57
EW CORNEA
April 2018
Contact information
Akpek: esakpek@jhmi.edu
Galor: agalor@med.miami.edu
Kempf: kempfks@aol.com
Vivino: Frederick.vivino@uphs.upenn.edu
and SS-B antibodies, rheumatoid fac-
tor, erythrocyte sedimentation rate,
C-reactive protein, and quantitative
immunoglobulins, Dr. Kempf said.
"Depending on clinical suspicions,
we might order an ultrasound of the
salivary and parotid glands or an
MRI of the same area. If a diagnosis
is critical, a minor salivary gland
biopsy could be performed and sent
to pathology," he said.
Looking forward
Last year, under the auspices of the
Sjögren's Syndrome Foundation,
a group of clinicians—including
an Ocular Working Group—pub-
lished clinical practice guidelines
to provide more information to
help various providers more effec-
tively manage Sjögren's syndrome.
3
"The guidelines have been helpful
for treatment purposes and have
given clinical rheumatologists some
guidance on treating a very hetero-
geneous disorder, but the guidelines
have not answered all questions,"
Dr. Kempf said.
Various changes over time
to the diagnosis guidelines for
Sjögren's make it challenging for
physicians to determine the best
testing approach, Dr. Akpek said.
Clinicians are looking for more
information to help define stan-
dard procedures and guide them on
which patients would benefit from
immune suppression, Dr. Kempf
said.
For ophthalmologists who want
to better identify Sjögren's patients,
Dr. Kempf advises the use of screen-
ing questionnaires, a recommen-
dation that comes from the Amer-
ican-European Consensus Criteria
for Sjögren's Syndrome diagnosis
guidelines, he said.
"In addition, if they find an
objective decrease in tear produc-
tion, send them to rheumatology,"
he advised. EW
References
1. Vivino FB. Sjögren's syndrome: Clinical
aspects. Clin Immunol. 2017;182:48–54.
2. Sjögren's Syndrome Foundation. Sjögren's
Syndrome Foundation accomplishes 5-year
breakthrough goal. www.sjogrens.org/home/
about-the-foundation/breakthrough-goal-/
wedidit
3. Vivino FB, et al. New treatment guidelines
for Sjögren's disease. Rheum Dis Clin North
Am. 2016;42:531–51.
4. Liew MS, et al. Prevalence and predictors
of Sjögren's syndrome in a prospective cohort
of patients with aqueous-deficient dry eye. Br
J Ophthalmol. 2012;96:1498–503.
Editors' note: Dr. Vivino has financial
interests with Trinity Biotech (James-
town, New York). Drs. Akpek, Galor,
and Kempf have no financial interests
related to their comments.
