May 18, 2016 By Dr Foster
Uveitis is the third leading cause of blindness in America, and 5% to 10% of the cases occur in children under the age of 16. But uveitis in children blinds a larger percentage of those affected than in adults, since 40% of the cases occurring in children are posterior uveitis, compared to the 20% of posterior uveitic cases in the adult uveitis population.
There are, at any one time, approximately 11,000 cases of pediatric uveitis in the United States, with 4,300 new cases occurring each year. Spread across the entire U.S. population, therefore, and across all offices of ophthalmic practitioners, the likelihood that any one individual practitioner will care for a patient with pediatric uveitis is relatively small, and the likelihood that any single individual will have significant experience in caring for large numbers of cases over a long period of time is vanishingly small. This accounts, we believe, at least in part for the sub-optimal care that many of our children with uveitis appear to be receiving, even in these “modern” times. The stakes are incredibly high, for the child, for the parents who will be faced with (usually) many years of dealing with this health problem in their child, and for society at large because of the life-time of dependence which occurs in those who eventually reap substantial visual handicap as the result of sub-optimal treatment.
We believe that current epidemiologic data emphasize two critically important goals in an effort to change the current prevalence of blindness caused by pediatric uveitis:
Statements (a) and (b) are true, but too often pull the doctor, and patient, and family into the seduction of nearly endless amounts of topical steroid therapy. It is generally true that the child will in fact “out grow” the uveitis, i.e., that the uveitis will no longer be a problem eventually. The pity is, however, that so often by the time the child “out grows it”, permanent structural damage to retina, optic nerve, or aqueous outflow pathways have already occurred, and the blinding consequences are now permanent. It is also true that for any individual episode of uveitis, the steroid drops usually will get the patient through it. But the fact is that so many children with pediatric uveitis have recurrent episodes of uveitis such that the cumulative damage caused by each episode of uveitis and the steroid therapy for each episode eventually produces vision-robbing damage. Item (c) is simply the result of the common viewpoint of ophthalmologists: That it is just an eye problem, and therefore should simply be treated with eye medications. Nothing could be further from the truth! Unless and until large numbers of ophthalmologists reframe this socially and epidemiologically important matter, and refer their patients to an ocular immunologist or uveitis specialist early, the prevalence of blindness secondary to pediatric uveitis is not going to change.