RESEARCH - Diagnostic performance of tear function tests in Sjogren's syndrome patients

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Laboratory Study

Eye (2007) 21, 229–237. doi:10.1038/sj.eye.6702204; published online 6

January 2006

Diagnostic performance of tear function tests in Sjogren's syndrome patients

P Versura1, M Frigato2, M Cellini1, R Mulè2, N Malavolta2 and E C Campos1

1Department of Surgical Science and Transplants, Sect. Ophthalmology,

Alma Mater Studiorum Università di Bologna, Bologna, Italy

2Department of Internal Medicine and Aging, Sect. Rheumatology, Alma

Mater Studiorum Università di Bologna, Italy

Correspondence: P Versura, Dipartimento 'A.Valsalva' Sezione

Oftalmologia, Alma Mater Studiorum Università di Bologna, Policlinico

S.Orsola - Via Massarenti, 9, 40138 Bologna, Italy

Abstract

Objective To evaluate the diagnostic performance of the tests included

in primary Sjogren's syndrome (SS-I) diagnostic criteria (Schirmer I,

break-up time, vital dye staining) and to compare them with other

examinations related to the ocular surface status.

Methods Clinical and cytological data were collected from 177 patients

(62 SS-1, 56 non-SS autoimmune diseases, 59 Sicca syndrome). Tear

tests included: a validated questionnaire on symptoms, Schirmer I,

test, Ferning test, BUT, corneal aesthesiometry, tear clearance

test, lissamine green staining, impression conjunctival cytology. Data

were statistically evaluated and sensitivity, specificity, likelihood

ratio (LR+), receiver-operating characteristics (ROC) curves were

calculated for each test.

Results Data showed a poor diagnostic performance of Schirmer test I

(sensitivity 0.42; specificity 0.76; LR+1.75) and BUT (sensitivity

0.92; specificity 0.17; LR+1.11) (area under the curve in ROC analysis

<0.58). Validated subjective symptoms questionnaire (sensitivity 0.89;

specificity 0.72; LR+3.18), test (sensitivity 0.60; specificity

0.88; LR+5), corneal aesthesiometry (sensitivity 0.80; specificity

0.67; LR+2.42), and tear clearance test (sensitivity 0.63; specificity

0.84; LR+3.93), all exhibited a high diagnostic performance (area

under the curve in the ROC analysis always >0.70). Lissamine green

staining exhibited the best performance (sensitivity 0.63; specificity

0.89; LR+5.72) but the result could be distorted by an incorporation

bias.

Conclusions Our data suggest to implement the items for ocular signs

and symptoms contained in many SS-I diagnostic criteria with the use

of a validated questionnaire, performance of test, corneal

aesthesiometry measurement, and tear clearance rate evaluation.

http://www.nature.com/eye/journal/v21/n2/abs/6702204a.html

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