The authors developed and assessed a novel scoring system for uveitis due to Behçet’s disease that they named Behçet’s disease ocular attack score 24 (BOS24).
They found that the scoring system, which includes a total of 24 points divided into six parameters of ocular inflammatory symptoms, had a low level of variance among five physicians and correlated well with a physician’s impression score of disease severity (1 through 10) based on the Behçet’s disease activity index.
Five uveitis specialists examined the severity of 50 ocular attacks in clinical charts using both BOS24 and a physician’s impression score (grade 1 to 10). They also retrospectively examined ocular disease activity before and after initiation of infliximab in 150 cases of ocular Behçet’s disease.
The average BOS24 score for the five doctors was highly correlated with the average physician’s impression score, and the variance coefficient for the BOS24 scores was much lower than that for the physician’s impression score.
BOS24 showed that infliximab therapy reduced both the frequency and severity of ocular attacks. The reduction of scores after initiation of therapy was particularly high in the posterior portion of the retina and fovea, demonstrating that infliximab has potential for preventing loss of visual acuity.
The authors write that the BOS24 scoring system is simple to use since it is based on new inflammatory signs in the eyes. Therefore, most ophthalmologists can use it by observing and noting fresh inflammatory signs, such as cells in the anterior chamber, vitreous haze, retinal hemorrhages, exudates and vasculitis. In addition, BOS24 is simple enough to use retrospectively with medical records.
Nevertheless, they note some limitations to the system. One is that ocular attacks cannot be scored if the patient does not undergo an examination during the attack. Furthermore, it is difficult to score retinal lesions if ocular fundus lesions are invisible due to vitreous opacity, vitreous hemorrhages or the presence of a cataract.
They conclude that further evaluations, minor changes to the system and accumulation of evidence are necessary.