported by the National Eye Institute R01-EY026972 and Research to Prevent Blindness.
Funding Information:
The International Sjögren’s Syndrome Biorepository and Data Registry is funded by the US Public Health Service/National Institutes of Health (NIH), National Institute of Dental and Craniofacial Research (NIDCR), the National Eye Institute (NEI), and the National Institutes of Health Office for Research on Women’s Health, Bethesda, MD, USA (contract #HHSN268201300057C). The Department of Ophthalmology at the University of California, San Francisco is supported by a core grant from the National Eye Institute, EY02162, an unrestricted grant from Research to Prevent Blindness, New York, NY, and That Man May See, Inc, San Francisco, CA.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Purpose:To evaluate the ocular signs and tests for keratoconjunctivitis sicca (KCS) in the absence of a gold standard.Methods:Cross-sectional study of participants from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Participants had oral/ocular/rheumatologic examinations, blood/saliva samples collected, and salivary gland biopsy. Latent class analysis (LCA) identified clusters of patients based on 3 to 4 predictor variables relating to signs or tests of KCS. The resulting model-based "gold standard" classification formed the basis for estimated sensitivity and specificity associated with these predictors.Results:A total of 3514 participants were enrolled into SICCA, with 52.9% classified as SS. LCA revealed a best-fit model with 2 groups. For the gold standard-positive group, an abnormal tear breakup time, ocular staining score (OSS), and Schirmer I had a sensitivity of 99.5%, 91.0%, and 47.4%, respectively. For the gold standard-negative group, an abnormal tear breakup time, OSS, and Schirmer I had a specificity of 32.0%, 84.0%, and 88.5%, respectively. OSS components (fluorescein and lissamine staining), exhibited a sensitivity of 82.6% and 90.5%, respectively, in the gold standard-positive group, whereas these signs in the gold standard-negative group had a specificity of 88.8% and 73.0%, respectively.Conclusions:OSS and its components (fluorescein and lissamine staining) differentiated 2 groups from each other better than other KCS parameters and had relatively high sensitivity and specificity.
AB - Purpose:To evaluate the ocular signs and tests for keratoconjunctivitis sicca (KCS) in the absence of a gold standard.Methods:Cross-sectional study of participants from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Participants had oral/ocular/rheumatologic examinations, blood/saliva samples collected, and salivary gland biopsy. Latent class analysis (LCA) identified clusters of patients based on 3 to 4 predictor variables relating to signs or tests of KCS. The resulting model-based "gold standard" classification formed the basis for estimated sensitivity and specificity associated with these predictors.Results:A total of 3514 participants were enrolled into SICCA, with 52.9% classified as SS. LCA revealed a best-fit model with 2 groups. For the gold standard-positive group, an abnormal tear breakup time, ocular staining score (OSS), and Schirmer I had a sensitivity of 99.5%, 91.0%, and 47.4%, respectively. For the gold standard-negative group, an abnormal tear breakup time, OSS, and Schirmer I had a specificity of 32.0%, 84.0%, and 88.5%, respectively. OSS components (fluorescein and lissamine staining), exhibited a sensitivity of 82.6% and 90.5%, respectively, in the gold standard-positive group, whereas these signs in the gold standard-negative group had a specificity of 88.8% and 73.0%, respectively.Conclusions:OSS and its components (fluorescein and lissamine staining) differentiated 2 groups from each other better than other KCS parameters and had relatively high sensitivity and specificity.
KW - Lissamine Green
KW - Schirmer 1
KW - Sjogren syndrome
KW - fluorescein
KW - keratoconjunctivitis sicca
KW - ocular staining score
KW - tear breakup time
KW - tear osmolarity
UR - http://www.scopus.com/inward/record.url?scp=85087532110&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087532110&partnerID=8YFLogxK
U2 - 10.1097/ICO.0000000000002311
DO - 10.1097/ICO.0000000000002311
M3 - Article
C2 - 32251167
AN - SCOPUS:85087532110
VL - 39
SP - 1013
EP - 1016
JO - Cornea
JF - Cornea
SN - 0277-3740
IS - 8
ER -