Pediatric Uveitis Prevalence Just 2% of All Cases

Though complications occurred such as cataracts and macular edema, pediatric patients with non-infectious uveitis rarely underwent ocular surgery. Photo: Michael Trottini, OD, and Candice Tolud, OD. Click image to enlarge. The heterogeneity of pediatric uveitis, coupled with the disease’s rarity, makes it challenging to recruit subjects for large, meaningful clinical trials. Clinicians caring for this patient population often depend on smaller retrospective datasets and individual clinical experiences to help guide diagnostic and treatment approaches. Pediatric patients also may present later in their disease course, are more likely to have systemic disease associations and have more limited treatment options than adult patients.Current knowledge of pediatric uveitis is limited to reports from academic centers, which may see more complex disease due to referral bias and may not accurately reflect the actual population.The Intelligent Research in Sight (IRIS) Registry captures a broader, real-world population and has not been previously used to study pediatric uveitis. A recent study published in Ophthalmology Retina used the IRIS Registry to describe pediatric non-infectious uveitis prevalence in the US and compare the demographic information and initial approach to therapy to historic estimates published in the literature.Patients with non-infectious uveitis diagnosed and treated at age 18 and younger with one year or more of follow-up were identified in the IRIS Registry over a seven-year period. A total of 5,722 pediatric patients (9,073 eyes) were identified, representing 2.1% of all non-infectious uveitis patients in the IRIS Registry. Annual prevalence was 11.9 cases per 100,000 patients. Mean age at diagnosis was 12.5 years, 51.3% were female, 56.3% were white, 46.2% had private insurance and 28.6% had Medicaid.The researchers assessed annual prevalence, demographic characteristics, ocular complications, need for ocular surgery, type of anti-inflammatory medications and difference in visual acuity (VA; logMAR) at presentation, one year and the final visit (≥15 months).Anatomical subtypes of uveitis included anterior (68.7%), intermediate (13.4%), posterior (6.1%) and panuveitis (10.2%). Mean VA was 0.26 at diagnosis, 0.18 at one year and 0.21 at final visit, with a mean follow-up of 1,216 days. The researchers found that 9.3% of eyes had severe vision loss (VA≥1.00 logMAR) during follow-up.Complications occurred in 20.7% of eyes, mostly as cataracts (10.6%) and macular edema (5.4%), and 5.3% of eyes required ocular surgery. The highest rate of complications and ocular surgeries was seen in patients with panuveitis and posterior uveitis, respectively. Local corticosteroids were used in 91.4% of eyes, and 43.1% were started on steroid-sparing agents after diagnosis, most commonly methotrexate (30.9%).“Our findings shed light on the modern demographic landscape of pediatric non-infectious uveitis in the U.S. as the largest national study of pediatric uveitis to date,” the researchers wrote in their paper. “The overall good visual outcomes in our study may be due to lack of referral bias, early diagnosis, and potential initiation of prompt treatment in the disease process, as also reflected by the low ocular complication rate in the IRIS Registry cohort.”The team did note that the observed rates of complications related to uveitis were lower than in their own individual practices. Whether this is because there was a greater representation of milder cases of uveitis in the IRIS Registry or because the researchers’ own practices tend to be biased towards more severe cases is unclear.They concluded that, “Future work will focus on treatment of specific categories of pediatric uveitis to identify at-risk patients, tailor treatment and monitoring and improve care delivery.”Click here for the journal source. Uner OE, Lin P, Koplin LJ, et al. Prevalence, treatment patterns and outcomes of pediatric non-infectious uveitis in the United States: an IRIS Registry analysis. Ophthalmol Retina. May 9, 2025. [Epub ahead of print].