Visual Functioning and Health-related Quality-of-Life are Compromised in Patients with Uveitis

Hui, Michelle; Wakefield, Denis; Patel, Ilesh; Cvejic, Erin; McCluskey, Peter; Chang, John H

doi:10.3109/09273948.2016.1139734

Cited by 33 publications

(30 citation statements)

References 22 publications

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“…7–9 Previous studies have demonstrated that patients with uveitis have a lower quality of life compared to the general population 7,10–13 and, in some cases, a lower quality of life compared to patients with other eye conditions. 14,15 Studies on quality of life in patients with noninfectious uveitis requiring systemic immunosuppressant therapy, however, have been limited in number and have typically explored populations on heterogeneous medication regimens.…”

Section: Introductionmentioning

confidence: 99%

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

Niemeyer

Gonzales

Rathinam

et al. 2017

American Journal of Ophthalmology

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Purpose To evaluate the changes in quality of life in noninfectious uveitis patients treated with two of the most commonly prescribed antimetabolite treatments. Design Secondary analysis of a multicenter, block-randomized, clinical trial (ClinicalTrials.gov NCT01232920). Methods Eighty patients at Aravind Eye Hospitals in Madurai and Coimbatore, India, with noninfectious intermediate, posterior, or panuveitis were randomized to receive oral methotrexate, 25 mg weekly, or oral mycophenolate mofetil, 1 g twice daily, and were followed up monthly for 6 months. Best-corrected visual acuity, IND-VFQ, and SF-36 were obtained at enrollment and at 6 months (or prior in the event of early treatment failure). Results IND-VFQ scores, on average, increased by 9.2 points from trial enrollment to 6 months (95% CI: 4.9, 13.5, P =0.0001). While the SF-36 physical component summary score did not significantly differ over the course of the trial, the mental component summary score decreased by 2.3 points (95% CI: −4.4, −0.1, P=0.04) and the vitality subscale decreased by 3.5 points (95% CI: −5.6, −1.4, P=0.001). Quality of life scores did not differ between treatment arms. Linear regression modeling showed a 3.2 point improvement in IND-VFQ score for every 5 letter improvement in visual acuity (95% CI: 1.9, 4.3; P<0.001). Conclusions Although uveitis treatment was associated with increased vision and vision-related quality of life, patient-reported physical health did not change after 6 months of treatment, and, mental health decreased. Despite improved visual outcomes, uveitis patients receiving systemic immunosuppressive therapy may experience a deterioration in mental health-related quality of life.

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Section: Introductionmentioning

confidence: 99%

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

Niemeyer

Gonzales

Rathinam

et al. 2017

American Journal of Ophthalmology

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“…21 Several studies have focused on the effect of uveitis symptoms on quality-of-life outcomes. [22][23][24][25][26][27] Given that both uveitis and corticosteroid therapy are related to an increased likelihood of complications, it may be difficult to determine disease vs treatment effect on comorbidity and quality of life. Moreover, noninfectious uveitis is associated with a number of systemic disorders, including Behçet disease, juvenile idiopathic arthritis, rheumatoid arthritis, Vogt-Koyanagi-Harada disease, sarcoidosis, ankylosing spondylitis, psoriatic arthritis, and multiple sclerosis.…”

mentioning

confidence: 99%

Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis in the VISUAL-1 and VISUAL-2 Trials

et al. 2017

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INTERVENTIONS In VISUAL-1 and VISUAL-2, patients were randomized to receive adalimumab, 80-mg, subcutaneous loading dose followed by 40 mg every other week or placebo for 80 weeks. All patients underwent prednisone tapering, with patients in VISUAL-1 receiving an initial prednisone burst. MAIN OUTCOMES AND MEASURES The 25-item National Eye Institute Vision Function Questionnaire (NEI VFQ-25) composite score questionnaire assessed the impact of visual impairment from the patient's perspective; scores on the questionnaire range from 0 to 100, with higher scores indicating better vision-related quality of life. The change in NEI VFQ-25 from best state achieved prior to week 6 (VISUAL-1) and from baseline state (VISUAL-2) to the final or early termination visit was determined in each group and statistically compared using analysis of variance. The temporal effects of adalimumab and placebo on NEI VFQ-25 were investigated using a longitudinal model. RESULTS Of the 217 patients in VISUAL-1, 124 (57.1%) were women; the mean (SD) age was 42.7 (14.9) years. Of the 226 patients in VISUAL-2, 138 (61.1%) were women; the mean (SD) age was 42.5 (13.4). In VISUAL-1, the change from final score to best score in NEI VFQ-25 was −1.30 for adalimumab and −5.50 for placebo-a difference of 4.20 (95% CI, 1.04 to 7.36; P = .01) associated with adalimumab compared with placebo. In VISUAL-2, the change from baseline NEI VFQ-25 was 3.36 for adalimumab and 1.24 for placebo-a difference of 2.12 (95% CI, −0.81 to 5.04; P = .16). In both trials, the longitudinal models showed a significant difference in NEI VFQ-25 between adalimumab and placebo of 3.07 (95% CI, 2.09 to 4.06; P < .001) and 4.66 (95% CI, 0.05 to 9.26; P = .048) in the VISUAL-1 (74.15 vs 71.08) and VISUAL-2 (82.39 vs 77.73) trials, respectively. CONCLUSIONS AND RELEVANCE This post hoc analysis suggests that adalimumab is associated with statistically significant and clinically meaningful improvements in patient-reported visual functioning for patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis.

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“…20,29,35,41,48,49,55 Other indications for the use of NCSIT may include disease that severely impairs essential activities of daily living and, consequently, quality of life. 59,60 Contraindications to corticosteroid therapy include behavioral patterns (noncompliance), health-related factors (e.g., history of tuberculosis or hepatitis), and reproductive status (Appendix 6, available at www.aaojournal.org). It should be noted that these contraindications should be evaluated within the context of the overall benefit versus the risk of any therapy.…”

Section: Resultsmentioning

confidence: 99%

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

et al. 2018

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Visual Functioning and Health-related Quality-of-Life are Compromised in Patients with Uveitis

Abstract: Patients with uveitis have significantly poorer VR- and HR-QoL than healthy control subjects. Uveitis has a more debilitating impact on VR-QoL than DR.

Cited by 33 publications

References 22 publications

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

Quality-of-Life Outcomes From a Randomized Clinical Trial Comparing Antimetabolites for Intermediate, Posterior, and Panuveitis

Effect of Adalimumab on Visual Functioning in Patients With Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis in the VISUAL-1 and VISUAL-2 Trials

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

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