Saira Akbarali1, Jugnoo S Rahi2, Andrew D Dick3, Kiren Parkash4, Katie Etherton5, Clive Edelsten6, Xiaoxuan Liu7, Ameenat L Solebo8. 1. Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK. 2. Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, UK. 3. NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK, and Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK. 4. University of Birmingham Medical School, Birmingham, UK. 5. Moorfields Eye Hospital NHS Foundation Trust, London, UK. 6. Great Ormond Street Hospital for Children NHS Foundation Trust, London UK, and Ipswich Hospital NHS Foundation Trust, Ipswich, UK. 7. University of Birmingham College of Medical and Dental Sciences, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 8. Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
Abstract
OBJECTIVE: Children with juvenile idiopathic arthritis (JIA) need regular examinations for uveitis to avoid visual morbidity from the most common extraarticular manifestation of disease. This study was undertaken to investigate the feasibility, acceptability, and performance of optical coherence tomography (OCT) imaging-based diagnosis of uveitis. METHODS: This observational cross-sectional study included children with and those without uveitis. The children underwent routine clinical examinations and anterior segment OCT scanning of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analog scale and length of time needed to acquire images. Interobserver and intraobserver variability of manual counting of acquired images (Bland-Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of anterior segment OCT detection of active inflammation were assessed. RESULTS: Of the 26 children ages 3-15 years (median age 8 years) who underwent imaging, 12 had active inflammation. All patients rated the acceptability of image acquisition as at least 8.5 on a scale of 0-10. Time taken to acquire images ranged from 1.5 minutes to 22 minutes (median time 8 minutes). There was good positive correlation between clinical assessment and image-based cell quantification (R2 = 0.63, P = 0.002). Sensitivity of anterior segment OCT manual image cell count for diagnosis of active inflammation was 92% (95% confidence interval [95% CI] 62-99%), specificity was 86% (95% CI 58-98%), and negative predictive value (ruling out uveitis) was 92% (95% CI 65-99%). CONCLUSION: Non-contact, high-resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming pediatric practice. Further work is needed to determine the analytic and clinical validity of anterior segment OCT quantification of active inflammation, and the clinical utility and cost-effectiveness of imaging-based disease monitoring.
OBJECTIVE:Children with juvenile idiopathic arthritis (JIA) need regular examinations for uveitis to avoid visual morbidity from the most common extraarticular manifestation of disease. This study was undertaken to investigate the feasibility, acceptability, and performance of optical coherence tomography (OCT) imaging-based diagnosis of uveitis. METHODS: This observational cross-sectional study included children with and those without uveitis. The children underwent routine clinical examinations and anterior segment OCT scanning of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analog scale and length of time needed to acquire images. Interobserver and intraobserver variability of manual counting of acquired images (Bland-Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of anterior segment OCT detection of active inflammation were assessed. RESULTS: Of the 26 children ages 3-15 years (median age 8 years) who underwent imaging, 12 had active inflammation. All patients rated the acceptability of image acquisition as at least 8.5 on a scale of 0-10. Time taken to acquire images ranged from 1.5 minutes to 22 minutes (median time 8 minutes). There was good positive correlation between clinical assessment and image-based cell quantification (R2 = 0.63, P = 0.002). Sensitivity of anterior segment OCT manual image cell count for diagnosis of active inflammation was 92% (95% confidence interval [95% CI] 62-99%), specificity was 86% (95% CI 58-98%), and negative predictive value (ruling out uveitis) was 92% (95% CI 65-99%). CONCLUSION: Non-contact, high-resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming pediatric practice. Further work is needed to determine the analytic and clinical validity of anterior segment OCT quantification of active inflammation, and the clinical utility and cost-effectiveness of imaging-based disease monitoring.
Authors: Edmund Tsui; Judy L Chen; Nicholas J Jackson; Omar Leyva; Haroon Rasheed; Elmira Baghdasaryan; Simon S M Fung; Deborah K McCurdy; Srinivas R Sadda; Gary N Holland Journal: Am J Ophthalmol Date: 2022-05-21 Impact factor: 5.488
Authors: Morgan Maring; Steven S Saraf; Marian Blazes; Sumit Sharma; Sunil Srivastava; Kathryn L Pepple; Cecilia S Lee Journal: Ocul Immunol Inflamm Date: 2022-02-17 Impact factor: 3.728