Analysis of uveitis in a Canadian aboriginal population

Abstract

ObjectiveTo compare patient demographics, uveitis characteristics, and outcomes in aboriginal First Nations (FN) versus non-aboriginal non-FN uveitis patients. DesignCase–control study. ParticipantsForty-three FN patients (80 eyes) and 45 control non-FN uveitis patients (69 eyes). MethodsRetrospective chart review comparing patient demographics (age, sex, residency), disease characteristics (laterality, anatomic classifications, granulomatous and chronic inflammation, systemic associations, specific uveitis diagnoses), and disease severity-related outcomes (therapies, visual outcomes, complications) between FN versus control patients. ResultsMean age at disease onset was significantly younger in FN patients (30.4 years) versus control patients (40.2 years; p < 0.0001). Bilateral uveitis was significantly more common in the FN group (86%) versus control patients (51%; p = 0.0005), and granulomatous uveitis was significantly more common in FN patients (53%) than among control patients (11%; p < 0.0001). There was no significant difference in rates of chronic uveitis between groups, identified in 74% of FN versus 60% of control subjects (p = 0.15). Anatomically, panuveitis was the prevalent form of uveitis within the FN group, occurring in 67% (versus 16% in control patients), whereas anterior uveitis was the prevalent anatomic classification in control patients, occurring in 73% (versus 26% in FN patients; p < 0.001). Vogt–Koyanagi–Harada (VKH) syndrome was the predominant causative uveitis diagnosis within the FN group, identified in 56% of FN patients versus 0% of control subjects (p < 0.001). Idiopathic uveitis was the predominant causative diagnosis within the control group and was identified in 40% of control patients, compared with 19% of FN uveitis patients (p = 0.002). All therapies except anterior segment surgeries (p = 0.88) were required more often in FN, including systemic corticosteroids (p = 0.002), injected corticosteroids (p = 0.042), systemic immunosuppression (p = 0.021), glaucoma therapy (p = 0.005), laser (p < 0.001), and posterior segment surgeries (p = 0.002). Complication rates were higher in FN patients (p < 0.001). Final visual outcome was worse in FN patients (35% FN ≤ 20/200 versus 9% control subjects; p = 0.001). ConclusionsMultiple findings differed strikingly between FN and control patients. Uveitis in FN patients was characterized by significantly younger age of onset. FN patients were more likely to have bilateral disease, panuveitis, and granulomatous disease. With respect to specific uveitic entities, VKH was more common in FN patients. FN patients also required more aggressive therapies, and yet had higher complication rates and had poorer visual outcomes.