Eyeworld

JANUARY/FEBRUARY 2020 | EYEWORLD | 73 Contact Goodman: Amy.Colgan@osumc.edu Kolomeyer: nkolomeyer@willseye.org Maxfield: jr3674@cumc.columbia.edu diagnosed, the ideal next step would be to perform screen- ing spirometry on XFS patients and matched controls to compare incidence and physiologic severity of obstruc- tion, controlling for tobacco use history. The results may lead to some small steps in the management of patients with XFS. "The study is probably com- pelling enough to suggest that physicians caring for XFS patients should ask about tobacco use and urge cessation," Dr. Goodman said. They also could refer for spirometry when appropri- ate. This same patient group should be advised to stop smoking because they have an increased risk for emphysema, said Roger Maxfield, MD. "It certainly would not hurt to discuss smoking cessation with XFS patients, if appli- cable," said Natasha Nayak Kolomeyer, MD. However, the state-specific database used in the study and the lack of diversity, as well as the reliance on billing code data, limit extrapolation of the findings, she thinks. "Further studies along this path do have the opportunity to change clinical management, de- pending on the findings," Dr. Kolomeyer said. Another future avenue for research could be looking for a correlation between XFS and emphysema specifically, Dr. Maxfield said. Although XFS has primarily been viewed as an ophthalmic disorder, further research in this area and the ability to study larger popula- tions may force a change in this perception, the researchers noted. "It will become increasingly important to have a broader appreciation of XFS as a systemic condition that may require increasing medical attention and be amenable to targeted therapy," they wrote. respective controls; conversely, COPD patients were less likely to be alive compared with matched controls. Patients with COPD were more likely to have a history of using tobacco compared with controls. Among those with XFS, it was somewhat more likely that they would have a history of COPD than respective controls (5.5% vs. 4.4%, respectively). However, those with COPD did not significantly differ regarding an XFS history compared with matched controls. When delving in further, there was a higher risk of COPD in a subset of 190 XFS patients who used tobacco. In that subset, COPD was associated with a 2.2-fold risk of XFS, and the risk was consistent both with patients with onset before or after 70 years old. Although XFS is associated with certain systemic comorbidities, those with a history of XFS had better survival overall than patients who did not have XFS. Although survival was lower with those who had COPD, having both XFS and COPD seemed to have a protective effect. Research and clinical implications The researchers concluded that if there is a genetic disposition to LOXL1-related XFS, in those who use tobacco, " ... perhaps the elas- tin repair processes called into action are thus altered such that there is an increase in subse- quent risk of COPD in this subset," they wrote. More research is needed, they added. When it comes to further study, Lauren Goodman, MD, would like to know whether COPD diagnoses were made by spirometry, or if the diagnosis codes reflect clinical suspi- cion for COPD. If COPD was not officially G "It certainly would not hurt to discuss smoking cessation with XFS patients, if applicable." —Natasha Nayak Kolomeyer, MD

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