December 12, 2013
2 min read

BLOG: Testing for Sjögren’s

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Read more from Darrell E. White, MD.

In some circles, there’s a persistent knock on our specialty: We are somehow not “real” doctors. You’ve heard this, I’m sure. Admit it: It hurts your feelings. I mean, c’mon, we went through the same 4 years of med school and 4 years of residency as our dermatology colleagues, and nobody talks about them that way. It’s just not fair.

Some of this stems from our ability as a specialty to function outside of most of the rest of medicine. We don’t use hospitals, and for the most part, since the decline of beta-blockers in glaucoma care, the only persistent crossroad where we intersect with medical docs is when a patient is on a “high-risk” drug like Plaquenil (hydroxychloroquine, sanofi-aventis). Sure, we make the occasional life-saving diagnosis of a brain tumor, or tip off the family doc about occult diabetes, but in reality the vast majority of us really do function to the side of what most docs consider regular medicine. Dry eye syndrome (DES) is quite possibly a new place for us to more fully engage our medical colleagues.

Sjögren’s syndrome is perhaps the most confusing part of the daily life of a DES specialist. Many patients come to the clinic with this diagnosis only for us to discover that they have no clinical signs of dryness whatsoever. Do they still have Sjögren’s? The flip side of that scenario is the patient who has a bitter dry eye with everything that we associate with the ophthalmic findings of Sjögren’s, and yet their medical doctor or their rheumatologist has “ruled out” Sjögren’s. Now what? The hard data say that one in 10 DES patients has Sjögren’s, that there are roughly 4 million people in the U.S. with Sjögren’s and that only 25% of those people have received an accurate diagnosis.

Here’s where you, the Dry Eye Doc, come in. There’s a new point-of-service test from Nicox called “Sjo,” which is being rolled out now. It should allow us, the Dry Eye Docs, to dramatically lessen the time it takes to make an accurate diagnosis of Sjögren’s syndrome, yea or nay. This in turn will allow us to make the appropriate and necessary referrals to make sure that our patients get earlier treatment and hopefully fewer complications from this otherwise relentlessly progressive autoimmune disease.

And you might even remember how much you really liked all those medical docs!

Information is available at

Disclosure: White is a consultant for Bausch + Lomb, Allergan, Nicox and Eyemaginations. He is on the speaker board for Bausch + Lomb, Allergan and TearLab.