FEB 2017

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/777639

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3. Sambursky R, et al. Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immuno- assay for diagnosing inflammation related to dry eye. JAMA Ophthalmol. 2013;131:24–28. 4. Holland EJ, et al. Lifitegrast clinical efficacy for treatment of signs and symptoms of dry eye disease across three randomized controlled trials. Curr Med Res Opin. 2016 Jul 22:1–7. [Epub ahead of print] 5. Tomlinson A, et al. The interna- tional workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011;52:2006–2049. 6. Beckman KA, et al. Making the diagnosis of Sjögren's syndrome in patients with dry eye. Clin Ophthalmol. 2015;10:43–53. Dr. Gupta is assistant professor of ophthalmology, cornea and re- fractive surgery, Duke University Eye Center, and clinical med- ical director, Duke Eye Center at Page Road, Durham, North Carolina. She can be contacted at preeya.gupta@duke.edu. irritation and redness, and conjunctival staining im- proved. I referred her to rheuma- tology for a systemic evalua- tion because of her joint pain, and Sjögren's syndrome was diagnosed. Conclusion These cases highlight the im- portance of screening for ocu- lar surface disease to obtain a better surgical and refractive outcome as well as identify disease processes that require long-term treatment. References 1. Trattler W, et al. Cataract and dry eye: Prospective Health Assessment of Cataract Patients' Ocular Surface study. ASCRS•ASOA Symposium & Congress, March 2011. 2. Foulks GN, et al. TearLab osmolarity as a biomarker for disease severity in mild to moderate dry eye disease. American Academy of Ophthalmology, PO382, 2009. Sjögren's-specific antibody A and B. In contrast, the Sjö point-of-care test assesses for traditional markers and novel proprietary biomarkers (sali- vary protein-1, carbonic anhy- drase-6, and parotid secretory protein), increasing sensitivity and specificity. Sensitivity was reported as 89.9% and speci- ficity as 78.7% and 82.5% in age- and sex-matched controls and pediatric controls, respec- tively. 6 It is important to identify Sjögren's syndrome because these patients later have sys- temic risks of lymphoma and other conditions. In this patient I began treatment with lifitegrast as her MMP-9 levels were ele- vated and she had significant conjunctival and corneal stain- ing. At her 6-week follow-up appointment, MMP-9 tests were negative and osmolari- ty decreased to 300 and 295 mOsm/L. She reported less occasional dry mouth and periodic joint pain. She had 2+ conjunctival staining with lissamine green and 2+ corneal fluorescein staining. Her tear break-up time was approximately 6 sec- onds, and she had a positive MMP-9 test and tear osmolari- ty of 318 and 328 mOsm/L. In this patient I had a low threshold to perform meibomian gland imaging, which identified moderate meibomian gland atrophy. This technology is excellent in identifying gland atrophy and stratifying patients on the disease spectrum. 5 Although clinicians can apply pressure to the meibomian glands to assess oil function, with mei- bography we can determine how much atrophy is present. In young women with dry eye and dry mouth, clini- cians should consider testing for Sjögren's syndrome. Tradi- tional laboratory tests identify Supported by unrestricted educational grants from Alcon Laboratories Inc., Allergan Inc., Shire Pharmaceuticals, TearLab, and TearScience Figure 2. Case 2: Patient shows classic signs of dry eye 7

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