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Cohort studyJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 2026

The Sensitivity, Specificity, and Predictive Values of Serum Angiotensin-Converting Enzyme and Lysozyme in the Diagnosis of Sarcoid Optic Neuropathy.

Emily R Daly, Kasey Cooper, Ryan D Walsh

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OphthalmologyCohort study

Serum ACE testing misses most cases of sarcoid optic neuropathy, low sensitivity found.

The Sensitivity, Specificity, and Predictive Values of Serum Angiotensin-Converting Enzyme and Lysozyme in the Diagnosis of Sarcoid Optic Neuropathy.

Emily R Daly … Ryan D Walsh

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society · 2026

Background

This study describes the sensitivity, specificity, positive predictive value (positive predictive value), and negative predictive value (negative predictive value) of serum angiotensin-converting enzyme (s-ACE), and serum lysozyme in the diagnosis of sarcoid optic neuropathy (sarcoid optic neuropathy).

Methods

We retrospectively reviewed the electronic medical record (electronic medical record) of adult patients evaluated by neuro-ophthalmologists at Froedtert Hospital and the Medical College of Wisconsin clinics with a diagnosis of optic neuropathy (optic neuropathy) from January 1, 2012, through July 1, 2023, who had s-ACE and/or serum lysozyme levels assessed.

n = 706 patients

Results

s-ACE test caught this test caught only about 1 in 5 real cases

33.3%

Sensitivity

97%

Specificity

More results

Of these 706 patients, 395 (56%) were women and 311 (44%) were men, with a median age of 51 years (range: 18-90).

Fourteen of the 706 (2%) patients met criteria for a diagnosis of "Probable" (n = 13) or "Definite" (n = 1) sarcoid optic neuropathy.

Of these, 7 (50%) were women and 7 (50%) were men, with a median age of 42 years (range: 19-60).

More results

Seven of the 14 (50%) patients had a previously established diagnosis of sarcoidosis before presenting with optic neuropathy.

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Conclusion · 1 of 3

In diagnosing sarcoid optic neuropathy, we have found s-ACE to have a sensitivity of 21.4%, and a specificity of 97%. The positive predictive value of s-ACE was 12.5% and the negative predictive value was 98.4%.

Conclusion · 2 of 3

We have determined lysozyme in this setting to have a sensitivity of 33.3% and a specificity of 98%. The positive predictive value of lysozyme was 60% and the negative predictive value was 94.3%.

Conclusion · 3 of 3

The fact that s-ACE and lysozyme have low sensitivity for the diagnosis of sarcoid optic neuropathy indicates that neither of these tests is suitable as a general screening tool in this setting.

Post

The Sensitivity, Specificity, and Predictive Values of Serum Angiotensin-Converting Enzyme and Lysozyme in the Diagnosis of Sarcoid Optic Neuropathy.

Serum ACE testing misses most cases of sarcoid optic neuropathy, low sensitivity found.

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