June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Assessment of the Inclusion of Novel Autoantibodies into a Prediction Model to Screen Dry Eye Patients for Sjogren's Syndrome: Preliminary Findings
Author Affiliations & Notes
  • Kennedy Noel Johnson
    Penn, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Gui-Shuang Ying
    Penn, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Alexis Girón
    Penn, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Frederick Vivino
    Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Soo Abboud
    Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Franz Fogt
    Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Mina Massaro-Giordano
    Penn, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Vatinee Y Bunya
    Penn, Scheie Eye Institute, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Kennedy Johnson, None; Gui-Shuang Ying, None; Alexis Girón, None; Frederick Vivino, Biogen Idec, Inc. (C), Novartis, Inc. (C), Trinity Biotech/ Immco Diagnostics, Inc. (C); Soo Abboud, None; Franz Fogt, None; Mina Massaro-Giordano, Lynthera (C), PRN Fish Oil (I); Vatinee Bunya, Bausch & Lomb (F), EP 3210201 (P), National Eye Institute: R01 EY026972 (F), Research to Prevent Blindness (F), US 10,360,819 (P), US 10,783,505 (P)
  • Footnotes
    Support  NEI/NIH R01 EY026972 and Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1221. doi:
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      Kennedy Noel Johnson, Gui-Shuang Ying, Alexis Girón, Frederick Vivino, Soo Abboud, Franz Fogt, Mina Massaro-Giordano, Vatinee Y Bunya; Assessment of the Inclusion of Novel Autoantibodies into a Prediction Model to Screen Dry Eye Patients for Sjogren's Syndrome: Preliminary Findings. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1221.

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Abstract

Purpose : To determine if the addition of novel Sjogren syndrome (SS) autoantibody data improves the performance of a previously reported algorithm to screen dry eye patients for SS.

Methods : Inclusion criteria were age ≥18 years, no history of autoimmune disease, and dry eye complaints for ≥ 3 months. Ocular and systemic symptoms were assessed using a questionnaire. Subjects underwent an ocular surface exam, measurement of unstimulated whole salivary rate, serological testing, and a lip biopsy if indicated to diagnose SS. A participant was diagnosed with SS if they met the 2016 American College of Rheumatology/European League Against Rheumatism criteria. The screening algorithm score was originally determined using questionnaire responses, assessment of tear film break-up time and conjunctival staining with lissamine green (Bunya et al Cornea 2021). The presence or absence of IgG, IgM, or IgA isotypes of the novel SS antibodies (anti-salivary protein (SP), anti-parotid secretory protein (PSP), and anti-carbonic anhydrase isoenzyme VI (CA-VI)) was compared between patients with and without SS, and incorporated into the algorithm.

Results : 89 patients (18 SS, 71 no SS) were enrolled, 82% of them female with a mean age (±SD) of 57 (±17.6) years. There was no significant association between the presence of any one novel antibody and a positive SS diagnosis (Table 1). The percent of positive subjects in the following specific immunoglobulin groups: SP IgA, PSP IgM or CA-VI IgM, was higher in those with SS than those without SS (61.1% vs. 25.4%, p=0.0009, Table 1). The area under the ROC curve (95% CI) for SS screening was 0.68 (0.55-0.81) with the likelihood score alone, and significantly (p=0.04) improved to 0.77 (0.65-0.89) when using both the novel antibodies and the likelihood score (Figure 1).

Conclusions : We found that the inclusion of specific novel autoantibodies (SP IgA, PSP IgM and CA-VI IgM) significantly improved the performance of our previously reported SS screening tool. This likelihood scoring system can be implemented using the brief series of questions alone, or combined with standard ocular surface signs and novel SS antibody testing for improved performance. Once validated, the algorithm may serve as an effective screening tool to determine the likelihood of SS in dry eye patients, potentially allowing for earlier diagnosis and treatment.

This is a 2021 ARVO Annual Meeting abstract.

 

 

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