What are the best questions to ask to identify a patient with Sjögren syndrome?

According to a new study, there are four.

Wait, give me some background first.

Patients with Sjögren syndrome whose primary complaint is dry eye are diagnosed, on average, 10 years after the onset of symptoms. Because Sjögren syndrome has serious systemic complications, including vasculitis, pneumonitis, neuropathies, and lymphoma, early diagnosis is critical. One goal of this study was to develop an effective screening tool to facilitate the timely diagnosis of this condition.

Got it. Now tell me about the study.

More than 800 patients were included. At the baseline visit, patients answered a questionnaire regarding a review of systems and medical history. In addition, a full ocular surface examination was performed including Schirmer testing without anesthesia, tear breakup time, and ocular surface staining with fluorescein and lissamine green. All participants underwent dental and rheumatologic examinations, serological testing, and a lip biopsy (if not performed within 1 year of study entry) to determine their Sjögren syndrome status.

Four of the screening questions asked were found to be statistically significant for distinguishing the Sjögren syndrome group from the control group:
1. Is your mouth dry when eating a meal? (Yes)
2. Can you eat a cracker without drinking a fluid or liquid? (No)
3. How often do you have excessive tearing? (None of the time)
4. Are you able to produce tears? (No)

The take home:

According to the study authors, one of the most common questions used to screen patients with dry eye for Sjögren syndrome (“Does your mouth feel dry?”) was not useful in distinguishing those with or without Sjögren syndrome. However, the more specific questions (eg, “Is your mouth dry when eating a meal?” and “Can you eat a cracker without drinking a fluid or liquid?”) were helpful for distinguishing the two groups.


How common are complications from intravitreal injections?

According to a new retrospective IRB-approved review study published in Ophthalmology Retina, the complication rate is low.

Didn't we know this already?

We did, but the majority of intravitreal injection (IVI)-related complications data are derived from randomized controlled clinical trials, which report a high adverse event rate. According to the study authors, the nature of these protocol-driven trials limit their applicability to the diverse circumstances seen in routine clinical practice.

Tell me about the study.

Between 2012 and 2016 a total of 44,734 injections were performed in 5,318 patients at the Cleveland Clinic. The overall complication rate was low, at 1.9% of all injections given, and in 12.9% of patients. The most common complications were irritation (n = 312) and subconjunctival hemorrhage (n = 284), both requiring no intervention. More serious complications were corneal abrasion (n = 46) and iritis (n = 31). Endophthalmitis complications were excluded from this study, but there was a total of 19 presumed endophthalmitis cases, which correlates to previously published risk data.

The take home:

The study authors concluded that the overall low complication rate and even lower serious complication rate should give providers confidence when discussing the safety profile of this common intervention.


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How long can I use my N-95?

New research suggests no more than 2 days.


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