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Ryan O'Sullivan, Vatinee Y. Bunya, Maxwell Pistilli, Gui-Shuang Ying, Ilaria Macchi, Frederick Vivino, Mina Massaro-Giordano; Vitamin D and Neuropathy in Patients with Sjogren’s Syndrome. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6162.
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© ARVO (1962-2015); The Authors (2016-present)
In Sjogren’s syndrome (SS), there is preliminary evidence that hypovitaminosis D is a risk factor for the development of peripheral neuropathy; however the relationship between serum vitamin D levels, corneal innervation, and ocular surface disease in these patients has not been examined. The current study will examine the relationship between vitamin D levels, corneal nerve morphology, and ocular signs and symptoms in patients with suspected or confirmed SS. We hypothesize that patients with hypovitaminosis will have abnormal corneal innervation, which will correlate with more severe ocular surface discomfort and signs.
Subjects included adult patients with suspected or confirmed diagnoses of SS. Corneal nerve morphology was assessed by confocal microscopy with the Heidelberg Retina Tomograph II (HRTII) and Rostock Cornea Module. Blood samples were collected at baseline and analyzed for serum levels of 25-hydroxy vitamin D. Images of the corneal nerves located at the sub epithelial plexus were analyzed with the NIH freeware ImageJ. Individual nerve fibers were traced and fiber density, length, branch density, and tortuosity were computed. Patients underwent an ocular surface exam (tear break-up time, ocular surface staining) and symptoms were assessed using the Ocular Surface Disease Index (OSDI).
Preliminary data associates hypovitaminosis with abnormal corneal innervation and more severe ocular surface disease. After enrollment is complete, we will assess correlations among serum vitamin D levels, abnormal corneal innervation, ocular signs, and OSDI scores. Figure 1 displays confocal images obtained from one patient with Vitamin D deficiency, who presented with severe ocular surface pain and moderate signs of ocular surface disease.
Hypovitaminosis D may potentiate neuropathy and therefore play an important role in the corneal innervation and ocular surface disease in a subset of SS patients. This study represents the first effort to look at objective parameters of corneal nerve morphology alongside metrics of ocular surface disease in SS patients with variable levels of 25-hydroxy vitamin D. We hope to further characterize the importance of Vitamin D status in SS and ocular surface disease.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1: Image A is a representative control patient showing corneal nerves which are roughly linear and parallel. Images B and C were obtained from patient 1, and exhibit neuropathic branching and tortuosity.
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