Brian Toy, MD: Risk Factors for Uveitis

Investigators at the University of Southern California (USC) presented data on risk factors for infectious and non-infectious uveitis at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, BC.

Brian Toy, MD, Assistant Professor, Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, and an author on the poster, spoke with MD Magazine® about the research.

“One of the key findings that we found was that older patients and female patients were at higher risk of developing uveitis as well as sequelae or complications of uveitis,” Toy told MD Mag.

Toy also noted that, in the data, people with higher socioeconomic status were more likely to be diagnosed with uveitis, but less likely to develop complications. He said that this was likely due to disparities in health care access.

In part 1 of the interview, Toy outlined the research he and his colleagues presented at ARVO.

What risk factors for uveitis did you identify?

What comorbidities were associated with increased risk of uveitis?

Were any of the results surprising to you?

What further research would you like to see?

One of the key findings that we found was that older patients and female patients were at higher risk of developing uveitis as well as sequelae or complications of uveitis. Actually, patients who were of higher socioeconomic status were more likely to be diagnosed with uveitis—to have incident uveitis—but less likely to be developing complications from uveitis. So, that sort of disconnect lets us think about or leads us to think about—what are the healthcare disparities that are leading—even though these patients are more likely to be diagnosed with uveitis. So, they have possibly an increased ascertainment bias, because they're more likely to access care because they're of higher socioeconomic status, but they have fewer complications from it. Where there are some of the barriers that are causing patients of lower socioeconomic status to be at higher risk for developing complications from uveitis and how do we address those?So, infectious uveitides are often viral, like herpes viruses cause a fair amount of uveitis and then in the developing world things like tuberculosis and, in immunocompromised patients, things like syphilis and patients who have HIV for instance are also at increased risk of developing a CMV [cytomegalovirus] infection—CMV retinitis. So, certainly we found that there are different associations with various comorbidities for infectious uveitis. Then the other sub group was non-infectious uveitis. We did find that there is an association between systemic autoimmune diseases—things like rheumatoid arthritis, lupus, ankylosing spondylitis, inflammatory bowel disease, Behcet's disease—those are all associated with an increased risk of developing various forms of non-infectious uveitis.One thing that we did find that was a little bit surprising to us is that patients with uveitis were also more likely to have very common other chronic medical diseases like hypertension and diabetes, which aren't classically thought to be associated with an increased risk of uveitis. So, that's certainly some of the data we're delving more into to see if that's real signal.As powerful as the Optum database is, it utilizes just health insurance claims data, so there's not a whole lot of direct clinical measurements, nor are there a lot of measurements about quality of life effects on patients. I think more research can be done to help understand—what are the actual day-to-day implications of uveitis on vision impairments and vision-related quality of life and patients' activities of daily living and their overall functional status? I think demonstrating that effect and how different treatments can improve that is certainly a next step.