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Simon R. Taylor, Sue Lightman, Elizabeth A. Sugar, Glenn J. Jaffe, William R. Freeman, Michael M. Altaweel, Igor Kozak, Janet T. Holbrook, Douglas A. Jabs, John H. Kempen; The Impact Of Macular Edema On Visual Function In Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4309.
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To evaluate the impact of macular edema on visual acuity and visual field sensitivity in intermediate, posterior and panuveitis.
255 patients (481 eyes with uveitis) recruited into the MUST Trial at 23 subspecialty centers underwent best-corrected visual acuity testing using ETDRS methods, Humphrey 24-2 visual field testing, and optical coherence tomography (OCT) at the same visit. OCT images were graded for measures of macular edema by trained graders at the study Reading Center.
Macular edema was associated with impaired visual acuity (P<0.01). Cystoid changes without retinal thickening ≥240 µm were associated with 1.2 lines’ reduction in visual acuity (-6 ETDRS letters); retinal thickening ≥240 µm without cystoid changes was associated with 2.6 lines’ reduction (-13 letters); and with both cysts and thickening with 3.6 lines’ reduction (-18 letters). Uveitis sufficient to satisfy the study’s inclusion criteria was associated with impaired visual field sensitivity as measured by mean deviation, but eyes with macular edema had even worse visual field sensitivity (P<0.01). Cystoid spaces only (-4.4 dB) had less impact than retinal thickening only (-5.9 dB); both cysts and thickening had the greatest negative impact on mean deviation (-6.9 dB).
Macular edema substantially reduces visual function, suggesting that it is an important endpoint to study in the treatment of uveitis. As uveitis and macular edema both impair visual field sensitivity as measured by Humphrey 24-2 perimetry, both should be considered when evaluating patients with uveitis and raised intraocular pressure for glaucoma.
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