Incidence of remission and of cataract in ocular inflammatory diseases

Massachusetts Eye And Ear Infirmary, Boston MA

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Abstract

Abstract Uveitis is the sixth leading cause of blindness in the United States, causing ~10% of new cases of blindness, often in the prime of life. Scleritis and cicatrizing conjunctivitis related to pemphigoid add to the burden of ocular inflammatory disease. Advances in characterizing the clinical epidemiology of these diseases have begun to be achieved in recent years, but the evidence base guiding therapy still is limited. Conduct of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study was a major step toward understanding uveitis and its treatments better. In the process of assembling a database to assess the risks of death and cancer in association with the immunosuppressive drugs used commonly in the management of ocular inflammation, our research group assembled a rich database (17,907 distinct patients followed over 169,194 visits) providing a valuable resource to characterize the clinical epidemiology of ocular inflammatory disease. Our team's efforts in assessing the clinical epidemiology of uveitis and ocular inflammation already has provided a major part of the available evidence-based guidance to patients and clinicians. In this proposal, following up on our work regarding remission of intermediate uveitis and primary anterior uveitis, we will study remission in cases of chronic anterior uveitis, scleritis, and the cicatrizing conjunctivitis of mucous membrane pemphigoid. Remission is the ideal goal of clinical management, but little information presently is available regarding this outcome to guide clinical decision-making. In addition, cataract is a major cause of visual loss in ocular inflammatory diseases, and while cataract surgery often is effective, the relatively young patients affected lose accommodation for the rest of their lives. In a manner similar to our past work on the risk of intraocular pressure elevation, we will estimate the risk of cataract causing reduction in visual acuity to worse than 20/40 (as well as cataract surgery for confirmatory purposes). For each outcome, we will evaluate modifiable and unmodifiable risk factors, addressing questions such as whether there is a dose beyond which topical corticosteroids induce a high risk of cataract, and whether statins increase remission of uveitis. A predictive ?points? model will be generated to predict the incidence of remission or of cataract under alternative scenarios for anterior uveitis (the most common form of uveitis). These objectives are responsive to the Strategic Plan and goals of the National Eye Institute, to support applied clinical research concerning blinding eye diseases and preservation of sight, especially the goal ?Establish the causes and etiology of uveitis and improve methods for its diagnosis, treatment, and prevention.?