Abstract
BackgroundSystemic lupus erythematosus (SLE) can directly affect various part of the ocular system, but there was no comprehensive analysis of ophthalmic disorders of patients with SLE using population-based data. The aim of this study was to investigate the frequency and prevalence of ophthalmic disorders for ophthalmologist visits in adult patients with SLE and to evaluate the risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in these patients.MethodsThe Taiwan’s National Health Insurance Research Database was used to assemble a SLE cohort consisting of newly diagnosed SLE between 2000 and 2012. A comparison cohort was also sampled from the same database and it consisted of 10 patients without SLE for each patient with SLE, based on frequency matching for sex, five-year age interval, and index year. Both cohorts were followed until either the study outcomes have occurred or the end of the follow-up period.ResultsPatients with SLE (n = 521) exhibited a significantly higher prevalence (68.1% vs. 60.5%, P = 0.001) and frequency (median 5.51 vs. 1.71 per 10 years, P < 0.001) for outpatient ophthalmologist visits compared with patients without SLE. The risk of dry eye syndrome (adjusted incidence rate ratio [IRR] 4.45, P < 0.001), cataracts (adjusted IRR 3.18, P < 0.001), and glaucoma (adjusted IRR 2.23, P = 0.002) were significantly higher in patients with SLE. In addition, the risk of several SLE related ophthalmic disorders, including episcleritis and scleritis (adjusted IRR 6.11, P < 0.001) and retinal vascular occlusion (adjusted IRR 3.81, P = 0.023) were significantly higher in patients with SLE.ConclusionsThe increased risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in patients with SLE deserves vigilance.
Highlights
Systemic lupus erythematosus (SLE) can directly affect various part of the ocular system, but there was no comprehensive analysis of ophthalmic disorders of patients with SLE using population-based data
No significant differences were observed between the two groups with respect to sex, age, and geographic region, but the socioeconomic status, which was estimated by the insurance premium level was significantly higher in the SLE cohort
Frequency of outpatient ophthalmologist visits and frequency of ophthalmic disorders Patients with SLE had a higher proportion suffering from ophthalmic disorders (68.1% vs. 60.5%; P = 0.001) and a higher median frequency of ophthalmologist visits per year compared with the patients in the comparison cohort (5.5 vs. 1.7 per 10 years, P < 0.001) (Table 2)
Summary
Systemic lupus erythematosus (SLE) can directly affect various part of the ocular system, but there was no comprehensive analysis of ophthalmic disorders of patients with SLE using population-based data. SLE can directly attack the retina, lacrimal gland, choroid, optical nerve, and even the episclera and sclera of the ocular system [2, 3]. It may affect the ocular system indirectly through the adverse effects of long-term administration of certain medications for SLE [4] and infection related to impaired immunity [5]. We assessed the incidence and risk of several important ophthalmic disorders in patients with SLE
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