A novel measure of visual function and vision related quality of life for childhood uveitis

Abstract

 

Purpose

 

Studies on outcomes of juvenile idiopathic arthritis-associated uveitis (JIA-U) focus on the ocular exam and physical disability from arthritis. This assessment could improve by measuring the impact of uveitis on daily life. No instruments measure visual function and vision related quality of life (QOL) in this specific population. Our aim is to validate our measure, the “Effects of Youngsters’ Eyesight on Quality of Life” (EYE-Q), in children with uveitis.

 

Methods

 

Focus groups were held to modify the EYE-Q for children with uveitis. The new version has uveitis specific items. Rheumatology and ophthalmology medical records were reviewed. Questionnaires were completed on QOL (Pediatric QOL Inventory - PedsQL), physical function (Childhood Health Assessment Questionnaire - CHAQ), and visual function (EYE-Q).

 

Results

 

There were 108 children with JIA, 29 with JIA-U and 18 with idiopathic uveitis (I-U) (Table 1). Children with JIA-U were more frequently African American, had oligoarticular JIA, and were younger at arthritis onset (all p<0.001). There were no significant differences in gender, ANA, or HLA-B27. Children with I-U had worse visual acuity (VA) (p=0.005), and more ocular complications. There were significant differences in the EYE-Q, CHAQ, and VA, and no differences in PedsQL scores in all groups (Table 2). The EYE-Q had moderate correlations with VA (r = - 0.39, -0.31), PedsQL (r = 0.45) and CHAQ (r = -0.41). There were strong correlations between the parent and child EYE-Q (r = 0.72), and the old and new versions of the EYE-Q (r = 0.92). Cronbach’s α for the new EYE-Q child report was 0.91.

 

Conclusions

 

Children with I-U may have poorer visual outcome. Race, ethnicity, age of arthritis onset, RF status, and JIA subtype may be important risk factors for developing uveitis, whereas gender, ANA and HLA-B27 need further investigation. Compared to JIA and I-U, children with JIA-U have more components of disability. To improve the assessment of outcomes in JIA-U, a comprehensive approach incorporating all aspects of disability should be considered. The EYE-Q, with items specific to uveitis, is a valid measure of visual function and vision related QOL in uveitis. It is a promising global measure of pediatric vision that may complement the ophthalmic exam and arthritis specific measures. Longitudinal studies examining the performance of the EYE-Q in uveitis are ongoing.

 

 

 

Keywords: 432 autoimmune disease • 462 clinical (human) or epidemiologic studies: outcomes/complications • 746 uveitis-clinical/animal model