Ophthalmology. Retina · 2025
Prevalence, Treatment Patterns, and Outcomes of Pediatric Noninfectious Uveitis in the United States: An IRIS Registry Analysis.
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Uner Ogul E, Lin Phoebe, Kopplin Laura J, Lum Flora, Liu Lynn, Li Charles, Arepalli Sruthi, Goldstein Debra, Rosenbaum James T, Suhler Eric B, Thomas Akshay S
Аннотация
PURPOSE: To describe the prevalence, characteristics, and treatment patterns of pediatric noninfectious uveitis in the United States.
DESIGN: Retrospective database study.
SUBJECTS: Patients with noninfectious uveitis diagnosed and treated at age ≤18 years with ≥1 year follow-up identified in the IRIS® (Intelligent Research in Sight) Registry between January 1, 2013, and December 31, 2019.
METHODS: Mean annual prevalence of pediatric noninfectious uveitis was estimated overall and by anatomic location. Demographic information such as age, sex, race, ethnicity, and insurance status, along with types of anti-inflammatory medications, was evaluated. The Wilcoxon signed-rank test was used to compare distributions of visual acuity at baseline, 1 year, and final visits. Rates of ocular complications and surgeries among eyes with different anatomic locations of uveitis were compared using the chi-square test.
MAIN OUTCOME MEASURES: Annual prevalence, demographic characteristics, ocular complications, need for ocular surgery, type of anti-inflammatory medications, and difference in visual acuity (VA, logarithm of the minimum angle of resolution) at presentation, 1 year, and final visit (≥15 months).
RESULTS: A total of 5722 pediatric patients (9073 eyes) were identified, representing 2.1% of all patients with noninfectious uveitis in the IRIS Registry. Annual prevalence was 11.9 cases per 100 000 patients. The mean (standard deviation) age at diagnosis was 12.5 (4.0) years, 51.3% were female, 56.3% were White, 46.2% had private insurance, and 28.6% had Medicaid. Anatomical subtypes of uveitis included anterior (68.7%), intermediate (13.4%), posterior (6.1%), and panuveitis (10.2%). Mean VA ± standard deviation was 0.26 ± 0.37 at diagnosis, 0.18 ± 0.31 at 1 year (P < 0.001), and 0.21 ± 0.36 (P < 0.001) at final visit with a mean (standard deviation) follow-up of 1216 (579) days. Eight hundred forty-four (9.3%) eyes had severe vision loss (VA ≥1.00) during follow-up. Complications occurred in 1875 (20.7%) eyes, mostly as cataract (10.6%) and macular edema (5.4%), and 479 (5.3%) required ocular surgery. The highest rate of complications and ocular surgeries was seen in patients with panuveitis and posterior uveitis, respectively. Local corticosteroids were used in 5231 (91.4%), and 2467 (43.1%) were started on steroid-sparing agents after diagnosis, most commonly methotrexate (30.9%).
CONCLUSION: Annual prevalence of pediatric noninfectious uveitis in the United States per the IRIS Registry is 11.9 cases per 100 000 patients. It represents 2.1% of all noninfectious uveitis. Most patients are White and have anterior uveitis. Unlike adults with uveitis, there is no strong sex predilection. Mean VA improved significantly 1 year after diagnosis, but 9.3% of eyes had severe vision loss. The anatomic subtype of uveitis significantly affected visual outcomes, complications, and the need for ocular surgery. Methotrexate was the most commonly used steroid-sparing immunosuppressive agent. Although complications occurred, patients rarely underwent ocular surgery.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective database study.
SUBJECTS: Patients with noninfectious uveitis diagnosed and treated at age ≤18 years with ≥1 year follow-up identified in the IRIS® (Intelligent Research in Sight) Registry between January 1, 2013, and December 31, 2019.
METHODS: Mean annual prevalence of pediatric noninfectious uveitis was estimated overall and by anatomic location. Demographic information such as age, sex, race, ethnicity, and insurance status, along with types of anti-inflammatory medications, was evaluated. The Wilcoxon signed-rank test was used to compare distributions of visual acuity at baseline, 1 year, and final visits. Rates of ocular complications and surgeries among eyes with different anatomic locations of uveitis were compared using the chi-square test.
MAIN OUTCOME MEASURES: Annual prevalence, demographic characteristics, ocular complications, need for ocular surgery, type of anti-inflammatory medications, and difference in visual acuity (VA, logarithm of the minimum angle of resolution) at presentation, 1 year, and final visit (≥15 months).
RESULTS: A total of 5722 pediatric patients (9073 eyes) were identified, representing 2.1% of all patients with noninfectious uveitis in the IRIS Registry. Annual prevalence was 11.9 cases per 100 000 patients. The mean (standard deviation) age at diagnosis was 12.5 (4.0) years, 51.3% were female, 56.3% were White, 46.2% had private insurance, and 28.6% had Medicaid. Anatomical subtypes of uveitis included anterior (68.7%), intermediate (13.4%), posterior (6.1%), and panuveitis (10.2%). Mean VA ± standard deviation was 0.26 ± 0.37 at diagnosis, 0.18 ± 0.31 at 1 year (P < 0.001), and 0.21 ± 0.36 (P < 0.001) at final visit with a mean (standard deviation) follow-up of 1216 (579) days. Eight hundred forty-four (9.3%) eyes had severe vision loss (VA ≥1.00) during follow-up. Complications occurred in 1875 (20.7%) eyes, mostly as cataract (10.6%) and macular edema (5.4%), and 479 (5.3%) required ocular surgery. The highest rate of complications and ocular surgeries was seen in patients with panuveitis and posterior uveitis, respectively. Local corticosteroids were used in 5231 (91.4%), and 2467 (43.1%) were started on steroid-sparing agents after diagnosis, most commonly methotrexate (30.9%).
CONCLUSION: Annual prevalence of pediatric noninfectious uveitis in the United States per the IRIS Registry is 11.9 cases per 100 000 patients. It represents 2.1% of all noninfectious uveitis. Most patients are White and have anterior uveitis. Unlike adults with uveitis, there is no strong sex predilection. Mean VA improved significantly 1 year after diagnosis, but 9.3% of eyes had severe vision loss. The anatomic subtype of uveitis significantly affected visual outcomes, complications, and the need for ocular surgery. Methotrexate was the most commonly used steroid-sparing immunosuppressive agent. Although complications occurred, patients rarely underwent ocular surgery.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.