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Vision-threatening consequences of uveitis may be underappreciated
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CHICAGO — Uveitis is a significant cause of blindness around the world and its vision-impacting complications are perhaps underappreciated.
According to the published literature, between 2.4% and 10% of the world's blindness is due to uveitis, although different definitions of what constitutes blindness, as well as disparities in how blindness is reported, may not accurately depict the prevalence of blindness due to uveitis, David C. Gritz, MD, said here at Uveitis Subspecialty Day prior to the joint meeting of the American Academy of Ophthalmology and the Middle East Africa Council of Ophthalmology.
A major review by Rothova et al, published in 1999, found that 35% of uveitis patients had some degree of vision loss, while 4% were legally blind by World Health Organization standards. On the other hand, a population-based survey conducted in Northern California reported 19.1% of patients had some degree of vision loss, and 1.1% were legally blind by US definitions.
Pediatric onset of uveitis, which is arguably rarer than adult onset, appears to be vision-threatening more often, Dr. Gritz said.
The published literature suggests that between 15% to 38% of pediatric uveitis patients are blinded, with the level of inflammation on presentation being a major risk factor.
Around 58% of patients presenting with synechiae have a final vision worse than 20/200, Dr. Gritz said.
"This is an area where it is important for the general ophthalmologist not to hold onto the patient for too long," Dr. Gritz said referring to patients presenting with synechiae.
Uveitis continues to cause blindness 60 years after the first drop of corticosteroid was ever used as treatment. Uveitis continues to blind primarily because most ophthalmologists around the globe fail to appreciate not only the blinding potential of uveitis, but also the chronic use of corticosteroids employed endlessly for the treatment of uveitis patients when far better and safer therapies are available. Therefore, the relationship continues with uveitis, corticosteroid monotherapy and blindness, and I predict it will continue until more ophthalmology departments recruit onto their faculty ophthalmologists who are trained in the subspecialty of ocular immunology. That way, succeeding generations of graduates from those programs will learn there are more advanced treatment options to employ in the fight for a uveitis cure, rather than simply continue corticosteroid monotherapy.
– C. Stephen Foster, MD
Cambridge, Mass.