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R. Gupta, F. Forooghian, L. Derzko–Dzulynsky, D.T. Wong; The Canadian National Uveitis Survey: A Closer Look at Uveitis Investigation by Canadian Ophthalmologists . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5012.
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Purpose: Anterior uveitis (AU), non–granulomatous (NGAU) or granulomatous (GAU), is a common entity seen in ophthalmology practice that may result from a number of different underlying etiologies. However, often the condition first presents devoid of any accompanying signs or symptoms of systemic disease. The clinician must thus choose from a battery of potential screening tests. A non–selective approach to testing is costly and inefficient. Furthermore, this approach can lead to misinterpretation of false–positive results. The purpose of this study was to identify investigation patterns of ophthalmologists in Canada for AU, and to ultimately make recommendations based on the literature that would lead to improved patient care and more cost–effective use of health care resources. Methods: A cross–sectional survey of practicing ophthalmologists, fellows, and residents in Canada was conducted in September 2004. The survey instrument employed was an 11–item questionnaire. The survey was mailed out to 1197 physicians in Canada. Results: To date, 486 (41%) of physicians have responded. In the setting of NGAU, common ordered tests included HLA–B27 (68.4%), complete blood count (CBC), blood chemistries, &/or urinalysis (64.5%), syphilis (56.3%), erythrocyte sedimentation rate (ESR, 51.5%), chest radiographs (CXR, 51.1%), sacroiliac joint radiographs (40.3%), antinuclear antibodies (ANA, 43.7%), rheumatoid factor (RF, 36.6%), and angiotensin converting enzyme (ACE, 34.4%). For GAU, common tests included CXR (75.5%), syphilis (73.2%), CBC, blood chemistries &/or urinalysis (70.1%), tuberculosis (PPD, 64.1%), ACE (59.3%), ESR (55.4%), HLA–B27 (43.7%), ANA (38.3%), C–reactive protein (31.6%), and RF (31%). In a child with AU, the most common tests ordered were CBC, blood chemistries, &/or urinalysis (49.4%), rheumatoid factor (43.5%), and ANA (41.8%). When testing for possible syphilis in a patient with AU 12.1% reported ordering only a screening test, while 74.5% reported ordering the more specific confirmatory test as well. Conclusions: Many Canadian ophthalmologists assessed in this survey chose to order various tests with low diagnostic yields in the setting of AU. CBC, blood chemistries &/or urinalysis, ESR, CRP, and RF are too sensitive or non–specific to be valuable tests in the setting of AU. Although juvenile rheumatoid arthritis is a known cause of childhood uveitis, ANA was not ordered in the majority of cases. Increased education and awareness will undoubtedly lead to a more cost–effective and efficient approach to investigation in the setting of AU.
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