Analysis of new cases of uveitis at academic and community settings

Abstract

PurposeDescribe the demographics of new patients with uveitis presenting to an urban, academic centre and affiliated, suburban satellite clinics to assess if changes in infrastructure were needed for clinical care. Secondarily, examine the frequency of infectious uveitides.MethodsA retrospective chart review of single academic centre of 436 consecutive, new patients with uveitis (686 eyes) and 3 affiliated, satellite clinics seen by 8 uveitis specialists from 1 July 2013 to 31 March 2017. Demographics recorded included patient age, race, associated systemic disease, uveitis chronicity, and anatomic location. The main outcome measure was comparing frequencies of patient demographics, immunosuppressive agent use, and infectious uveitis between locations.Results366 patients (587 eyes) were evaluated at the academic clinic and 70 (99 eyes) at the satellite locations. Anterior uveitis was the most common anatomic location; more acute, unilateral cases were seen at satellites (p=0.007; p=0.002, respectively). A larger percentage of posterior and panuveitis cases presented to the academic centre (p<0.0001). There was no difference in systemic disease association (p=0.925) or infectious uveitis cases (p=0.956). The use of non-corticosteroid immunosuppressive medications was higher at the academic clinic (p<0.001).ConclusionsAnterior uveitis comprised the majority of cases in both clinics. Non-corticosteroid immunosuppressive agents were used more frequently at the academic clinic, reflecting more cases of chronic posterior and panuveitis. Compounded intravitreal injections, specialised ophthalmic imaging studies and high-risk medication monitoring can be centralised in the academic clinic. Infectious uveitis cases were seen at both locations, with an increase in syphilis diagnoses at the academic centre.

Analyzing the demographics of patients with uveitis in an indigent, urban population

“…A prominent feature of our study is the high prevalence of African American patients (67%), which is slightly higher than the percent of African Americans in the Philadelphia population in the 2010 census (41%). 17 Our cohort demonstrated more cases of sarcoidosis compared to previously published studies where the predominant underlying autoimmune disorder was HLA-B27 associated [ 18 , 19 ]. As the incidence of sarcoidosis is higher in African Americans than Caucasians in the United States, and it follows that the patients in our study would have a higher prevalence of sarcoid uveitis [ 20 ].…”

Current Landscape of Uveitis Specialists in the United States

“…In academic or tertiary referral settings, there is a higher proportion of patients referred for management of posterior uveitis, panuveitis, or chronic uveitis, due to the nature of these diseases having a higher likelihood of permanent vision loss and requiring IMT. 13,14,15 The need for expertise in academic and tertiary referral settings is supported by our survey demonstrating that over half of respondents practiced in an academic or university setting. A retrospective study using data from the Systemic Immunosuppressive Therapy for Eye Diseases cohort study and the Multicenter Uveitis Steroid Treatment trial found that visual acuity in patients with uveitis have improved visual acuity after initiating care with a uveitis specialist.…”