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

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.