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
References
Quartilho A, Simkiss P, Zekite A, Xing W, Wormald R, Bunce C . Leading causes of certifiable visual loss in England and Wales during the year ending March 2013. Eye 2016; 30: 602–607.
Durrani OM, Tehrani NN, Marr JE, Moradi P, Stavrou P, Murray PI . Degree, duration and causes of visual loss in uveitis. Br J Ophthalmol 2004; 88: 1159–1162.
Silva LM, Muccioli C, Oliveira FD, Arantes TE, Gonzaga LR, Nakanami CR . Visual impairment from uveitis in a reference hospital of Southeast Brazil: a retrospective review over a twenty years period. Arq Bras Oftalmol 2013; 76: 366–369.
Yeo TK, Ho SL, Lim WK, Teoh SC . Causes of visual loss associated with uveitis in a Singapore tertiary eye center. Ocul Immunol Inflamm 2013; 21: 264–269.
Jones NP . Manchester Uveitis Clinic: the first 3000 patients: 1. Epidemiology and casemix. Ocul Immunol Inflamm 2015; 23: 118–126.
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Jones, N. Visual loss in uveitis. Eye 30, 1521–1522 (2016). https://doi.org/10.1038/eye.2016.119
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DOI: https://doi.org/10.1038/eye.2016.119
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