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Visual field loss occurs faster with uveitis
The rate of visual field loss in patients with glaucoma appears to occur faster in those with uveitis compared to those without, according to findings published in the American Journal of Ophthalmology.
Xiaoxuan Liu, MBChB, and colleagues examined the rates of visual field loss in patients with uveitis and glaucoma against patients with primary open-angle glaucoma only to determine the association between IOP and the rate of visual field loss.
“The prevalence of treated glaucoma varies from 20% to 30% in most cohorts. Accurate stratification of patients at risk of uveitic glaucoma is necessary to identify those at high risk of irreversible vision loss,” Liu, of the University Hospitals Birmingham NHS Foundation trust and the Institute of Inflammation & Aging at the University of Birmingham, and colleagues wrote. “Intensive monitoring and active intervention are important to prevent irreversible visual impairment in these patients.”
In the retrospective study, the researchers anonymized visual field and IOP measurements taken from five glaucoma clinics in England. Liu and colleagues compared 205 eyes diagnosed with uveitis and glaucoma with 4,600 eyes with primary open-angle glaucoma only. Longitudinal IOP mean, range and variability were compared with rate of visual field progression.
The median baseline mean deviation in the uveitis group was –3.8 decibels (95% CI, –8.7 to –1.5) compared with the primary open-angle glaucoma group –3.1 (95% CI, –6.6 to –1.2), the researchers wrote. Rapid progression was found in 23 of the eyes with uveitis compared with 331 of the eyes with primary open-angle glaucoma.
The age-adjusted relative risk for the rapid progression in uveitic vs. primary open-angle glaucoma eyes was 1.9 (95% CI, 1.8-2), Liu and colleagues wrote.
In a mixed-effects model, there were higher rates of visual field progression in the uveitic eyes compared with the primary open-angle glaucoma group (–0.49 dB/year vs. –0.37 dB/year; P < .01), the researchers wrote. IOP range and variability were higher in rapidly progressing uveitic eyes.
“We suggest a low threshold for glaucoma screening in patients with uveitis, even if IOP is within normal limits and particularly in the presence of a fluctuating IOP,” Liu and colleagues wrote. – by Earl Holland Jr.
Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Uveitis is the fourth leading cause of blindness in working-age people throughout the developed world. Uveitis-associated macular edema, cataract and glaucoma are the specific causes, with glaucoma being the most concerning. How does uveitic glaucoma (UG) compare with primary open angle glaucoma (POAG)?
Liu and colleagues in their retrospective cohort study teach us something we already know. Patients with UG are more likely to progress than persons with POAG. Interestingly, they also found that UG patients had worse visual fields at glaucoma diagnosis than POAG patients. Additionally, UG patients were followed with IOP checks and visual fields at the same frequency as their POAG counterparts.
How will this inform your practice? First, please remember that uveitis patients are at higher risk of developing glaucoma. Make sure your patients have a good understanding of their disease and its sight-threatening potential. Second, carefully monitor your uveitis patients for glaucoma. Finally, when your uveitis patient develops glaucoma, monitor closely, treat aggressively and be quick to seek an expert opinion.
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