Visual acuity and uveitis

Accurate and timely diagnosis of uveitis can be a life-saving measure

Dermot McGrath

Posted: Friday, June 1, 2018

The treatment and prognosis of various uveitic entities varies greatly, so accurate diagnosis is imperative in order to get the best possible outcomes for patients over the long term, according to Prof Yan Guex-Crosier MD.
“When we see a patient in the uveitis clinic we know that there is a good chance that we will be seeing them for the next 10 or 15 years, so the goal as a treating clinician is to enable them to obtain a good visual acuity with a long-term follow-up,” Prof Yan Guex-Crosier told delegates attending the 8th EURETINA Winter Meeting in Budapest.
While uveitis was once considered a single disease entity, it is now known that it can be caused by a variety of autoimmune disorders, infections, malignancies (pseudo-uveitis), or it may be idiopathic in nature, said Prof Guex-Crosier.
He noted that uveitis is classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye, according to the SUN classification. He added that few studies have comprehensively assessed the presence of uveitis, with prevalence estimates varying greatly, from 38 to 115 cases per 100,000 people. The greatest frequency, 
however, is in working-age adults, which results in a greater burden of disease.
Diagnosis of uveitis includes a thorough examination and the recording of the patient’s complete medical history, said Prof Yan Guex-Crosier.
“The first golden rule is to know whether the uveitis is caused by an infectious process or an underlying disease. Laboratory tests may be done to rule out some classical cause of infection or an autoimmune disorder. Exclusion of an infectious disease is mandatory because if you treat a syphilis patient, for instance, with a huge amount of immunosuppresive therapy you may well irreversibly damage their vision, as syphilis is known to be the great imitator,” he said.
Another important rule of thumb is to exclude malignancy such as retinoblastoma or intraocular lymphoma that may masquerade as uveitis, said Prof Yan Guex-Crosier.
“The importance of accurate and timely diagnosis cannot be overstated, as making the correct diagnosis can be life-saving. If you start to treat what you think is simply an ocular inflammation and it turns out the patient has B-cell lymphoma, it could be catastrophic,” he said.
Once non-infectious uveitis has been diagnosed, treatment, usually in the form of oral or topical corticosteroids, should begin promptly to avoid serious complications. But a switch to immunosuppressive therapies or biologic agents is necessary in a second step in the presence of severe uveitis to avoid classical systemic and ocular complications of corticosteroids. Frequent complications of uveitis include: posterior synechiae, cataracts, glaucoma, band keratopathy, macular oedema and loss of vision, said Dr Guex-Crosier.
“We must know the specific complications of disease, with treatment tailored to individual patients and all the pros and cons discussed with the patient and their general practitioner. We also need to bear in mind that severe immunosuppression may also lead to opportunistic infections,” he concluded.