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Finny T John, Kai Ding, Ashvini Reddy; Outcomes of Vogt Koyanagi-Harada Disease Among At-Risk Native Americans. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6664.
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To compare the presentation, features, and outcomes of Native American and non-Native American patients with Vogt Koyanagi-Harada disease (VKH) at a single institution in Oklahoma City, OK.
Data were collected on six Native American and six non-native patients with VKH disease, seen and treated between 1992 and 2017. Main outcome measures included final best-corrected visual acuity, adverse outcomes such as hypotony and need for cataract or glaucoma surgery, and legal blindness. Patient-level data were compared between the two groups using Fisher’s exact test or two-sample t-test. Mixed models and generalized linear models were used to analyze eye-level data, accounting for within-patient correlations.
Native American patients had poorer median final visual acuity than non-native patients (0.7 LogMAR vs 0.1 LogMAR, p=0.09) despite comparable median initial visual acuities (1 LogMAR vs 0.8 LogMAR, p=0.81). Native Americans also tended to be younger at presentation (median 18.5 years vs 28 years) with longer follow-up (median 59 months vs 17 months, p=0.02) than non-natives. Native American eyes were more likely to require cataract surgery (75% vs 33%, p=0.14), experience hypotony (66.7% vs 16.7%, p=0.04), and develop legal blindness (41.7% vs 8.3%, p=0.10). All patients were treated initially with oral prednisone and received some form of immunosuppressive, steroid-sparing therapy, with nine of 12 receiving methotrexate with or without another agent over the course of their disease.
Native Americans with VKH disease present at a younger age and have greater risk of legal blindness, ocular hypotony, and poor visual outcome than non-native patients with VKH disease despite immunosuppression. Further studies are warranted to better understand these differences.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Ocular Features and Outcomes of Native Americans vs Non-Natives with Vogt-Koyanagi-Harada Disease
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