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R. M. Wainess, L. Dustin, N. A. Rao, International VKH Study Group; Ethnic Variations in Vogt-Koyanagi-Harada Disease Presentation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3539.
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Vogt-Koyanagi-Harada (VKH) is a multisystem disease with a complex set of diagnostic criteria. However, there is high associations of exudative retinal detachment in acute VKH and sunset glow fundus in chronic VKH. In this study, an attempt is made to characterize variations in VKH presentations based on geographic and ethnic factors.
Data from 1147 patients with bilateral uveitis from 10 centers around the world was collected prospectively. These patients were analyzed using a standardized matrix to diagnose VKH based on currently accepted clinical features. Data was analyzed to identify most common presenting features of VKH. The data was also stratified by geographic and ethnic factors to evaluate variation in VKH clinical features among patients.
Among 1147 patients, 180 were diagnosed with VKH disease. In diagnosing chronic VKH, there was a higher predictive value of sunset glow fundus in the Hispanic (PPV 91.3, NPV 76.9) and Asian groups (PPV 98.0, NPV 91.1) vs. Caucasian patients (PPV 77.8, NPV 97.0). Of the patients with VKH, the associations of nummular scars with sunset glow fundus versus those without sunset glow fundus were more pronounced in the Hispanic patients (90.5% vs. 11.1%, p<.001) as compared with the Asian patients (53.2% vs. 22.2%, p=0.01) and the Caucasian patients (78.6% vs. 55.6%, p=0.36).
Sunset glow fundus has higher predictive values in Asian and Hispanic than Caucasian patients but can still be used to make the diagnosis of VKH in many cases. Nummular scars were more likely to correlate to sunset glow fundus in Hispanic patients vs. Asian and Caucasian patients. Better understanding these ethnic variations will lead to improved diagnosis.
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