AB1019 THE EFFECT OF TREATMENT REGIMEN ON HEALTH-RELATED QUALITY OF LIFE AND FUNCTIONING IN CHILDREN WITH UVEITIS

Abstract

Background Pediatric non-infectious uveitis can lead to ocular complications and blindness. Complex treatment regimens are often needed and consist of frequent topical treatments (glucocorticoids, mydriatics, glaucoma medications) and systemic immunosuppression. Objectives To examine the impact of topical and systemic treatment on health-related quality of life (HRQOL), mental health, and uveitis-related quality of life (QOL) of children with uveitis. Methods We reviewed records of 40 children with uveitis (22 JIA-associated uveitis (JIA-U), 18 other uveitis types). Parents and patients completed questionnaires on general QOL (Pediatric Quality of Life Inventory- PedsQL), depression and anxiety (Revised Children’s Anxiety and Depression Scale- RCADs), physical functioning (Childhood Health Assessment Questionnaire- CHAQ), and visual function and uveitis-related QOL (Effect of Youngsters’ Eyesight on QOL-EYE-Q). We used ANOVA and T-Test to compare treatment groups: 1) topical only vs. systemic only vs. combined topical and systemic treatment; 2) topical vs. no topical treatment. Results Of 40 children most were non-Hispanic (98%), Caucasian (80%), and female (70%). Most had bilateral (73%), anterior disease (83%), with minimal disease activity (93% inactive uveitis) and normal vision (100% visual acuity 20/40 or better). When comparing by treatment group, there were worse EYE-Q Parent and Child uveitis-related QOL scores among the children of the topical treatment only group compared to those on systemic treatment only or the combined treatment group, however they were not statistically significant. (Parent: 1.57 vs. 1.83 vs. 1.6, p=0.13)(Child: 1.68 vs. 1.9 vs. 1.7, p=0.20). However, when comparing children by use of topical treatment, children on topical treatment had worse EYE-Q total scores compared to those who were not on topical treatment for Parent reports (1.75 vs. 1.93, p=0.01) (Table 1). They also had worse EYE-Q visual function scores (1.82 vs. 1.96, p=0.02) and uveitis-related QOL scores (1.59 vs. 1.83, p=0.04). For child reports, EYE-Q total score and subscores were lower in the topical treatment group but were not statistically significant. Children with uveitis had similar Parent and Child reports of PedsQL, RCADS, and CHAQ regardless of treatment group. Conclusion The parents of children with uveitis who need topical treatments as part of their therapy regimen report worse uveitis-related QOL. This is likely secondary to parental responsibility for instilling topical therapy. Additionally, visual function scores were also lower in the topical treatment group and could reflect disease activity or use of mydriatics which can affect vision. Other measures including the PedsQL, CHAQ, and RCADS did not appreciate differences based on treatment regimen. Our findings demonstrate the importance of including uveitis-specific disease measures in the assessment of the impact of uveitis. The burden of medication use, specifically eye drops, that can sting, require frequent application, or affect vision, needs further study as this can affect medication adherence and patient outcomes. Disclosure of Interests: Joseph McDonald: None declared, Virginia Utz Grant/research support from: Retrophin, Consultant for: Spark Therapeutics - >12 months ago, Theresa Hennard: None declared, Najima Mwase: None declared, Jessi Lipscomb: None declared, Amy Cassedy: None declared, Sheila Angeles-Han: None declared