Longitudinal Vision-Related Quality of Life for Patients with Noninfectious Uveitis Treated with Fluocinolone Acetonide Implant or Systemic Corticosteroid Therapy

• Published in: Ophthalmology (Rochester, Minn.) Vol. 124; no. 11; pp. 1662 - 1669
• Main Authors: Sugar, Elizabeth A., PhD, Venugopal, Vidya, PhD, Thorne, Jennifer E., MD, PhD, Frick, Kevin D., PhD, Holland, Gary N., MD, Wang, Robert C., MD, Almanzor, Robert, COA, Jabs, Douglas A., MD, MBA, Holbrook, Janet T., PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: Adult; Aged; Cohort Studies; Drug Implants; Female; Fluocinolone Acetonide - administration & dosage; Follow-Up Studies; Glucocorticoids - administration & dosage; Health Status; Humans; Male; Middle Aged; Ophthalmology; Panuveitis - drug therapy; Panuveitis - psychology; Quality of Life - psychology; Risk Factors; Sickness Impact Profile; Surveys and Questionnaires; Uveitis, Intermediate - drug therapy; Uveitis, Intermediate - psychology; Uveitis, Posterior - drug therapy; Uveitis, Posterior - psychology; Vision, Ocular - physiology; Visual Acuity - physiology; Visual Fields - physiology; VRQoL; EQ-5D; vision-related quality of life; CI; visual acuity; EuroQol-5D; confidence interval; Multicenter Uveitis Steroid Treatment; NEI-VFQ-25; VA; MUST; 25-item National Eye Institute Visual Functioning Questionnaire
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2017.05.015

Purpose To evaluate longitudinal vision-related quality of life (VRQoL) in patients with noninfectious uveitis. Design Cohort study using randomized controlled trial data. Participants Patients with active or recently active intermediate uveitis, posterior uveitis, or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study. Methods Data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization were evaluated semiannually. Analyses were stratified by assigned treatment (129 implants therapy vs. 126 systemic therapies) because of substantial differences in the trajectories of VRQoL. The impact of baseline measurements of visual function (visual acuity and visual field), demographics, and disease characteristics was assessed using generalized estimating equations. Main Outcome Measures Primary outcome was the NEI-VFQ-25 composite score over 3 years after randomization. Results Individuals in both treatment groups showed similar improvement in NEI-VFQ-25 scores after 3 years of follow-up (implant: 11.9 points; 95% confidence interval [CI], 8.6–15.2; P < 0.001; systemic: 9.0 points; 95% CI, 5.6–12.3; P < 0.001; P  = 0.21 for interaction). Individuals in the implant group showed a substantial improvement during the first 6 months followed by stable scores, whereas individuals in the systemic group showed a steady improvement over the course of follow-up. Worse initial visual acuity and visual fields were associated with lower initial NEI-VFQ-25 scores for both treatment groups. In the systemic group, these differences were maintained throughout follow-up. In the implant group, individuals with initial visual acuity worse than 20/40 showed additional improvement in NEI-VFQ-25 score to come within −7 points (95% CI, −15.0 to 0.9) of those with visual acuity 20/40 or better initially, a clinically meaningful but not statistically significant difference ( P  = 0.081). Results based on sensitivity analyses showed similar patterns. Conclusions Both treatment groups demonstrated significant improvements in NEI-VFQ-25 scores; however, the improvement was immediate for the implant group as opposed to gradual for the systemic group. Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years.