Impact of inflammation and treatment on quality of life (QoL) in patients with Vogt-Koyanagi-Harada disease (VKHD)

Abstract

Purpose : To evaluate associations between self-reported QoL metrics and disease inflammatory parameters and treatment in patients with VKHD

Methods : Cross-sectional study (Jul-Dec 2017) with 22 patients with VKHD followed for a minimum 12-mo from disease onset with predefined treatment protocols and systematic clinical, posterior segment imaging exams and full-field electroretinogram (ffERG). Clinical disease activity was defined as cells in anterior chamber (ACC) and/or macular edema; subclinical activity was defined as optic disc or perivascular leakage and/or dark dots. Visual function was measured by best-corrected visual acuity (BCVA), ffERG and contrast sensitivity. Self-reported vision-related (VR)-QoL and health-related (HR)-QoL were assessed by NEI-VFQ25 and SF36 questionnaires, respectively. Data were analyzed using Mann- Whitney and Spearman's rank correlation tests and multivariate regression analysis. This study was approved by Institutional Ethics Committee and followed the Helsinki declaration

Results : Clinical data are presented at Table. Figure represents SF36 and NEI-VFQ25 main significant associations. Gender, age, educational level, employment status and mensal household income had significant negative impact on certain aspects of general health and mental health measured by SF36 subscale item scores. Higher cumulative total dose of oral prednisone and use of immunosuppressive therapy impacted negatively on both questionnaires, e.g. on physical, mental and emotional aspects. Systemic complications (e.g. infection) impacted on mental health, social and physical SF36 items scores. Fluctuation of BCVA and presence of ACC impacted negatively on VR-QoL items. Worse BCVA in better eye and more severe fundus graduation also impacted negatively on VR-QoL items. Positive associations were found with optic disc hyperfluorescence, fluctuation of choroidal thickness and worsening ffERG concerning VR-QoL items

Conclusions : Despite good BCVA and absence of clinical inflammation in the majority of patients with VKHD, still inflammation and mainly its treatment (corticosteroid and IMT), have significant impact on both questionnaires. VR-QoL and HR-QoL questionnaires together with psychophysical measurements of visual impairment bring more extensive understanding of the impact of choroidal inflammation and treatment in VKHD

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Clinical data

 

SF36 and NEI-VFQ25 main significant associations