Improving paediatric uveitis visual outcomes and quality of life.

Abstract

Purpose : To investigate visual outcomes and perceived quality of life of paediatric patients with uveitis treated in a multidisciplinary clinic involving Ophthalmologists and Rheumatologists at a tertiary children's hospital.

Methods : Review of all paediatric uveitis patients presenting to the Children’s Hospital Westmead, Sydney Eye Hospital and Save Sight Institute from 2005-2020. Inclusion criteria includes less than 18 years age of diagnosis, any form of diagnosis of uveitis based on SUN criteria, follow up at least 3 months, WGA paediatric glaucoma guidelines for OHT and glaucoma, ocular morbidities and treatment of the uveitis. Completion of 3 validated instruments for children to assess (1) functional visual ability (FVA) with the Cardiff Visual Ability Questionnaire for Children (CVAQC), (2) VR QoL with the Impact of Vision Impairment for Children (IVI-C), and (3) HR QoL with the Pediatric Quality of Life Inventory (PedsQL) version 4.0.

Results : There were 111 patients (207 eyes) diagnosed with paediatric uveitis 2005-2020. There were 61 female and 48 male patients. The most common aetiological diagnoses was JIA-U (n =65, 59%) followed by Idiopathic uveitis (n = 33, 29.6%) with 84% being anterior uveitis and 16% being non-anterior uveitis. Fifty-three patients were on Methotrexate/Mycophenolate, 30 patients on Adalimumab, 3 patients Infliximab, 3 patients on Tocilizumab and 2 patients Tofacitinib. The mean duration of inflammation prior to commencement of a biological agent was 22.0 months (range: 1-48 months). Over 50% eyes diagnosed with uveitis developed raised IOP at some point, 43/207 eyes (21%) had glaucoma surgery. Mean VA significantly improved after 6 weeks of biological therapy and then was maintained over 12 months. Scores for FVA, VR QoL, and HR QoL were reduced in children with paediatric uveitis. Patients and family members reported improved quality of life being able to be seen by all treating doctors at the same multidisciplinary clinic.

Conclusions : Paediatric uveitis has a marked effect on FVA and QoL. Control of intraocular inflammation is essential in paediatric uveitis. Rapid taper of any steroids crucial as ocular hypertension /glaucoma and cataract is dose and duration dependent. Commencing a step ladder of systemic therapy quickly if steroid treatment not working. Biological therapy reduced intraocular inflammation with maintained visual acuity. Multidisciplinary clinics are gold standard treatment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.