Validity of Forced Eyelid Closure Test: A Novel Clinical Screening Test for Ocular Myasthenia Gravis.

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Title Validity of Forced Eyelid Closure Test: A Novel Clinical Screening Test for Ocular Myasthenia Gravis.
Creator Supanut Apinyawasisuk; Xinkai Zhou; Jack J. Tian; Giancarlo A. Garcia; Rustum Karanjia; Alfredo A. Sadun
Affiliation Doheny Eye Center, Department of Ophthalmology (SA, JJT, GAG, RK, AAS), David Geffen School of Medicine, UCLA, Los Angeles, California; Ophthalmology Department (SA), King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Ophthalmology (SA), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Medicine (XZ), Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California; David Geffen School of Medicine (JJT), UCLA, Los Angeles, California; University of California-Irvine School of Medicine (GAG), Irvine, California; and The Ottawa Eye Institute (RK), Department of Ophthalmology University of Ottawa, Ottawa, Ontario, Canada.
Abstract Forced eyelid closure test (FECT) is a clinical screening test developed from the original Cogan lid twitch (CLT) sign to assist in the diagnosis of ocular myasthenia gravis (OMG), We evaluated the sensitivity and specificity of FECT compared with CLT and benchmarked to standard diagnostic tests. This study was a retrospective chart review of 48 patients using electronic medical records of those that presented with ptosis and/or diplopia at Doheny Eye Institute, University of California, Los Angeles between February 2015 and April 2016. Patients without FECT testing were excluded. FECT and CLT results, and final diagnosis were recorded. To perform FECT, the patient was asked to squeeze his or her eyelids shut for 5-10 seconds then open quickly and fixate in primary position. The excessive upward overshoot of eyelids movement indicated a positive FECT. The test was performed by a neuro-ophthalmologist before establishing the diagnosis. Patients who had equivocal test results and/or inconclusive final diagnosis were excluded. Of the 48 patients studied, 18 patients (37.5%) had positive FECT; 15 of whom had a final diagnosis of OMG (83.3%). Of the 30 patients with negative FECT, 1 had OMG (3.3%). Of the 48 patients, 35 patients also had a documented CLT result (72.9%). CLT was positive in 11 of these 35 patients (31.4%), and 9 of these 11 had OMG (81.8%). Of the 24 patients with negative CLT, 2 of them had OMG (8.3%). Sensitivity and specificity of FECT were 94% and 91% (joint 95% confidence region: sensitivity × specificity = [0.70, 1] × [0.75, 1]). The relative true-positive fraction (rTPF) between FECT and CLT was 1.15; the relative false-positive fraction was 1.31. FECT is a simple clinical screening test with good sensitivity and specificity for OMG.
Subject Blepharoptosis; Diagnostic Techniques, Ophthalmological; Disease Progression; Eyelids; Female; Follow-Up Studies; Humans; Male; Myasthenia Gravis; Reproducibility of Results; Retrospective Studies
OCR Text Show
Date 2017-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2017, Volume 37, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s67q36n2
Setname ehsl_novel_jno
ID 1374443
Reference URL https://collections.lib.utah.edu/ark:/87278/s67q36n2
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