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
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.
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