Sjögren's requires an understanding beyond traditional symptoms

September 18, 2014

Lupus, dry mouth, and arthritis aren’t usually associated with optometry, but it may well need to become a necessary part of any optometrist's knowledge base as awareness of Sjögren's syndrome becomes more prevalent, reported Dr. Milton M. Hom, OD, FAAO, at his most recent seminar at Vision Expo West.

Las Vegas-Lupus, dry mouth, and arthritis aren’t usually associated with optometry, but it may well need to become a necessary part of any optometrist's knowledge base as awareness of Sjögren's syndrome becomes more prevalent, reported Dr. Milton M. Hom, OD, FAAO, at his most recent seminar at Vision Expo West.

Dubbed the "new dry eye" by Dr. Hom, Sjögren's syndrome has classically been characterized by a triad of symptoms that include dry eyes, dry mouth, and associated autoimmune disorders. But recent studies have observed the syndrome is more complicated than that, and as first-line defenders, eyecare practitioners (ECPs) need to become aware of associated symptoms that reach beyond this simple scope.

In fact, with everything coming out about the disorder, Dr. Hom says ECPs need to expand their understanding of the possible associated symptoms from the traditional triad.

A chronic autoimmune disease, Sjögren's syndrome is most commonly identified by dry mouth and dryness of the eyes. The disease is characterized by the body attacking its own tear and saliva-generating glands-often affect other moisture dependent areas of the body such as the skin, joints, lungs, and other areas of the body-and can lead to severe problems such as lymphoma. Because of this, many cases Sjögren's syndrome go undetected as patients receive diagnoses that range from rheumatoid arthritis to lupis, even to exercise-induced asthma, as was the case for tennis star Venus Williams.

"The way I'm practicing now is much different from a year ago," Dr. Hom said. "Some of the patients I didn't expect to have Sjögren's syndrome, have now been diagnosed with it."

Because the disease goes largely undiagnosed, estimates on how many people actually have Sjögren's syndrome vary, but many agree that the number could be as high as four million in the United States alone. But with the increased level of awareness of the disease and new tools in early detection, that's all changing.

Point-of-care diagnostics change the way we manage patients

There are new, high-tech methods of detection. Tools such as the Keratograph 5M, LipiFlow/LipiView, MiBoFlo, Sjö, and TearLab have all shown promise, though each have their pros and cons, both in terms of result reliability and cost. Of those, Dr. Hom was especially encouraged by Sjö's effectiveness. However, knowing when to test a patient for Sjögren's syndrome is still dependent on the eye care professional, Dr. Hom said.

It starts with understanding the patient's condition beyond just eye care. He recommends an expanded patient questionnaire that also asks if patients have experience dryness in the entire body, the level of fatigue experienced over the past two years, and if they've experienced severe pain in their arms and feet-all symptoms associated with the syndrome but relatively unknown to healthcare professionals.

Ultimately, it comes down to awareness.

"If you have patients in your practice with dry eye, the likelihood is that you have patients with Sjögren's syndrome," Dr. Hom said. And with only one million of the suspected four million cases of Sjögren's syndrome actually diagnosed, chances are many optometrists are guilty of having missed those cases.

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