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Sezen Karakus, Esen K Akpek, Robert W Massof; An objective measure of dry eye severity is associated with serologic markers in Sjogren’s syndrome. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5685.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if a single previously validated dry eye severity variable, which is estimated from a battery of clinical tests and patient–reported symptoms, is associated with serologic markers in dry eye patients with Sjogren’s syndrome (SS).
This study included 55 dry eye patients diagnosed with primary SS and 143 dry eye patients without SS (non-SS). Diagnosis of SS was based on the 2012 classification criteria of the American College of Rheumatology. Tests performed during the study visit: review of systems; OSDI questionnaire; tear osmolarity; Schirmer’s test, automated tear break-up time (T-BUT); corneal staining with fluorescein; and conjunctival staining with lissamine green. The Sjögren's International Collaborative Clinical Alliance (SICCA) grading system was used for grading corneal and conjunctival staining. Capillary blood was collected on a card through a finger prick for serological testing of anti-SSA, anti-SSB, rheumatoid factor (RF), and antinuclear antibody (ANA). A single dry eye severity variable was estimated for each participant from Rasch analysis of clinical signs and symptoms using the Masters partial credit model (each of the 5 clinical tests and 12 OSDI questions was defined to be a separate indicator variable, or “item”, in the model).
The positivity rates of the serologic markers for all dry eye patients were: anti-SSA, 21%; anti-SSB, 12%; RF, 27%; and ANA titer≥1/320, 21%. Mean values of dry eye severity were -0.065±0.06 logit in SS group and -0.306±0.04 logit in non-SS group (p=0.003). The difference between two means was 0.241 with a 95% CI of 0.15. Dry eye patients with positive anti-SSA, anti-SSB, RF, and ANA had significantly higher severity measures than those with negative results (mean logit values: 0.004±0.07, p=0.001; 0.082±0.09, p=0.001; -0.096±0.06, p=0.018; and 0.072±0.07, p<0.000, respectively). The differences between means with a 95% CI were shown in Figure 1. ANA had the greatest difference between means (0.393±0.16 logit) followed by anti-SSB (0.365±0.20 logit).
Although increased dry eye severity measures were associated with positive values of all serologic markers for SS, the association with ANA was found to be the strongest.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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