Unveiling dry eye with autoimmune features (DEAF): insights from a prospective longitudinal study

Area of Science:

• Ophthalmology
• Immunology
• Rheumatology

Background:

• Dry eye disease (DED) is common, often co-occurring with autoimmune conditions like Sjögren's disease (SjD).
• Some DED patients exhibit autoimmune signs but don't meet criteria for diagnosed connective tissue diseases (CTDs).
• This necessitates defining a distinct group: dry eye with autoimmune features (DEAF).

Purpose of the Study:

• To describe and propose the novel concept of "dry eye with autoimmune features (DEAF)".
• To identify distinct clinical and serological characteristics of DEAF patients.
• To evaluate the potential progression of DEAF to CTDs.

Main Methods:

• Prospective longitudinal study in an ophthalmology clinic.
• Collected data on medical history, ocular exams, and serology.
• Utilized heatmap, PCA, and PLS-DA for patient clustering into dry eye, DEAF, and SjD groups.

Main Results:

• DEAF patients exhibited higher DEQ-5/SPEED scores and lower IgG than SjD patients.
• Nasal conjunctival OSS levels were higher in DEAF and SjD groups.
• Anti-α-fodrin antibody levels were elevated in DEAF patients.
• 39.3% of DEAF patients developed CTDs, predominantly SjD, within 3 years.

Conclusions:

• DEAF patients possess unique clinical and serological profiles.
• DEAF may represent an early phase in the autoimmune disease spectrum.
• Identifying DEAF can aid early diagnosis and management of potential CTDs.