Sir,

Quartilho et al1 present the recent aetiology of visual impairment in England and Wales. A brief scan of these figures raises the immediate question—where is uveitis? These inflammations may cause severe vision impairment in up to 22% of patients in the UK,2 disproportionately in patients of working age. The problem is worldwide: a recent study from Brazil3 found that uveitis was the second most common cause of vision impairment (15.7%) and in Singapore4 7.5% had severe vision loss, most commonly from cataract and glaucoma.

The current CVI registration form contains only ‘chorioretinitis (unspecified), H30.9’ as a specific uveitis category. However, a recent large study from this tertiary centre5 permits only 671 of 3000 uveitis patients (21%) to be so labelled if severely affected. Uveitis causes visual loss from direct inflammation, but also substantially from macular oedema, epiretinal membrane, cataract, glaucoma, choroidal neovascular membrane and retinal detachment. One might suspect that in addition to the 0.43% of patients with chorioretinitis recorded by the authors,1 many of the patients with uveitis in this study are ‘hiding in plain sight’ within ‘secondary glaucoma’, ‘cataract’, ‘other retinal disorders’ and so on. At a time when great advances in the control of uveitis by immunosuppression and biologic therapy are being thwarted by funding restrictions, it would mean a disservice to affected patients if their disease cannot be adequately represented in vision impairment statistics. For those attempting to record accurately and to raise the profile of uveitis in the registration process, the most useful codes for the few open-field boxes on the CVI form include the following:

H20.1 Chronic iridocyclitis

H26.2 Complicated cataract (includes chronic iridocyclitis)

H30.1 Disseminated chorioretinal inflammation

H31.0 Chorioretinal scars (there is no ICD10 code for macular oedema or epiretinal membrane)

H35.0 Includes retinal vasculitis

H40.4 Glaucoma secondary to eye inflammation

H44.4 Hypotony of eye