A41: The Effects of Youngsters' Eyesight on Quality of Life as a Measure of Uveitis Activity, Visual Function and Vision Related Quality of Life in Childhood Uveitis
Authors: Angeles–Han Sheila T. , McCracken Courtney , Jenkins Kirsten , Myoung Erica , Stryker Daneka , Ponder Lori , Stevens Kelly Rouster , Vogler Larry B. , Kennedy Christine , Yeh Steven , Drews‐Botsch Carolyn , Prahalad Sampath 
Published: March 2014

Background/Purpose:

The Effects of Youngsters Eyesight on Quality of Life (EYE‐Q) is a valid instrument that measures visual function and vision related quality of life (QOL) in children with ocular disease. Our objective is to determine whether the EYE‐Q is valid in children with uveitis.

Methods:

Children with uveitis (JIA‐associated uveitis (JIA‐U) and idiopathic uveitis (IU)) who have had a slit lamp examination within one month of completing the EYE‐Q were included. We collected data related to uveitis clinical characteristics and the ocular examination (LogMAR visual acuity (VA), intraocular pressure (IOP), and # of cells) in the worse and better eye. Questionnaires were completed on overall QOL (Pediatric QOL Inventory—MPedsQL), and vision (EYE‐Q). We determined associations between the EYE‐Q and the ocular exam using Spearman's correlation coefficients.

Results:

There were 19 children with JIA‐U and 17 with I‐U included with a total of 42 ocular examinations performed. Females comprised 75%, with a mean age of diagnosis of 5.6 (SD = 3.6) years. There were 29 (80%) children with bilateral disease, with varied uveitis locations (anterior (69%), intermediate (25%), and panuveitis (6%)), and numerous ocular complications (synechiae (53%), cataracts (44%), band keratopathy (25%), cystoid macular edema (22%), and glaucoma (6%)). At time of examination, 28% were being treated with oral methotrexate, 52% with subcutaneous methotrexate, 14% with infliximab, and 2% with adalimumab. There were 71% of children on eye drops, 59% on ocular steroids, and 2% on mydriatics. Mean PedsQL score was 80.9 ± 15.6. Mean EYE‐Q score was 3.1 ± 0.6. Slit lamp examination showed worse LogMAR VA in children with I‐U compared to JIA‐U but similar IOP and # of cells (Table ).

For both the child and parent reports, the EYE‐Q had moderate correlations with LogMAR VA and the PedsQL, and mild to no correlations with # of cells and IOP (Table ). The PedsQL had mild to no correlations with LogMAR VA, # of cells and IOP.

Ocular examinations in children with uveitis

Ophthalmology exam
Uveitis (n=21)
JIA‐U (n=21)

Worse eye

Intraocular pressure, mean±SD
17.9 ± 7.9
17.6 ± 7.3

LogMar visual acuity, mean±SD
0.75 ± 0.67
0.18 ± 0.20

Slit lamp exam Cells, N (%)

        0 (<1 cell in field)
11 (73.3%)
11 (55.5%)

        0.5+ (1–5 cells in field)
1 (6.7%)
2 (10.0%)

        1+ (6–15 cells in field)
1 (6.7%)
3 (15.0%)

        2+ (16–25 cells in field)
0 (0.0%)
4 (20.0%)

        3+ (26–50 cells in field)
2 (13.3%)
0 (0.0%)

Better Eye

Intraocular pressure, mean±SD
12.9 ± 5.0
13.9 ± 4.4

LogMar visual acuity, mean±SD
0.31 ± 0.38
0.07 ± 0.12

Slit lamp exam Cells, N (%)

        0 (<1 cell in field)
13 (86.7%)
16 (80.0%)

        0.5+ (1–5 cells in field)
0 (0.0%)
1 (5.0%)

        1+ (6–15 cells in field)
1 (6.7%)
1 (5.0%)

        2+ (16–25 cells in field)
0 (0.0%)
2 (10.0%)

        3+ (26–50 cells in field)
1 (6.7%)
0 (0.0%

Correlation of the EYE‐Q and PedsQL with standard measures of uveitis activity

EYE‐Q child (range 0–4)
R [95% CI]
P value

Better Eye

LogMAR VA
−0.36 (−0.66−0.06)
0.089

Cells
−0.16 (−0.56−0.31)
0.501

IOP
0.167 (−0.28−0.55)
0.463

Worse Eye

LogMAR VA
−0.51 (−0.75−(−0.12))
0.010

Cells
0.063 (−0.39−0.49)
0.795

IOP
−0.16 (−0.54−0.29)
0.492

PedsQL Total scale
0.66 (0.32–0.84)
<0.001

EYE‐Q parent (range 0–4)

Better Eye

LogMAR VA
−0.31 (−0.56−0.004)
0.050

Cells
−0.07 (−0.49−0.37)
0.751

IOP
0.06 (−0.46−0.22)
0.457

Worse Eye

LogMAR VA
−0.35 (−0.59−(−0.04))
0.027

Cells
−0.14 (−0.45−0.21)
0.411

IOP
−0.14 (−0.46−0.22)
0.457

PedsQL Total scale
0.52 (0.23−0.72)
<0.001

PedsQL (range 0‐100)

Better Eye

LogMAR VA
0.03 (−0.30−0.35)
0.867

Cells
−0.21 (−0.51−0.15)
0.240

IOP
0.05 (−0.32−0.41)
0.792

Worse Eye

LogMAR VA
−0.13 (–0.43–0.21)
0.434

Cells
−0.25 (−0.54−0.11)
0.169

IOP
0.13 (–0.25–0.47)
0.494

Spearman's correlation coefficients

p–value <0.05

Mild correlations: R <0.3; Moderate correlations: R = 0.3–0.7; Strong correlation: R = >0.7

Effects of Youngsters Eyesight on QOL

LogMAR visual acuity

intraocular pressure

Pediatric Quality of Life Inventory

Conclusion:

The EYE‐Q is an important instrument in the measurement of QOL and function in children with uveitis. Since many children with active disease are asymptomatic, the EYE‐Q may not reflect the presence of active disease based on the slit lamp examination, but can detect changes in vision related to function and QOL. Since the EYE‐Q demonstrated moderate correlations with standard measures of QOL and function, whereas the PedsQL showed mild to no correlations, the EYE‐Q may be an important component of the global assessment of visual function and QOL in this population.