The discrepancy between SightBook mobile app and the clinic charts acuities may be large; however, the results are highly reproducible. Obtaining baseline SightBook acuity allows future vision comparisons. SightBook mobile app offers a new portable vision assessment tool for the office and remote patient monitoring.

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PurposeTo report on a case of a young female with progressing dry eye symptoms and evolving autoimmune markers consistent with a presentation of early Sjogren's syndrome (SS).ObservationsA 32 year-old female presented with chronic dry eye symptoms refractory to artificial tears. Slit lamp examination revealed punctate epithelial erosions, decreased tear break-up time, and decreased tear lake bilaterally. Initial tests for ocular surface inflammation (InflammaDry, Quidel, San Diego) and systemic autoantibodies (antinuclear antibodies, anti-SSA/Ro and anti-SSB/La) were negative. After 4 months of persistent ocular symptoms and signs, ocular surface inflammation was detected via InflammaDry and blood results included a positive antinuclear antibody (1:160), rheumatoid factor (IgG 25.3 EU/ml), and carbonic anhydrase 6 (IgM 20.2 EU/ml), but persistently negative anti-SSA/Ro and anti-SSB/La antibodies.Conclusions and importanceTaken together, these findings were suggestive of early Sjogren's syndrome with simultaneous appearance of both ocular and serum biomarkers. Novel autoantibodies testing in suspected patients can guide early intervention and potentially improve both the glandular and extra-glandular function in patients.

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We thank Drs. Sabour and Ghassemi for their interest in our paper and for their didactic attention to the correct analytic methods for quantifying the test-retest reliability of a measurement method, the intraclass correlation coefficient (ICC), 1 and agreement between measurements made with two different methods, the Bland-Altman analysis. 2 We did, in fact, use the single measure ICC. Both of these statistical techniques, not just the former, played an important role in our analysis which led to our conclusion, which we stand by. The SightBook mobile app has excellent test-retest reliability and so can be usefully employed to follow acuity over time, as long as baseline measurements are made with the SightBook. However, there are clinically substantial differences, quantified with the BlandAltman Limits of Agreement, between SightBook measurements and those made using near cards or Snellen charts. This means that SightBook acuity measurements should not be used at follow-up to compare against baseline measurements made with one of the other methods.