Background/Purpose: Sjögren’s Disease (SjD) is a systemic autoimmune disorder marked by mucosal dryness and ocular surface damage. For diagnosis, the ACR-EULAR 2016 criteria require the Ocular Staining Score (OSS) or the van Bijsterveld score (vBs), both rarely used in routine care. The Oxford Grading Scale (OGS), a simpler and widely applied tool, may offer a more accessible alternative. The objective of this study is to assess the correlation and diagnostic agreement of OGS with OSS and vBs in patients fulfilling the ACR-EULAR 2016 criteria for SjD, aiming to support its use as a practical screening method.

Methods: We conducted a cross-sectional study of 20 patients from the SSAD project at a single center (June–December 2024), all meeting ACR-EULAR 2016 criteria for SjD. Each underwent ocular surface staining assessments using the OSS, vBs, and OGS on the same day, following standardized protocols (Figures A-C).OSS evaluates corneal and conjunctival staining (0–12) with fluorescein and lissamine green; vBs scores three conjunctival zones (0–9) using the same dyes; OGS assesses corneal epithelial damage (0–5) via fluorescein staining. Positive thresholds were OSS ≥5 or vBs ≥4 per ACR-EULAR criteria. OGS thresholds were explored to determine optimal concordance with OSS and vBs.We analyzed correlations using Spearman’s rho for continuous scores and assessed agreement through percentage concordance and Cohen’s kappa for binary classifications. OGS positivity was determined across various thresholds, selecting the one maximizing Cohen’s kappa for further analysis. OSS and vBs served as reference standards to calculate OGS’s positive and negative predictive values at different thresholds.

Results: A total of 20 patients (mean age 57 years, 16 women [80%]) who met the classification criteria for SjD, regardless of their OSS or vBS results, were included.A Near-perfect agreement between standard scoring systems (OSS and vBs) was observed (rho = 0.94, p < 0.001 for both eyes).A Moderate-to-good agreement was observed for positive/negative classification based on ACR-EULAR thresholds (OSS ≥5, vBS ≥4), with 85% concordance (kappa = 0.67). Discrepancies were partially atributable to the treshold differences; for instance, some cases had a vBS of 4 (classified as positive) but an OSS of 3 or 4 (negative).OGS showed Moderate correlations with both OSS and vBs, ranging from rho=0.44 to rho=0.6, slightly higher for OSS than for vBS.An OGS threshold of ≥1 in at least one eye yielded the highest agreement with OSS and vBS (kappa: 0.5 for OSS, 0.6 for vBS), with excellent negative predictive values (NPV: 1.0 for OSS, 0.9 for vBS) but modest positive predictive values (PPV: 0.5 for OSS, 0.7 for vBS).The PPV-maximizing cutoffs were OGS ≥3 for OSS (PPV = 1) and OGS ≥2 for vBS (PPV = 0.70). These are conservative thresholds with only 1 and 3 positive cases, respectively.Notably, all patients with a positive vBS were also OSS-positive, suggesting OSS may be the more conservative assessment.

Conclusion: OGS moderately correlates with OSS and vBs and shows excellent rule-out capability when the score is 0. Given its simplicity and high NPV, OGS could serve as a practical screening tool for ocular damage in SjD, especially in settings lacking access to OSS or vBs.

Figures A–C: Simultaneous ocular surface staining in a patient with Sjögren’s disease (SjD).

A: Fluorescein staining of the ocular surface.

B–C: Lissamine green staining of the cornea (B) and conjunctiva (C).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-and-concordance-between-the-oxford-grading-scale-ocular-staining-score-and-van-bijsterveldscore-in-the-diagnosis-of-sjogrens-disease/