This retrospective, case-controlled study assessed the epidemiology of infectious uveitis and scleritis in the United States.
Study design
Researchers used a claims database (Optum) containing data from 21.5 million privately insured individuals enrolled for 15 months or more between 2007 and 2015. Patients were excluded if the claim was within 3 months of intraocular surgery. Rates of disease were determined by anatomic site.
Outcomes
Infectious etiologies accounted for less than 20% of uveitis and scleritis cases. The mean incidence and prevalence rates were 18.9 and 60.6 per 100,000 persons, respectively. Mean prevalence of infectious anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis and scleritis were 27.7, 0.17, 23.4, 4.4, and 4.6 per 100,000 persons, respectively. Risk of infectious disease increased with age, female sex, non-Hispanic white race and along the East South Central census division (Alabama, Kentucky, Tennessee, Missouri). Common comorbidities included HIV and rheumatologic disease.
Limitations
Despite access to a large claims database, the study lacked the ability to review charts, limiting clinical correlations of large data findings. In addition, ICD-9 codes have been found to have a lower than expected positive predictive value for clinical diagnosis (61% in one study), limiting the ability to estimate the prevalence of infectious uveitis. The authors indexed pharmacy claims data for antimicrobial use to capture infectious cases, but acknowledge that this may include false positives where patients were empirically treated even when the final diagnosis was a noninfectious etiology.
Clinical significance
Infectious uveitis and scleritis are more common than previously reported in the literature. Clinicians should pay attention to demographic, geographic and clinical factors that increase the risk of an infectious etiology, and ensure that a proper workup is obtained for these patients.