Evaluation of fluorescein staining with the yellow filter in the diagnosis of Sjögren disease in Japan

Sjögren disease (SjD) requires ocular surface assessment during diagnostic evaluation. In Japan, the 1999 revised Japanese Ministry of Health criteria include the van Bijsterveld score based on the Rose Bengal test; however, this test is rarely performed in current clinical practice. Although fluorescein staining with the yellow filter is widely used as an alternative method, its performance for suspected SjD remains unclear. To clinically evaluate this method, this multicenter retrospective study included 400 patients who underwent fluorescein staining with the yellow filter for suspected SjD between 2010 and 2024. Expert clinical diagnosis served as the reference diagnosis, with 322 being diagnosed with SjD and 78 classified as non-SjD. At a cutoff value ≥3 for the van Bijsterveld score using fluorescein staining with the yellow filter, sensitivity was 48.4% and specificity 84.6%, with a positive predictive value of 92.9%. At a cutoff value ≥4, sensitivity was 32.6% and specificity 93.6%, with a positive predictive value of 95.5%. After replacing the Rose Bengal test in the 1999 criteria with fluorescein staining with the yellow filter, the modified criteria showed 86.6% sensitivity, 93.6% specificity, and 88.0% accuracy. Fluorescein staining with the yellow filter may be a practical ocular assessment method for suspected SjD.