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Zhang Z, Griva K, Rojas-Carabali W, Patnaik G, Liu R, Sobrin L, Kempen JH, Finger RP, Gupta V, Ang B, Agrawal R. Psychosocial Well-Being and Quality of Life in Uveitis: A Review. Ocul Immunol Inflamm 2024; 32:1380-1394. [PMID: 37713271 DOI: 10.1080/09273948.2023.2247077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE As a potentially sight-threatening disease with ocular, systemic, and treatment-related complications, uveitis diminishes quality of life (QOL) and affects psychosocial well-being. This review summarizes the existing tools for evaluating psychosocial well-being and/or QOL in patients with uveitis, explores the biological and non-biological factors affecting psychosocial well-being and/or QOL, and proposes future directions for incorporating these tools into clinical practice. METHODS A systematic search of the MEDLINE, Embase, and Cochrane databases from inception to June 8, 2022 was conducted, screening for articles focused on psychosocial well-being and/or QOL in patients with uveitis. Both quantitative and qualitative analyses were performed. RESULTS In uveitis research, the most frequently studied patient-reported outcome measures were vision-related QOL (e.g. Visual Function Questionnaire [VFQ-25]) and health-related QOL (e.g. Short Form Survey [SF-36]), followed by mental health indicators including depression and anxiety. Instruments have also been developed specific to the pediatric population (e.g. Effects of Youngsters' Eyesight on Quality of Life [EYE-Q]). Generally, studies report worse psychosocial outcomes and QOL in patients with uveitis compared to the general population. Contributory factors include both clinical (e.g. visual impairment, ocular comorbidities) and patient-related (e.g. older age, female sex) factors. CONCLUSION Given the heterogeneity of instruments used, it is worth considering standardization across large uveitis studies and trials. Beyond research, given the biopsychosocial effects on patients with uveitis, there are benefits to incorporating QOL and psychosocial assessments into clinical practice. Simplification of questionnaires into abridged forms, focusing on the most clinically relevant aspects of patient care, may be considered.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gazal Patnaik
- Sankara Netralaya, Medical Research Foundation, Chennai, India
| | - Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM Comprehensive Specialized Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Robert P Finger
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bryan Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Xie JS, Ocampo V, Kaplan AJ. Anterior uveitis for the comprehensive ophthalmologist. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00238-2. [PMID: 39128830 DOI: 10.1016/j.jcjo.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
Anterior uveitis presents a diagnostic challenge due to its wide array of etiologies and clinical manifestations. This narrative review aims to equip general ophthalmologists with a comprehensive understanding of anterior uveitis epidemiology, diagnosis, and treatment. Particular emphasis is placed on developing a tailored and stepwise strategy, rather than a one-size-fits-all approach, for the workup and treatment of anterior uveitis. Chest radiography and serologic testing for syphilis, human leukocyte antigen B27, and angiotensin-converting enzyme are appropriate routine investigations in cases of severe, bilateral, recurrent, or chronic anterior uveitis. Additional testing should be guided by clinical findings and regional epidemiology, especially when considering expensive and invasive modalities. Investigations that are obtained in the absence of clinical and epidemiologic orientation are of limited utility and incur significant costs to patients and health care systems. Most cases of anatomically isolated anterior uveitis resolve with topical corticosteroids, but some patients require escalation to systemic immunomodulatory therapy (IMT). IMT should be considered in patients who respond poorly to corticosteroids, develop side effects related to corticosteroids that limit their use, require high doses to maintain disease remission, or have concomitant systemic inflammatory disease. Comprehensive ophthalmologists should feel comfortable comanaging patients that require conventional disease-modifying antirheumatic drugs/antimetabolite therapy (i.e., methotrexate, azathioprine, and mycophenolate mofetil) with rheumatologists and providing guidance on ocular dosing. When uveitis quiescence cannot be achieved despite maximally tolerated antimetabolite therapy, patients should be referred to a uveitis specialist for consultation and consideration of IMT escalation. The timing of uveitis referral may depend on local factors specific to health care jurisdictions.
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Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vanessa Ocampo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Scarborough Health Network, Rheumatology Department, Scarborough, ON, Canada
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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Souto FMS, Missaka RFBG, Lavezzo MM, Nóbrega PFC, Sakata VM, Oyamada MK, Hirata CE, Yamamoto JH. Quality of Life (QoL) in Non-Acute Vogt-Koyanagi-Harada Disease (VKHD) at Two Time Points 24 Months Apart. Ocul Immunol Inflamm 2024; 32:384-390. [PMID: 36637906 DOI: 10.1080/09273948.2022.2152697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/01/2022] [Accepted: 11/11/2022] [Indexed: 01/14/2023]
Abstract
AIMS To investigate the changes in quality-of-life (QoL) metrics at a 24-month interval in non-acute VKHD patients and their association with inflammation, treatment, and visual function. METHODS SF-36 and VFQ-25 questionnaires were administered at two 24-month-apart moments to 22 non-acute VKHD patients followed for ≥12 months since acute disease onset. "Improvement," "unchanged," or "worsening" in questionnaires scores (difference >5-point) between M1 and M2 and their associations were sought. RESULTS Absence of systemic treatment or optic disc hyperfluorescence was associated with improved general health (SF-36). Improvement in binocular contrast sensitivity resulted in better ocular pain score; absence of anterior uveitis relapse, stable fundus findings, no use of cyclosporine or no intravitreal injections resulted in unchanged/better dependency score; no intravitreal injections resulted in unchanged/better mental health score (VFQ-25). CONCLUSION Stability/improvement in QoL scores was associated with controlled inflammation, better visual function, and no need for treatment. Subclinical inflammatory signs did not impact QoL scores.
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Affiliation(s)
| | | | - Marcelo Mendes Lavezzo
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Maria Kiyoko Oyamada
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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Foeldvari I, Petrushkin H. How should we approach management of childhood onset chronic anterior uveitis refractory to adalimumab? Expert Rev Clin Immunol 2024; 20:267-276. [PMID: 37990508 DOI: 10.1080/1744666x.2023.2284845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The management of refractory juvenile idiopathic associated uveitis (JIAU) or childhood-onset chronic anterior uveitis (CAU) is a challenge. There is no clear consensus or evidence base for to suggest the most appropriate therapy after primary or secondary failure of biweekly adalimumab. In this scenario, most clinicians advocate switching to another anti-tumor necrosis factor alpha inhibitor; however, there are a variety of other disease modifying agents to choose from albeit with a differing levels of evidence. AREAS COVERED We discuss how to define nonresponse and potential treatment options for patients with JIAU and CAU refractory to biweekly adalimumab. EXPERT OPINION Uncontrolled CAU and JIAU remain one of the most challenging diseases to manage and can lead to irreversible loss of vision in a third of those affected. Amongst the possible choices, weekly adalimumab, infliximab, tocilizumab and abatacept have more evidence to support their use. JAK inhibitors seem to be a promising option. Golimumab and Rituximab has also been thought to be partially effective in some refractory cases, whereas IL-17, IL-23, and IL-12 inhibition along with apremilast seem not to be a therapeutic option currently. The route of administration should also be considered as there can be significant pros and cons for different children.
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Affiliation(s)
- Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence An der Schön Klinik Hamburg Eilbek, Hamburg, Germany
- Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, Hungary
| | - Harry Petrushkin
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Great Ormond Street Hospital For Children, NHS Foundation Trust, London, UK
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Senthil MP, Simon S, Constable PA. A review of patient-reported outcome measures used in uveitis. Surv Ophthalmol 2023; 68:225-240. [PMID: 36395825 DOI: 10.1016/j.survophthal.2022.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
We review patient-reported outcome measures (PROMs) used to evaluate the quality of life (QoL) in uveitis and provide a quality assessment of the psychometric properties of the PROMs, making it easier to choose the best questionnaire for uveitis. Our review included 158 articles. A total of 98 PROMs were used to measure QoL in uveitis and the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ -25) was the most frequently used PROM in these studies. There were 5 uveitis-specific PROMs, but they were meant for either birdshot choroidopathy or cytomegalovirus retinitis or paediatric uveitis. There are no PROMs developed explicitly for the more common, anterior uveitis, intermediate uveitis, panuveitis, and chronic uveitis. The uveitis-specific PROMs performed better in our quality assessment criteria compared to other PROMs. However, these PROMs were constructed using traditional classical test theory and have not been assessed using the modern family of psychometric assessment methods such as Rasch analysis. As new therapeutic modalities for uveitis such as the new biological agents and steroid implants, continue to evolve, a comprehensive PROM will be increasingly valued in clinical trial settings to compare the effects of treatments from the patient's perspective.
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Affiliation(s)
- Mallika Prem Senthil
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.
| | - Sumu Simon
- University of Adelaide, Adelaide, South Australia, Australia
| | - Paul A Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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Psychological Effects and Quality of Life in Parents and Children with Jia-Associated Uveitis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121864. [PMID: 36553308 PMCID: PMC9777304 DOI: 10.3390/children9121864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease common in children and young adults. Uveitis is the most frequent serious extra-articular JIA manifestation and can lead to severe ocular complications, vision loss, and permanent blindness. This study aims to evaluate the psychological condition and the quality of life of children affected by JIA associated with uveitis (JIA-U) and the repercussion of this condition on parents. Thirty children and adolescents with active uveitis (Uveitis group) and comorbid joint symptoms of JIA were referred to the Unit of Ophthalmology, Giovanni XXIII Hospital of Bari, and 30 age-matched healthy controls (Healthy group) were enrolled with their parents. Four questionnaires were administered: Child Behaviour Checklist (CBCL), Parent Stress Index in Short Form (PSI), Pediatric Quality of Life Inventory (PedsQL), and Coping Inventory for Stressful Situations (CISS). The data were collected from February 2021 to December 2021. No significant differences between the two groups in CBCL, PSI, or CISS tests were shown (p > 0.05). Conversely, significant differences between the two groups were observed in the PedsQL (p < 0.05). This study shows how several ocular complications, recurrent eye examinations, and the rigor of long-term treatment may negatively influence health-related quality of life in children with JIA-U.
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McDonald J, Cassedy A, Altaye M, Andringa J, Cooper AM, Drews-Botsch C, Engelhard G, Hennard T, Holland GN, Jenkins K, Lambert SR, Lipscomb J, McCracken C, McCurdy DK, Mwase N, Prahalad S, Shantha J, Stahl E, Miraldi Utz V, Walker AA, Yeh S, Angeles-Han ST. Comprehensive Assessment of Quality of Life, Functioning, and Mental Health in Children With Juvenile Idiopathic Arthritis and Noninfectious Uveitis. Arthritis Care Res (Hoboken) 2022; 74:1311-1320. [PMID: 33421338 PMCID: PMC8267048 DOI: 10.1002/acr.24551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric uveitis can lead to sight-threatening complications and can impact quality of life (QoL) and functioning. We aimed to examine health-related QoL, mental health, physical disability, vision-related functioning (VRF), and vision-related QoL in children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis (JIA-U), and other noninfectious uveitis. We hypothesized that there will be differences based on the presence of eye disease. METHODS A multicenter cross-sectional study was conducted at four sites. Patients with JIA, JIA-U, or noninfectious uveitis were enrolled. Patients and parents completed the Pediatric Quality of Life Inventory (PedsQL; health-related QoL), the Revised Childhood Anxiety and Depression Scale (RCADS; anxiety/depression), the Childhood Health Assessment Questionnaire (C-HAQ; physical disability), and the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) (VRF/vision-related QoL). Clinical characteristics and patient-reported outcome measures were compared by diagnosis. RESULTS Of 549 patients, 332 had JIA, 124 had JIA-U, and 93 had other uveitis diagnoses. Children with JIA-U had worse EYE-Q scores compared to those with JIA only. In children with uveitis, those with anterior uveitis (JIA-U and uveitis only) had less ocular complications, better EYE-Q scores, and worse C-HAQ and PedsQL physical summary scores compared to those with nonanterior disease. In children with anterior uveitis, those with JIA-U had worse PedsQL physical summary and C-HAQ scores than anterior uveitis only. Further, EYE-Q scores were worse in children with bilateral uveitis and more visual impairment. There were no differences in RCADS scores among groups. CONCLUSION We provide a comprehensive outcome assessment of children with JIA, JIA-U, and other uveitis diagnoses. Differences in QoL and function were noted based on underlying disease. Our results support the addition of a vision-specific measure to better understand the impact of uveitis.
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Affiliation(s)
- Joseph McDonald
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Ashley M. Cooper
- Division of Rheumatology, Children’s Mercy Hospital, Kansas City, MO and Department of Pediatrics, University of Missouri-Kansas City
| | - Carolyn Drews-Botsch
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - George Engelhard
- Division of Educational Psychology, The University of Georgia, Athens, GA
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Gary N. Holland
- UCLA Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, CA
| | | | | | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Deborah K. McCurdy
- Department of Pediatrics and David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Childrens Healthcare of Atlanta
| | - Jessica Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
| | - Erin Stahl
- Section of Pediatric Ophthalmology, Children’s Mercy Hospital, Kansas City, MO and Department of Ophthalmology, University of Missouri-Kansas City
| | - Virginia Miraldi Utz
- Division of Ophthalmology, Cincinnati Children’s Hospital Medical Center and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
| | - Sheila T. Angeles-Han
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
- Section of Pediatric Ophthalmology, Children’s Mercy Hospital, Kansas City, MO and Department of Ophthalmology, University of Missouri-Kansas City
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Occurrence and Risk Factors for Macular Edema in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis. J Clin Med 2021; 10:jcm10194513. [PMID: 34640527 PMCID: PMC8509447 DOI: 10.3390/jcm10194513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose: To analyze occurrence and risk factors for macular edema (ME) in juvenile idiopathic arthritis-associated uveitis (JIA-U). Methods: Retrospective analysis of patients with JIA-U at a tertiary referral uveitis center between 2000 and 2019. Epidemiological data and clinical findings before ME onset were evaluated. Results: Out of 245 patients, ME developed in 41 (18%) of the 228 JIA-U patients for whom data documentation was complete during the follow-up (mean 4.0 ± 3.8 years). Risk factors (univariable logistic regression analysis) at baseline for subsequent ME onset included older age at initial documentation at institution (hazard ratio, HR 1.19, p < 0.0001), longer duration of uveitis at initial documentation (HR 1.17, p < 0.0001), worse best-corrected visual acuity (BCVA; HR 2.49, p < 0.0001), lower intraocular pressure (IOP; HR 0.88, p < 0.01), band keratopathy (HR 2.29, p < 0.01), posterior synechiae (HR 2.55, p < 0.01), epiretinal membrane formation (HR 6.19, p < 0.0001), optic disc swelling (HR 2.81, p < 0.01), and cataract (HR 4.24, p < 0.0001). Older age at initial documentation at institution (HR 1.55, p < 0.001), worse BCVA (HR 28.56, p < 0.001), and higher laser-flare photometry (LFM) values (HR 1.003, p = 0.01) were independent risk factors for ME manifestation. Patients with ME revealed significant changes in BCVA, LFM, and IOP and new optic disc swelling at 6 and 3 months before ME onset compared to timepoint of ME occurrence (p < 0.05, each). Conclusion: ME is a common complication of JIA-U. Demographic risk factors and courses of IOP, BCVA, and LFM may indicate patients at risk for ME onset.
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Mueller CM, Ward L, O'Keefe GAD. Health Literacy, Medication Adherence, and Quality of Life in Patients With Uveitis. Ocul Immunol Inflamm 2021; 30:1060-1067. [PMID: 33739905 DOI: 10.1080/09273948.2020.1861304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluate health literacy, medication adherence, and quality of life (QOL) in uveitis patients.Methods: Cross-sectional quality improvement study using questionnaires of health literacy (Short Assessment of Health Literacy), adherence (Beliefs about Medicine Questionnaire), and QOL (12-item Short Form Health Survey).Results: Sixty patients were surveyed: 57% women, 80% identified as Black, and 42% with schooling beyond high school. Forty-three percent of the patients had poor health literacy, with lower scores among those with less schooling (p < .01). Necessity scores were higher for multiple providers (p = .02). Necessity (p = .03) and Concerns (p < .01) scores were higher for patients seeing a rheumatologist. Patients had lower physical (p < .01) and mental QOL (p < .01) than the general US population.Conclusions: Uveitis patients reported many barriers to care. Despite strong perceptions of treatment necessity, there were significant concerns, especially among patients seeing a rheumatologist. We recommend multidisciplinary care, individualized education, and counseling regarding medication safety and the necessity to improve adherence.
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Affiliation(s)
- Claire M Mueller
- Department of Ophthalmology, Oregon Health & Science University Casey Eye Institute, Resident, Portland, OR, USA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Associate Faculty, Emory University, Atlanta, GA, USA
| | - Ghazala A Datoo O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Assistant Professor of Ophthalmology, Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Atlanta, GA, USA
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García-Aparicio Á, García de Yébenes MJ, Otón T, Muñoz-Fernández S. Prevalence and Incidence of Uveitis: A Systematic Review and Meta-analysis. Ophthalmic Epidemiol 2021; 28:461-468. [PMID: 33557663 DOI: 10.1080/09286586.2021.1882506] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Although the impact of uveitis on people's lives is clear, the frequency of this condition is unclear.Objective: To estimate the prevalence and incidence of uveitis.Methods: A systematic review with meta-analysis was conducted. Medline, Embase, and Cochrane Library were searched from inception to January 2019. The quality of the included studies was critically appraised with a grading system based on the Oxford Levels of Evidence. A detailed description of the populations studied and of factors affecting estimates was undertaken. Pooled analyses were conducted using a random-effects approach and expressed as incidence rates per 100,000 with 95% confidence intervals. Subgroup analyses by geographical region were conducted along with meta-regression to analyze possible factors for heterogeneity.Results: A total of 49 studies were included and critically appraised. Twenty-two were population-based, and 27 hospital-based. Heterogeneity was substantial in terms of populations studied, methods for ascertaining uveitis, including definitions, and reporting of results. This was especially important in prevalence studies, with data ranging from 9 to 730 cases per 100,000. For incidence studies, the meta-analysis yielded a pooled incidence of 50.45 per 100.000. The meta-regression showed the geographic region as an important explanatory factor of the heterogeneity between studies.Conclusion: Population-based estimates of the epidemiology of uveitis vary widely, owing to methodologies employed, definitions of uveitis and geographical regions; the representativeness and generalizability of many epidemiological studies of uveitis are limited.
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Affiliation(s)
- Ángel García-Aparicio
- Department of Rheumatology, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | - Teresa Otón
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Santiago Muñoz-Fernández
- Department of Rheumatology, Infanta Sofía University Hospital, San Sebastián de los Reyes, and Biomedical Science and Health Faculty, Universidad Europea, Madrid, Spain
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Prem Senthil M, Lim L, Braithwaite T, Denniston A, Fenwick EK, Lamoureux E, Khadka J, Pesudovs K. The Impact of Adult Uveitis on Quality of Life: An Exploratory Study. Ophthalmic Epidemiol 2020; 28:444-452. [PMID: 33345711 DOI: 10.1080/09286586.2020.1856385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE: This exploratory qualitative research was conducted to understand the quality of life (QoL) impacts of adult uveitis to develop a uveitis QoL item bank, and we present here the results of qualitative analysis of uveitis patient experience.METHODS: A qualitative approach with phenomenological study design was employed to explore the common QoL domains in uveitis. Data were collected using focus groups and face-to-face interviews. The sessions were audio-recorded, transcribed verbatim, and analysed thematically. NViVo software was used to perform qualitative analysis.RESULTS: Eight focus groups and 10 interviews were conducted with 41 patients with uveitis. Seven QoL domains were identified, namely symptoms, emotional, activity limitation, health concerns, convenience, social, and economic impact. Although these QoL domains have been previously identified in other eye diseases, the sub-themes within each QoL domain were unique to uveitis. Participants described a variety of symptoms including increased light sensitivity, blurred vision, pain, redness, and tearing. Participants repeatedly described feeling frustrated due to prognostic uncertainty and associated discomfort. Participants were concerned about the frequent relapses of inflammation, as well as side-effects from long-term systemic medications. Uveitis affected their ability to perform daily tasks such as using computers, driving, and reading books. Direct financial impacts included reduced work hours and the costs of treatment and specialist care.CONCLUSION: Participants with uveitis experience many symptoms in addition to medication-related inconveniences and activity limitations. The QoL issues identified will be used to develop a uveitis-specific QoL item bank.
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Affiliation(s)
- Mallika Prem Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lyndell Lim
- Centre for Eye Research Australia, University of Melbourne, the Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Alastair Denniston
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jyoti Khadka
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,University of South Australia Business School, Adelaide, Australia
| | - Konrad Pesudovs
- University of New South Wales, Sydney, Australia.,Anglia Ruskin University, Cambridge, UK
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12
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Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
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Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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13
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Cassedy A, Altaye M, Andringa J, Cooper AM, Drews-Botsch C, Engelhard G, Hennard T, Holland GN, Jenkins K, Lambert SR, Lipscomb J, McCracken C, McCurdy DK, McDonald J, Mwase N, Prahalad S, Stahl E, Miraldi Utz V, Walker AA, Yeh S, Angeles-Han ST. Assessing the validity and reliability of the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire among children with uveitis. Arthritis Care Res (Hoboken) 2020; 74:355-363. [PMID: 33085849 DOI: 10.1002/acr.24491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/05/2022]
Abstract
PURPOSE The Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire measures vision-related functioning (VRF) and vision-related quality of life (VRQOL) in children with uveitis. Our aim was to revise the Alpha version of the EYE-Q to refine VRF and VRQOL subscales and assess the validity of the EYE-Q. METHODS Children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis, and other non-infectious uveitis were enrolled. Patients and parents completed the EYE-Q, PedsQL (overall QOL), and CHAQ (physical functioning). The Development site completed the Alpha version of the EYE-Q, and the Composite sites completed the Beta version. We compared item-subscale correlations, internal consistency, construct and discriminant validity amongst the different versions. RESULTS Of the 644 patients enrolled, 61.6% completed the Alpha version, and 38.4% the Beta version of the EYE-Q. Mean patient age was 11.1 (SD = 4.2) years, and 70% were female. Fewer white patients (73.5%) completed the Alpha version compared to the Beta version (86.2%, p <0.001). With the exception of patient-reported VRF, both versions had similar item-subscale correlations. Version comparisons on scale internal consistencies indicated significant differences for parent- and patient-reported VRF, but each scale had a Cronbach's Alpha >0.80 Beta. When data were combined, the EYE-Q showed significant differences between JIA-only and uveitis patients on all parent and patient scores, except for patient-reported VRF. CONCLUSION The EYE-Q appears to be a valid measure of VRF and VRQOL in pediatric uveitis. Our results suggest it may be used as an outcome measure in multi-center pediatric uveitis studies.
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Affiliation(s)
- Amy Cassedy
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | | | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - George Engelhard
- Division of Educational Psychology, The University of Georgia, Athens, GA, United States
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Gary N Holland
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | | | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Deborah K McCurdy
- Department of Pediatrics and David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Joseph McDonald
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Childrens Healthcare of Atlanta
| | - Erin Stahl
- Children's Mercy Hospital, Kansas City, MO, United States
| | - Virginia Miraldi Utz
- Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheila T Angeles-Han
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
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14
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Ailioaie LM, Litscher G. Molecular and Cellular Mechanisms of Arthritis in Children and Adults: New Perspectives on Applied Photobiomodulation. Int J Mol Sci 2020; 21:E6565. [PMID: 32911717 PMCID: PMC7554967 DOI: 10.3390/ijms21186565] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Juvenile idiopathic arthritis and adult rheumatoid arthritis are two major groups with chronic joint pain and inflammation, extra-articular manifestations, and high risk of comorbidities, which can cause physical and ocular disability, as well as create great socio-economic pressure worldwide. The pathogenesis of arthritis manifested in childhood and adulthood is multifactorial, unclear, and overly complex, in which immunity plays an important role. Although there are more and more biological agents with different mechanisms of action for the treatment of arthritis, the results are not as expected, because there are partial responses or non-responsive patients to these compounds, high therapeutic costs, side effects, and so on; therefore, we must turn our attention to other therapeutic modalities. Updating knowledge on molecular and cellular mechanisms in the comparative pathogenesis of chronic arthritis in both children and adults is necessary in the early and correct approach to treatment. Photobiomodulation (PBM) represents a good option, offering cost-effective advantages over drug therapy, with a quicker, more positive response to treatment and no side effects. The successful management of PBM in arthritis is based on the clinician's ability to evaluate correctly the inflammatory status of the patient, to seek the optimal solution, to choose the best technology with the best physical parameters, and to select the mode of action to target very precisely the immune system and the molecular signaling pathways at the molecular level with the exact amount of quantum light energy in order to obtain the desired immune modulation and the remission of the disease. Light is a very powerful tool in medicine because it can simultaneously target many cascades of immune system activation in comparison with drugs, so PBM can perform very delicate tasks inside our cells to modulate cellular dysfunctions, helping to initiate self-organization phenomena and finally, healing the disease. Interdisciplinary teams should work diligently to meet these needs by also using single-cell imaging devices for multispectral laser photobiomodulation on immune cells.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iaşi, Romania;
- Ultramedical & Laser Clinic, 83 Arcu Street, 700135 Iaşi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, and Traditional Chinese Medicine (TCM) Research Center Graz, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
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15
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Grazziotin LR, Currie G, Kip MMA, IJzerman MJ, Twilt M, Lee R, Marshall DA. Health State Utility Values in Juvenile Idiopathic Arthritis: What is the Evidence? PHARMACOECONOMICS 2020; 38:913-926. [PMID: 32390065 DOI: 10.1007/s40273-020-00921-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objectives of this systematic review were to identify health state utility values (HSUV) of children and adults with juvenile idiopathic arthritis in the literature and to assess whether HSUV were appropriately reported and could be used to inform parameter inputs for a model-based cost-utility analysis to inform decision making. METHODS MEDLINE, EMBASE, PsycINFO, EconLit and CINAHL databases were searched in July 2019. Inclusion criteria were studies using preference-based instruments, targeting children or adults with juvenile idiopathic arthritis, and in the English language. The quality of studies was assessed using a modified checklist that included relevant sources of bias and assessment of quality of HSUV valuation and measurement. A descriptive analysis was conducted, including assessment on reporting of population characteristics and stratification of HSUV by potential health states or population subgroup. RESULTS From 620 identified articles, ten reported HSUV. Seven studies reported HSUV of children with juvenile idiopathic arthritis, and three of adults with a history of juvenile idiopathic arthritis. Population disease activity status and drug treatment were reported in less than half of the studies. Six (out of ten) studies stratified HSUV results for at least one of the potential health state categories, but they represent very specific situations or interventions (e.g. patients receiving different types of physiotherapy or treated with etanercept over time). CONCLUSIONS We have identified critical gaps in the literature reporting HSUV in patients with juvenile idiopathic arthritis including a lack of HSUV measures for distinct health states, particularly in adults with a history of juvenile idiopathic arthritis. The current reported HSUV data in juvenile idiopathic arthritis are insufficient for a full cost-utility analysis with a short or lifetime horizon.
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Affiliation(s)
- Luiza Raquel Grazziotin
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gillian Currie
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Raymond Lee
- Alberta Health Services, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Room 3C56, Health Research Innovation Centre, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
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16
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Bertrand PJ, Jamilloux Y, Kodjikian L, Errera MH, Perard L, Pugnet G, Tieulie N, Andre M, Bielefeld P, Bron AM, Decullier E, Bin S, Seve P. Quality of life in patients with uveitis: data from the ULISSE study (Uveitis: cLInical and medico-economic evaluation of a Standardised Strategy for the Etiological diagnosis). Br J Ophthalmol 2020; 105:935-940. [PMID: 32709757 DOI: 10.1136/bjophthalmol-2020-315862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/12/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022]
Abstract
AIMS To assess vision-related (VR-QOL) and health-related quality of life (HR-QOL) in a large series of patients with de novo uveitis at baseline and 6-month follow-up. METHODS Non-inferiority, prospective, multicentre, cluster randomised controlled trial registered under the Unique Identifier: NCT01162070. VR-QOL and HR-QOL were assessed by the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and the Medical Outcomes Study 36-item Short Form Survey (SF-36). RESULTS At inclusion, 466 patients completed the VFQ-25. The mean composite score was 80.0 (±16.7). In multivariate analysis, higher age, female sex and insidious onset were significantly associated with lower QOL. At 6 months, 138 patients completed the VFQ-25, with a significantly higher mean composite score of 82.6 (±16.7). SF-36 mental component was 42.9 (±11.3) and physical component was 47.2 (±8.5) at inclusion (n=425). HR-QOL improvement at 6 months was not clinically significant. CONCLUSION QOL seems relatively well preserved in this cohort; only VR-QOL improved significantly at 6 months, especially in patients with low initial visual acuity.
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Affiliation(s)
| | - Yvan Jamilloux
- Internal Medicine, Hopital De La Croix-Rousse,Lyon, France
| | - Laurent Kodjikian
- Ophthalmology, Croix Rousse University Hospital, Hospices Civils De Lyon, Lyon, France
| | | | - Laurent Perard
- Internal Medicine, Edouart Herriot University Hospital, Hospices Civils De Lyon, Lyon, France
| | - Gregory Pugnet
- Department of Internal Medicine, Purpan University Hospital, Toulouse, France
| | | | - Marc Andre
- Médecine Interne, Hopital Gabriel Montpied, Clermont-Ferrand,France
| | - Philip Bielefeld
- Médecine Interne, Centre Hospitalier Universitaire De Dijon, Dijon, France
| | - Alain M Bron
- Ophthalmology, University Hospital, Dijon, France
| | | | - Sylvie Bin
- Pole IMER Lyon, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- Internal Medicine, Hospices Civils De Lyon, Lyon, France
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17
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Souto FMS, Missaka RFBG, Magalhães BM, Caetano VMC, Takiuti JT, Lavezzo MM, Sakata VM, Oyamada MK, Hirata CE, Yamamoto JH. Impact of Inflammation and Treatment on Self-reported Quality of Life in Patients with Non-acute Vogt-Koyanagi-Harada Disease (VKHD). Ocul Immunol Inflamm 2019; 29:137-148. [PMID: 31671020 DOI: 10.1080/09273948.2019.1668431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: To evaluate associations between vision-related (VR-) and health-related (HR-) QoL metrics and inflammation and treatment in non-acute VKHD patients.Methods: Cross-sectional study in a tertiary center in Sao Paulo, Brazil with 22 patients with non-acute VKHD followed prospectively for ≥12 months since acute disease onset, with systematic evaluation and predefined treatment protocols. VR- and HR-QoL aspects were assessed by VFQ-25 and SF-36 questionnaires, respectively. Associations between the questionnaire's subscale item scores with inflammation and systemic medical therapies were assessed.Results: After generalized linear model analysis, worse VA, severe fundus changes, fluctuation of VA and fluctuation of anterior chamber cells impacted negatively on VR-QoL items. Higher cumulative total dose of corticosteroids and use of immunosuppressive therapy impacted negatively on both questionnaires.Conclusion: Worse VA, clinical inflammation and systemic treatment have a significant impact on VR- and HR-QoL questionnaires. Subclinical choroidal inflammation did not seem to impact QoL.
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Affiliation(s)
| | | | - Breno Marchiori Magalhães
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Victor Marcos Couto Caetano
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Julia Thiemi Takiuti
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Mendes Lavezzo
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Viviane Mayumi Sakata
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Department of Ophthalmology, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Maria Kiyoko Oyamada
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, LIM-33, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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18
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Foeldvari I, Klotsche J, Simonini G, Edelsten C, Angeles-Han ST, Bangsgaard R, de Boer J, Brumm G, Torrent RB, Constantin T, DeLibero C, Diaz J, Gerloni VM, Guedes M, Heiligenhaus A, Kotaniemi K, Leinonen S, Minden K, Miranda V, Miserocchi E, Nielsen S, Niewerth M, Pontikaki I, de Vicuna CG, Zilhao C, Yeh S, Anton J, Calzada J. Proposal for a definition for response to treatment, inactive disease and damage for JIA associated uveitis based on the validation of a uveitis related JIA outcome measures from the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Pediatr Rheumatol Online J 2019; 17:66. [PMID: 31575380 PMCID: PMC6774210 DOI: 10.1186/s12969-019-0345-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/03/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND JIA-associated uveitis (JIAU) is a serious, sight-threatening disease with significant long-term complications and risk of blindness, even with improved contemporary treatments. The MIWGUC was set up in order to propose specific JIAU activity and response items and to validate their applicability for clinical outcome studies. METHODS The group consists of 8 paediatric rheumatologists and 7 ophthalmologists. A consensus meeting took place on November 2015 in Barcelona (Spain) with the objective of validating the previously proposed measures. The validation process was based on the results of a prospective open, international, multi-centre, cohort study designed to validate the outcome measures proposed by the initial MIWGUC group meeting in 2012. The meeting used the same Delphi and nominal group technique as previously described in the first paper from the MIWGUC group (Arthritis Care Res 64:1365-72, 2012). Patients were included with a diagnosis of JIA, aged less than 18 years, and with active uveitis or an uveitis flare which required treatment with a disease-modifying anti-rheumatic drug. The proposed outcome measures for uveitis were collected by an ophthalmologist and for arthritis by a paediatric rheumatologist. Patient reported outcome measures were also measured. RESULTS A total of 82 patients were enrolled into the validation cohort. Fifty four percent (n = 44) had persistent oligoarthritis followed by rheumatoid factor negative polyarthritis (n = 15, 18%). The mean uveitis disease duration was 3.3 years (SD 3.0). Bilateral eye involvement was reported in 65 (79.3%) patients. The main findings are that the most significant changes, from baseline to 6 months, are found in the AC activity measures of cells and flare. These measures correlate with the presence of pre-existing structural complications and this has implications for the reporting of trials using a single measure as a primary outcome. We also found that visual analogue scales of disease activity showed significant change when reported by the ophthalmologist, rheumatologist and families. The measures formed three relatively distinct groups. The first group of measures comprised uveitis activity, ocular damage and the ophthalmologists' VAS. The second comprised patient reported outcomes including disruption to school attendance. The third group consisted of the rheumatologists' VAS and the joint score. CONCLUSIONS We propose distinctive and clinically significant measures of disease activity, severity and damage for JIAU. This effort is the initial step for developing a comprehensive outcome measures for JIAU, which incorporates the perspectives of rheumatologists, ophthalmologists, patients and families.
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Affiliation(s)
- Ivan Foeldvari
- Head of the Hamburg Centre for Pediatric and Adolescence Rheumatology Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest An der Schön Klinik Hamburg Eilbek Dehnhaide, 120 22081, Hamburg, Germany.
| | - Jens Klotsche
- 0000 0000 9323 8675grid.418217.9German Rheumatism Research Centre, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Gabriele Simonini
- 0000 0004 1757 2304grid.8404.8Rheumatology Unit- A. Meyer Children’s Hospital- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Clive Edelsten
- grid.420468.cDept Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Sheila T. Angeles-Han
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229; Department of Pediatrics, University of Cincinnati, Cincinnati, OH USA
| | - Regitze Bangsgaard
- Department of Ophthalmology, Copenhagen University Hospital Glostrup/Rigshospitalet, Copenhagen, Denmark
| | - Joke de Boer
- 0000000090126352grid.7692.aUMC Utrecht, Utrecht, Netherlands
| | - Gabriele Brumm
- 0000 0001 2180 3484grid.13648.38Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rosa Bou Torrent
- 0000 0001 0663 8628grid.411160.3Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain ,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Tamas Constantin
- 0000 0001 0942 9821grid.11804.3c2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | | | - Jesus Diaz
- 0000 0004 1768 8905grid.413396.aOphtalmology Department, Hospital Sant Pau, Barcelona, Spain ,0000 0001 0663 8628grid.411160.3Ophtalmology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Valeria Maria Gerloni
- 0000 0004 1757 2822grid.4708.bUniversità di Milano - Istituto Gaetano Pini, Milan, Italy
| | - Margarida Guedes
- 0000 0001 1503 7226grid.5808.5Pediatric Rheumatology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Kaisu Kotaniemi
- 0000 0000 9950 5666grid.15485.3dDepartment of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Leinonen
- 0000 0000 9950 5666grid.15485.3dDepartment of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Kirsten Minden
- 0000 0000 9323 8675grid.418217.9German Rheumatism Research Centre, 10117 Berlin, Germany ,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Vasco Miranda
- 0000 0001 1503 7226grid.5808.5Pediatric Ophthalmologist at the Centro Hospitalar Universitario do Porto, Teaching Unit of the Abel Salazar Institute of Biomedical Sciences, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Elisabetta Miserocchi
- 0000000417581884grid.18887.3eOcular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, Via Olgettina 60, 20122 Milan, Italy
| | - Susan Nielsen
- Department of Ophthalmology, Copenhagen University Hospital Glostrup/Rigshospitalet, Copenhagen, Denmark
| | - Martina Niewerth
- 0000 0000 9323 8675grid.418217.9German Rheumatism Research Centre, 10117 Berlin, Germany
| | - Irene Pontikaki
- 0000 0004 1757 2822grid.4708.bUniversità di Milano - Istituto Gaetano Pini, Milan, Italy
| | - Carmen Garcia de Vicuna
- 0000 0001 0663 8628grid.411160.3Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carla Zilhao
- 0000 0001 1503 7226grid.5808.5Pediatric Rheumatology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Steven Yeh
- 0000 0004 0583 4098grid.419974.6Emory Clinic, Atlanta, USA
| | - Jordi Anton
- 0000 0001 0663 8628grid.411160.3Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain ,Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Department of Surgery and Surgery Specializations. Universitat de Barcelona, Barcelona, Spain
| | - Joan Calzada
- 0000 0001 0663 8628grid.411160.3Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain ,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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19
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Solebo AL, Rahi JS, Dick AD, Ramanan AV, Ashworth J, Edelsten C. Areas of agreement in the management of childhood non-infectious chronic anterior uveitis in the UK. Br J Ophthalmol 2019; 104:11-16. [PMID: 31048286 DOI: 10.1136/bjophthalmol-2018-313789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS There is a paucity of high-level evidence to support the management of childhood uveitis, particularly for those children without juvenile idiopathic arthritis uveitis (JIA). We undertook a modified Delphi consensus exercise to identify agreement in the management of chronic anterior uveitis (CAU), the most common manifestation of childhood disease. METHODS A four-round, two-panel process was undertaken between June and December 2017. Paediatric uveitis specialists identified through multiple sources, including a multicentre network (the Paediatric Ocular Inflammation Group), were invited to participate. They were asked whether they agreed with items derived from existing guidelines on the management of JIA-U when extrapolated to the population of all children with CAU. Consensus was defined as agreement greater than or equal to 75% of respondents. RESULTS 26 of the 38 (68%) invited specialists participated with the exercise, and response rates were 100% for rounds one to three, and 92% for round four. Consensus was reached on 23 of the 44 items. Items for which consensus was not reached included management at presentation, use of systemic and periocular steroids for children with severe disease and the role of conventional steroid sparing immunosuppressants beyond methotrexate. CONCLUSION The areas of management uncertainty at the level of the group, as indicated by absence of consensus, reflect the areas where the evidence base is particularly poor. Our findings identify the key areas for the future research needed to ensure better outcomes for this blinding childhood ocular inflammatory disorders.
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Affiliation(s)
- Ameenat Lola Solebo
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health University College London, London, UK .,NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital and Institute of Child Heath, UniversityCollege London, London, UK
| | - Jugnoo S Rahi
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health University College London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK.,Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital and Institute of Child Heath, UniversityCollege London, London, UK
| | - Andrew D Dick
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK.,Ophthalmology Department, University of Bristol, Bristol, UK
| | - Athimalaipet V Ramanan
- Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Clive Edelsten
- Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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20
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Haasnoot AMJ, Kuiper JJ, de Boer JH. Predicting uveitis in juvenile idiopathic arthritis: from biomarkers to clinical practice. Expert Rev Clin Immunol 2019; 15:657-666. [DOI: 10.1080/1744666x.2019.1593139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Anne-Mieke J.W. Haasnoot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas J.W. Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke H. de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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21
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Rebane K, Ristolainen L, Relas H, Orenius T, Kautiainen H, Luosujärvi R, Aalto K, Säilä H. Disability and health-related quality of life are associated with restricted social participation in young adults with juvenile idiopathic arthritis. Scand J Rheumatol 2018; 48:105-113. [PMID: 30270708 DOI: 10.1080/03009742.2018.1493140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe a cohort of Finnish juvenile idiopathic arthritis (JIA) patients, to recognize those young adults who are at risk of becoming socially restricted by their long-term rheumatic disease, and to assess which areas of self-rated health-related quality of life (HRQoL) are associated with the emergence of restricted social participation. METHODS A total of 195 young adults with JIA completed questionnaires addressing demographics, health behaviour, physical activity, functional ability, HRQoL, depressive symptoms, and self-esteem. Patients were classified as having non-restricted social participation if they were engaged in studying, working, maternity leave, or military service, and restricted social participation if they were unemployed or on disability pension. RESULTS Of the patients, 162 (83%) were considered as having non-restricted social participation and 33 (16%) restricted social participation. Among patients with restricted social participation, five (15%) were on disability pension and 28 (85%) were unemployed. Patients with restricted social participation participated less in leisure-time non-physical activities (p = 0.033), felt more disturbed during their leisure time (p = 0.010), had lower self-esteem (p = 0.005), and had higher disability scores (p = 0.024). HRQoL scores revealed statistically significant differences between the groups: physical functioning (p = 0.043), social functioning (p = 0.016), and emotional well-being (p = 0.049) were all lower in patients with restricted social participation. CONCLUSIONS Socially restricted patients showed a higher degree of disability, and lower levels of physical functioning, self-esteem, emotional well-being, and social functioning. These patients should be recognized earlier and interventions provided to enhance their social participation.
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Affiliation(s)
- K Rebane
- a Children's Hospital , University of Helsinki and Helsinki University Central Hospital , Helsinki , Finland
| | - L Ristolainen
- b Research Institute Orton , Orton, Helsinki , Finland
| | - H Relas
- c Department of Medicine, Division of Rheumatology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - T Orenius
- d Orton Orthopaedic Hospital , Orton, Helsinki , Finland
| | - H Kautiainen
- e Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Central Hospital , Helsinki , Finland
| | - R Luosujärvi
- c Department of Medicine, Division of Rheumatology , Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - K Aalto
- a Children's Hospital , University of Helsinki and Helsinki University Central Hospital , Helsinki , Finland
| | - H Säilä
- d Orton Orthopaedic Hospital , Orton, Helsinki , Finland
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Chronic Anterior Uveitis in Children: Psychosocial Challenges for Patients and Their Families. Am J Ophthalmol 2018; 191:xvi-xxiv. [PMID: 29601821 DOI: 10.1016/j.ajo.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe issues of concern to children with chronic anterior uveitis; to consider the psychological impact of chronic anterior uveitis on children's lives; and to understand the effect of a child's chronic illness on other family members. DESIGN Expert commentary. METHODS Author experiences were supplemented by a review of pertinent medical literature and by consideration of content from semi-structured, separate patient and parent interviews. RESULTS Vision loss and the fear of blindness are not the only stressors for children with chronic anterior uveitis and their families; of additional concern are the burdens of examinations and treatment regimens, as well as drug toxicities. Children with chronic anterior uveitis experience medical, academic, interpersonal, psychological, and developmental challenges. The impact of disease extends to other members of a patient's family as well; parents experience challenges in similar domains. Problems with adherence to medical regimens are common. Both the disease and its treatment affect quality of life, and can interfere with successful management of disease and transition to autonomy in adulthood, as reported for other chronic conditions. Coping processes vary greatly between different families. CONCLUSIONS Eye examinations and the rigors of long-term treatment often influence the psychosocial health of patients and families; physicians who are aware of these issues can help patients and families cope with chronic illness and may improve outcomes. Further psychosocial research to understand the experiences of children dealing with chronic anterior uveitis is warranted; this commentary can serve as a foundation for development of age- and disease-specific research questions.
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