Demographic and socioeconomic associations with outcomes in pediatric uveitis: An IRIS® registry study

Objective To evaluate the associations of demographic and socioeconomic factors—including race and ethnicity, sex, insurance type, age, and geographic region—with visual outcomes, ocular complications, and the need for ocular surgery in children with non-infectious uveitis Design Retrospective cohort study using the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry, a national ophthalmic disease registry Participants Pediatric patients with non-infectious uveitis Methods Patients with non-infectious uveitis diagnosed and treated at age ≤18 with ≥1 year follow-up with complete demographic information identified in the IRIS® Registry between January 1, 2013 and December 31, 2019. Insurance type was used as a proxy for socioeconomic status, and analyses accounting for the inclusion of both eyes of the same patient were performed using generalized estimating equations. Multivariable logistic or linear regression were performed to assess whether age, sex, race, region and insurance type were associated with higher risk of poor visual acuity outcomes, complications of uveitis and requirement for ocular surgery. Results Data from 3611 unique patients (5,723 eyes) were included. Compared to White children, Black children were more likely to have a final visual acuity of 20/200 or worse and develop glaucoma and cystoid macular edema (OR for White vs Black children for 20/200 or worse vision 0.59, 95% CI 0.42–0.82; P<0.05). Compared to children with private insurance, those with Medicaid were more likely to have a final visual acuity of 20/200 or worse, as well as suffer from amblyopia, posterior synechiae, and band keratopathy (OR for private vs Medicaid for 20/200 or worse vision 0.50, 95% CI 0.37–0.67; P<0.05 for all). Children with age ≤12 years were more likely to develop band keratopathy and amblyopia compared to those 13-18 years old (amblyopia OR 4.99, 95% CI 3.00–8.31; band keratopathy OR 2.62, 95% CI 1.89–3.63; P<0.001 for both). Conclusion Socioeconomic and demographic factors associated with poorer clinical outcomes in pediatric non-infectious uveitis include younger age at presentation, Black