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: Sheila T. Angeles-Han, Courtney McCracken, Kirsten Jenkins, Erica Myoung, Daneka Stryker, Lori Ponder, Kelly Rouster Stevens, Larry B. Vogler, Christine Kennedy, Steven Yeh, Carolyn Drews-Botsch, Sampath Prahalad
Journal: Arthritis & Rheumatology (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 1).



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 2). The PedsQL had mild to no correlations with LogMAR VA, # of cells and IOP. 


Table 1. 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%	


Table 2. Correlation of the EYE-Q and PedsQL with standard measures of uveitis activity	EYE-Qc child (range 0–4)	R [95% CI]b	P value




Spearman's correlation coefficients


a

p–value <0.05


b

Mild correlations: R  0.7


c

Effects of Youngsters Eyesight on QOL


d

LogMAR visual acuity


e

intraocular pressure


f

Pediatric Quality of Life Inventory




	
Better Eye	 	 	
LogMAR VAd	−0.36 (−0.66−0.06)	0.089	
Cells	−0.16 (−0.56−0.31)	0.501	
IOPe	0.167 (−0.28−0.55)	0.463	
Worse Eye	 	 	
LogMAR VAd	−0.51 (−0.75−(−0.12))	0.010a	
Cells	0.063 (−0.39−0.49)	0.795	
IOPe	−0.16 (−0.54−0.29)	0.492	
PedsQLf Total scale	0.66 (0.32–0.84)	<0.001a	
EYE-Qc parent (range 0–4)	 	 	
Better Eye	 	 	
LogMAR VAd	−0.31 (−0.56−0.004)	0.050	
Cells	−0.07 (−0.49−0.37)	0.751	
IOPe	0.06 (−0.46−0.22)	0.457	
Worse Eye	 	 	
LogMAR VAd	−0.35 (−0.59−(−0.04))	0.027a	
Cells	−0.14 (−0.45−0.21)	0.411	
IOPe	−0.14 (−0.46−0.22)	0.457	
PedsQLf Total scale	0.52 (0.23−0.72)	<0.001a	
PedsQLf (range 0-100)	 	 	
Better Eye	 	 	
LogMAR VAd	0.03 (−0.30−0.35)	0.867	
Cells	−0.21 (−0.51−0.15)	0.240	
IOPe	0.05 (−0.32−0.41)	0.792	
Worse Eye	 	 	
LogMAR VAd	−0.13 (–0.43–0.21)	0.434	
Cells	−0.25 (−0.54−0.11)	0.169	
IOPe	0.13 (–0.25–0.47)	0.494	



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.