A screening tool to detect chronic ocular graft versus host disease in a haematology/oncology outpatient setting

Abstract

AbstractPurpose: To develop an effective and efficient screening tool for chronic ocular graft versus host disease (oGvHD) that could be integrated into a post‐allogeneic transplant follow‐up clinic.Methods: Consecutive patients attending the post‐allogeneic transplant follow‐up clinic were recruited. Participants completed questionnaires before ophthalmic examination to prevent bias and were considered to have chronic oGvHD if they fulfilled either the National Institute of Health or International Chronic Ocular Graft‐vs‐Host‐Disease Consensus Group diagnostic criteria. PHASE I participants completed the Ocular Surface Disease Index (OSDI) questionnaire. In this instance a threshold score of >33 was considered suggestive of chronic oGvHD. PHASE II participants completed the OSDI as part of a new algorithm in which score of >33 in the context of daily ocular lubricant usage was considered suggestive of chronic oGvHD. Those diagnosed with chronic oGvHD were recruited into a prospective study. This aimed to correlate ocular surface disease severity which was scored using the Oxford Grading schematic and OSDI results during subspecialist treatment.Results: PHASE I (n = 100) resulted in a sensitivity of 100%, specificity of 86.9%, positive predictive value (PPV) of 0.59, negative predictive value (NPV) of 1.0 and likelihood ratio (LR) of 7.3 (p < 0.0001). PHASE II (n = 68) resulted in 100% sensitivity and specificity with a PPV and NPV of 1.00 (p < 0.0001). Finally OSDI score and ocular surface disease severity was found to be strongly correlated (n = 65, 0.67, p < 0.0001).Conclusions: An algorithm including the self‐administered OSDI questionnaire and a polar ‘yes/no’ question relating to ocular lubricant usage can be used to reliably and consistently identify patients with chronic oGvHD, triggering earlier referral to ophthalmology. The OSDI score strongly correlates with disease severity and will aid ophthalmologists to accurately triage patients with oGvHD referred to their care.