Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis

The systemic immunosuppressive therapy for eye diseases study

Anthony C. Gregory, John H. Kempen, Ebenezer Daniel, R. Oktay Kaçmaz, C. Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, James T. Rosenbaum, Eric B. Suhler, Jennifer Thorne

Research output: Contribution to journalArticle

Abstract

Purpose: To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. Design: Multicenter retrospective cohort study. Participants: A total of 327 patients (596 affected eyes) with JIA-associated uveitis managed at 5 tertiary uveitis clinics in the United States. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. Results: At presentation, 240 eyes (40.3%) had a VA of ≤20/50, 144 eyes (24.2%) had a VA of ≤20/200, and 359 eyes (60.2%) had at least 1 ocular complication. The incidences of VA loss to the ≤20/50 and ≤20/200 thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least 1 new ocular complication over follow-up was 0.15/EY (95% confidence interval [CI], 0.13-0.17). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least 1 ocular complication during follow-up was lower (0.04/EY; 95% CI, 0.02-0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the ≤20/50 and ≤20/200 thresholds both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced risk of visual loss, particularly for the ≤20/50 outcome (hazard ratio, 0.40; 95% CI, 0.21-0.75; P

Original languageEnglish (US)
Pages (from-to)186-192
Number of pages7
JournalOphthalmology
Volume120
Issue number1
DOIs
StatePublished - Jan 2013

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Juvenile Arthritis
Eye Diseases
Uveitis
Immunosuppressive Agents
Visual Acuity
Therapeutics
Confidence Intervals
Incidence
Cohort Studies
Anterior Chamber
Medical Records

ASJC Scopus subject areas

  • Ophthalmology

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Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis : The systemic immunosuppressive therapy for eye diseases study. / Gregory, Anthony C.; Kempen, John H.; Daniel, Ebenezer; Kaçmaz, R. Oktay; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer.

In: Ophthalmology, Vol. 120, No. 1, 01.2013, p. 186-192.

Research output: Contribution to journalArticle

Gregory, AC, Kempen, JH, Daniel, E, Kaçmaz, RO, Foster, CS, Jabs, DA, Levy-Clarke, GA, Nussenblatt, RB, Rosenbaum, JT, Suhler, EB & Thorne, J 2013, 'Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: The systemic immunosuppressive therapy for eye diseases study', Ophthalmology, vol. 120, no. 1, pp. 186-192. https://doi.org/10.1016/j.ophtha.2012.07.052
Gregory, Anthony C. ; Kempen, John H. ; Daniel, Ebenezer ; Kaçmaz, R. Oktay ; Foster, C. Stephen ; Jabs, Douglas A. ; Levy-Clarke, Grace A. ; Nussenblatt, Robert B. ; Rosenbaum, James T. ; Suhler, Eric B. ; Thorne, Jennifer. / Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis : The systemic immunosuppressive therapy for eye diseases study. In: Ophthalmology. 2013 ; Vol. 120, No. 1. pp. 186-192.
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abstract = "Purpose: To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. Design: Multicenter retrospective cohort study. Participants: A total of 327 patients (596 affected eyes) with JIA-associated uveitis managed at 5 tertiary uveitis clinics in the United States. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. Results: At presentation, 240 eyes (40.3{\%}) had a VA of ≤20/50, 144 eyes (24.2{\%}) had a VA of ≤20/200, and 359 eyes (60.2{\%}) had at least 1 ocular complication. The incidences of VA loss to the ≤20/50 and ≤20/200 thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least 1 new ocular complication over follow-up was 0.15/EY (95{\%} confidence interval [CI], 0.13-0.17). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least 1 ocular complication during follow-up was lower (0.04/EY; 95{\%} CI, 0.02-0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the ≤20/50 and ≤20/200 thresholds both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced risk of visual loss, particularly for the ≤20/50 outcome (hazard ratio, 0.40; 95{\%} CI, 0.21-0.75; P",
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AU - Daniel, Ebenezer

AU - Kaçmaz, R. Oktay

AU - Foster, C. Stephen

AU - Jabs, Douglas A.

AU - Levy-Clarke, Grace A.

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