Long-Term Risk of Cataracts Higher in Pediatric Uveitis Patients: JAMA

A new study published in the Journal of American Medical Association found an increased incidence of cataracts in pediatric patients with uveitis when compared to pediatric patients without uveitis.

Uveitis is one of the most frequent ophthalmologic disorders affecting children's eyes and increases the risk of cataract development. Other variables that may increase the risk of cataract development include the use of steroid eye drops and other immunosuppressive drugs often administered for uveitis. While the specific processes are uncertain, several animal models have revealed that immunosuppressive drugs might negatively influence the proliferation of lens epithelial cells by potentially contributing to cataract formation. To address these information gap in pediatric population, Alan Hsu and colleagues undertook this research on young patients with uveitis to determine the risk of cataract development.

This cohort research included pediatric patients with and without uveitis in the multinational TriNetX database from January 1, 2002 to December 31, 2022. Utilizing diagnostic codes, this study identified a total of 22,687 pediatric patients with uveitis and an equal number of control patients without uveitis. These groups were meticulously matched for age, sex, race, ethnicity and specific comorbidities to ensure robust comparisons. The average age of the participants was 10.3 years with a roughly equal distribution of males and females.

The key findings of this study were:

The primary outcome measure was the hazard ratio (HR) for developing cataracts when comparing the uveitis group to the non-uveitis group.

The results showed that pediatric patients with uveitis had a significantly increased risk of developing cataracts over a follow-up period of up to 20 years. The overall hazard ratio was 17.17 that indicated a more than 17-fold increase in risk for the children with uveitis.

Subgroup studies found an increased cataract risk in all age groups: 0 to 6 years, 7 to 12 years and 13 to 18 years. Both male and female patients with uveitis showed a significantly higher risk of cataracts. Also, the outcomes found increased risks across different racial groups (Asian, Black or African American and White races).

The children who had or did not have a history of immunosuppressive drugs, steroid eye drop usage or intraocular surgeries were more likely to develop cataracts. Overall, this study discovered that patients under the age of 18 with uveitis may have a considerably increased risk of developing cataracts. These findings imply that juvenile patients with uveitis should be closely watched for the development of cataracts.

Reference:

Hsu, A. Y., Kuo, H.-T., Lin, C.-J., Hsia, N.-Y., Kuo, S.-C., Wei, C.-C., Lai, C.-T., Chen, H.-S., Wang, Y.-H., Wei, J. C.-C., & Tsai, Y.-Y. (2024). Cataract Development Among Pediatric Patients With Uveitis. In JAMA Network Open (Vol. 7, Issue 7, p. e2419366). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.19366