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

Media type: E-Article
Title: 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
Contributor: 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: Wiley, 2014
Published in: Arthritis & Rheumatology, 66 (2014) S3
Language: English
DOI: 10.1002/art.38457
ISSN: 2326-5191; 2326-5205
Keywords: Immunology ; Rheumatology ; Immunology and Allergy
Origination:
Footnote:
Description: <jats:sec><jats:title>Background/Purpose:</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>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 <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-tbl-0001" />).</jats:p><jats:p>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 <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-tbl-0002" />). The PedsQL had mild to no correlations with LogMAR VA, # of cells and IOP. </jats:p><jats:p><jats:table-wrap> <jats:caption><jats:title>Ocular examinations in children with uveitis</jats:title></jats:caption> <jats:table frame="hsides"> <jats:col /> <jats:col /> <jats:col /> <jats:thead> <jats:tr> <jats:th>Ophthalmology exam</jats:th> <jats:th>Uveitis (n=21)</jats:th> <jats:th>JIA‐U (n=21)</jats:th></jats:tr></jats:thead> <jats:tbody> <jats:tr> <jats:td>Worse eye</jats:td></jats:tr> <jats:tr> <jats:td>Intraocular pressure, mean±SD</jats:td> <jats:td>17.9 ± 7.9</jats:td> <jats:td>17.6 ± 7.3</jats:td></jats:tr> <jats:tr> <jats:td>LogMar visual acuity, mean±SD</jats:td> <jats:td>0.75 ± 0.67</jats:td> <jats:td>0.18 ± 0.20</jats:td></jats:tr> <jats:tr> <jats:td>Slit lamp exam Cells, N (%)</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td> 0 (<1 cell in field)</jats:td> <jats:td>11 (73.3%)</jats:td> <jats:td>11 (55.5%)</jats:td></jats:tr> <jats:tr> <jats:td> 0.5+ (1–5 cells in field)</jats:td> <jats:td>1 (6.7%)</jats:td> <jats:td>2 (10.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 1+ (6–15 cells in field)</jats:td> <jats:td>1 (6.7%)</jats:td> <jats:td>3 (15.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 2+ (16–25 cells in field)</jats:td> <jats:td>0 (0.0%)</jats:td> <jats:td>4 (20.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 3+ (26–50 cells in field)</jats:td> <jats:td>2 (13.3%)</jats:td> <jats:td>0 (0.0%)</jats:td></jats:tr> <jats:tr> <jats:td>Better Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>Intraocular pressure, mean±SD</jats:td> <jats:td>12.9 ± 5.0</jats:td> <jats:td>13.9 ± 4.4</jats:td></jats:tr> <jats:tr> <jats:td>LogMar visual acuity, mean±SD</jats:td> <jats:td>0.31 ± 0.38</jats:td> <jats:td>0.07 ± 0.12</jats:td></jats:tr> <jats:tr> <jats:td>Slit lamp exam Cells, N (%)</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td> 0 (<1 cell in field)</jats:td> <jats:td>13 (86.7%)</jats:td> <jats:td>16 (80.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 0.5+ (1–5 cells in field)</jats:td> <jats:td>0 (0.0%)</jats:td> <jats:td>1 (5.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 1+ (6–15 cells in field)</jats:td> <jats:td>1 (6.7%)</jats:td> <jats:td>1 (5.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 2+ (16–25 cells in field)</jats:td> <jats:td>0 (0.0%)</jats:td> <jats:td>2 (10.0%)</jats:td></jats:tr> <jats:tr> <jats:td> 3+ (26–50 cells in field)</jats:td> <jats:td>1 (6.7%)</jats:td> <jats:td>0 (0.0%</jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap></jats:p><jats:p><jats:table-wrap> <jats:caption><jats:title>Correlation of the EYE‐Q and PedsQL with standard measures of uveitis activity</jats:title></jats:caption> <jats:table frame="hsides"> <jats:col /> <jats:col /> <jats:col /> <jats:thead> <jats:tr> <jats:th>EYE‐Q<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0004" /> child (range 0–4)</jats:th> <jats:th>R [95% CI]<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0003" /></jats:th> <jats:th>P value</jats:th></jats:tr></jats:thead> <jats:tbody> <jats:tr> <jats:td>Better Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>−0.36 (−0.66−0.06)</jats:td> <jats:td>0.089</jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>−0.16 (−0.56−0.31)</jats:td> <jats:td>0.501</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>0.167 (−0.28−0.55)</jats:td> <jats:td>0.463</jats:td></jats:tr> <jats:tr> <jats:td>Worse Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>−0.51 (−0.75−(−0.12))</jats:td> <jats:td>0.010<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0002" /></jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>0.063 (−0.39−0.49)</jats:td> <jats:td>0.795</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>−0.16 (−0.54−0.29)</jats:td> <jats:td>0.492</jats:td></jats:tr> <jats:tr> <jats:td>PedsQL<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0007" /> Total scale</jats:td> <jats:td>0.66 (0.32–0.84)</jats:td> <jats:td><0.001<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0002" /></jats:td></jats:tr> <jats:tr> <jats:td>EYE‐Q<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0004" /> parent (range 0–4)</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>Better Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>−0.31 (−0.56−0.004)</jats:td> <jats:td>0.050</jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>−0.07 (−0.49−0.37)</jats:td> <jats:td>0.751</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>0.06 (−0.46−0.22)</jats:td> <jats:td>0.457</jats:td></jats:tr> <jats:tr> <jats:td>Worse Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>−0.35 (−0.59−(−0.04))</jats:td> <jats:td>0.027<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0002" /></jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>−0.14 (−0.45−0.21)</jats:td> <jats:td>0.411</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>−0.14 (−0.46−0.22)</jats:td> <jats:td>0.457</jats:td></jats:tr> <jats:tr> <jats:td>PedsQL<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0007" /> Total scale</jats:td> <jats:td>0.52 (0.23−0.72)</jats:td> <jats:td><0.001<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0002" /></jats:td></jats:tr> <jats:tr> <jats:td>PedsQL<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0007" /> (range 0‐100)</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>Better Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>0.03 (−0.30−0.35)</jats:td> <jats:td>0.867</jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>−0.21 (−0.51−0.15)</jats:td> <jats:td>0.240</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>0.05 (−0.32−0.41)</jats:td> <jats:td>0.792</jats:td></jats:tr> <jats:tr> <jats:td>Worse Eye</jats:td> <jats:td /> <jats:td /></jats:tr> <jats:tr> <jats:td>LogMAR VA<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0005" /></jats:td> <jats:td>−0.13 (–0.43–0.21)</jats:td> <jats:td>0.434</jats:td></jats:tr> <jats:tr> <jats:td>Cells</jats:td> <jats:td>−0.25 (−0.54−0.11)</jats:td> <jats:td>0.169</jats:td></jats:tr> <jats:tr> <jats:td>IOP<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#art38457-note-0006" /></jats:td> <jats:td>0.13 (–0.25–0.47)</jats:td> <jats:td>0.494</jats:td></jats:tr></jats:tbody></jats:table> <jats:table-wrap-foot> <jats:fn><jats:p>Spearman's correlation coefficients</jats:p></jats:fn> <jats:fn><jats:p>p–value <0.05</jats:p></jats:fn> <jats:fn><jats:p>Mild correlations: R <0.3; Moderate correlations: R = 0.3–0.7; Strong correlation: R = >0.7</jats:p></jats:fn> <jats:fn><jats:p>Effects of Youngsters Eyesight on QOL</jats:p></jats:fn> <jats:fn><jats:p>LogMAR visual acuity</jats:p></jats:fn> <jats:fn><jats:p>intraocular pressure</jats:p></jats:fn> <jats:fn><jats:p>Pediatric Quality of Life Inventory</jats:p></jats:fn></jats:table-wrap-foot></jats:table-wrap></jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>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.</jats:p></jats:sec>
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