A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry

John P Whitcher; Caroline H Shiboski; Stephen C Shiboski; Ana Maria Heidenreich; Kazuko Kitagawa; Shunhua Zhang; Steffen Hamann; Genevieve Larkin; Nancy A McNamara; John S Greenspan; Troy E Daniels; Sjögren's International Collaborative Clinical Alliance Research Groups

doi:10.1016/j.ajo.2009.09.013

A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry

John P Whitcher, Caroline H Shiboski, Stephen C Shiboski, Ana Maria Heidenreich, Kazuko Kitagawa, Shunhua Zhang, Steffen Hamann, Genevieve Larkin, Nancy A McNamara, John S Greenspan, Troy E Daniels, Sjögren's International Collaborative Clinical Alliance Research Groups

224 Citations (Scopus)

Abstract

Purpose: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein. Design: Prospective, observational, multicenter cohort study. Methods: The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (≥3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both). Results: Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS. Conclusions: This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.

Original language	English
Journal	American Journal of Ophthalmology
Volume	149
Issue number	3
Pages (from-to)	405-15
Number of pages	11
ISSN	0002-9394
DOIs	https://doi.org/10.1016/j.ajo.2009.09.013
Publication status	Published - 1 Mar 2010

Access to Document

10.1016/j.ajo.2009.09.013

Cite this

Whitcher, J. P., Shiboski, C. H., Shiboski, S. C., Heidenreich, A. M., Kitagawa, K., Zhang, S., Hamann, S., Larkin, G., McNamara, N. A., Greenspan, J. S., Daniels, T. E., & Sjögren's International Collaborative Clinical Alliance Research Groups (2010). A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry. American Journal of Ophthalmology, 149(3), 405-15. https://doi.org/10.1016/j.ajo.2009.09.013

Whitcher, JP, Shiboski, CH, Shiboski, SC, Heidenreich, AM, Kitagawa, K, Zhang, S, Hamann, S, Larkin, G, McNamara, NA, Greenspan, JS, Daniels, TE & Sjögren's International Collaborative Clinical Alliance Research Groups 2010, 'A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry', American Journal of Ophthalmology, vol. 149, no. 3, pp. 405-15. https://doi.org/10.1016/j.ajo.2009.09.013

@article{6193e01eb5a9454bbb39ef75ad391996,

title = "A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sj{\"o}gren's Syndrome International Registry",

abstract = "Purpose: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein. Design: Prospective, observational, multicenter cohort study. Methods: The National Institutes of Health-funded Sj{\"o}gren's Syndrome International Registry (called Sj{\"o}gren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sj{\"o}gren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (≥3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both). Results: Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS. Conclusions: This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.",

author = "Whitcher, {John P} and Shiboski, {Caroline H} and Shiboski, {Stephen C} and Heidenreich, {Ana Maria} and Kazuko Kitagawa and Shunhua Zhang and Steffen Hamann and Genevieve Larkin and McNamara, {Nancy A} and Greenspan, {John S} and Daniels, {Troy E} and Steffen Hamann",

year = "2010",

month = mar,

day = "1",

doi = "10.1016/j.ajo.2009.09.013",

language = "English",

volume = "149",

pages = "405--15",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry

AU - Whitcher, John P

AU - Shiboski, Caroline H

AU - Shiboski, Stephen C

AU - Heidenreich, Ana Maria

AU - Kitagawa, Kazuko

AU - Zhang, Shunhua

AU - Hamann, Steffen

AU - Larkin, Genevieve

AU - McNamara, Nancy A

AU - Greenspan, John S

AU - Daniels, Troy E

AU - Sjögren's International Collaborative Clinical Alliance Research Groups

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Purpose: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein. Design: Prospective, observational, multicenter cohort study. Methods: The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (≥3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both). Results: Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS. Conclusions: This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.

AB - Purpose: To describe, apply, and test a new ocular grading system for assessing keratoconjunctivitis sicca (KCS) using lissamine green and fluorescein. Design: Prospective, observational, multicenter cohort study. Methods: The National Institutes of Health-funded Sjögren's Syndrome International Registry (called Sjögren's International Collaborative Clinical Alliance [SICCA]) is developing standardized classification criteria for Sjögren syndrome (SS) and is creating a biospecimen bank for future research. Eight SICCA ophthalmologists developed a new quantitative ocular grading system (SICCA ocular staining score [OSS]), and we analyzed OSS distribution among the SICCA cohort and its association with other phenotypic characteristics of SS. The SICCA cohort includes participants ranging from possibly early SS to advanced disease. Procedures include sequenced unanesthetized Schirmer test, tear break-up time, ocular surface staining, and external eye examination at the slit lamp. Using statistical analyses and proportional Venn diagrams, we examined interrelationships between abnormal OSS (≥3) and other characteristics of SS (labial salivary gland [LSG] biopsy with focal lymphocytic sialadenitis and focus score >1 positive anti-SS A antibodies, anti-SS B antibodies, or both). Results: Among 1208 participants, we found strong associations between abnormal OSS, positive serologic results, and positive LSG focus scores (P < .0001). Analysis of the overlapping relationships of these 3 measures defined a large group of participants who had KCS without other components of SS, representing a clinical entity distinct from the KCS associated with SS. Conclusions: This new method for assessing KCS will become the means for diagnosing the ocular component of SS in future classification criteria. We find 2 forms of KCS whose causes may differ.

U2 - 10.1016/j.ajo.2009.09.013

DO - 10.1016/j.ajo.2009.09.013

M3 - Journal article

SN - 0002-9394

VL - 149

SP - 405

EP - 415

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

IS - 3

ER -

A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry

Abstract

Access to Document

Fingerprint

Cite this