The Impact of Macular Edema on Visual Function in Intermediate, Posterior, and Panuveitis

Abstract

Purpose: To evaluate the impact of macular edema on visual acuity and visual field sensitivity in uveitis.

Design: This study utilized baseline data from the Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized, parallel treatment clinical trial comparing alternative treatments for intermediate, posterior and panuveitis.

Patients & Methods: 255 patients (481 eyes with uveitis) recruited at 23 subspecialty centers. Visual acuity, optical coherence tomography and Humphrey 24-2 visual field testing.

Results: Macular edema was associated with impaired visual acuity (p < 0.01). Different phenotypes of macular edema were associated with different degrees of visual impairment: cystoid changes without retinal thickening were associated with moderately impaired visual acuity (–5 ETDRS letters), but visual acuity was worse in eyes with retinal thickening (–13 letters) and with both cysts and thickening (–19 letters). Uveitis sufficient to satisfy the study’s inclusion criteria was associated with impaired visual field sensitivity, but eyes with macular edema had even worse visual field sensitivity (p < 0.01).

Conclusions: The observation that macular edema substantially reduces visual function suggests macular edema itself is an important endpoint to study in the treatment of uveitis. As uveitis and macular edema both impair visual field sensitivity as measured by Humphrey 24-2 perimetry, both should be considered when evaluating patients with uveitis and raised intraocular pressure for glaucoma.

Keywords::

• cataract
• cystoid macular edema
• OCT
• uveitis
• visual acuity
• visual field, vitrectomy

Declaration of interest: This study was supported by cooperative agreements from the National Eye Institute to the Mount Sinai School of Medicine (U10 EY 014655), The Johns Hopkins University Bloomberg School of Public Health (U10 EY 014660), and the University of Wisconsin, Madison, School of Medicine (U10 EY 014656). SRJT was supported by the UK National Institute of Health Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. National Eye Institute, the U.S. National Institutes of Health, or the UK National Institute of Health Research. Additional support was provided by Bausch & Lomb, Inc, Rochester, NY.

MUST CREDIT ROSTER

Key Personnel (MUST certified)

2005–2010 (30 July 2010)

Participating Clinical Centers

Duke University, Durham, NC: Glenn J. Jaffe, MD (Director); Michael Cusick, MD; Justis Ehlers. Former Members: Claxton Baer, MD; Sai Chavala, MD; Pouya Dayani, MD; Muge Kesen, MD Alex Melamud, MD; Jawad A. Qureshi, MD; Robert F. See, MD; Cindy Skalak; Adrienne Williams Scott; Robert K. Shuler, MD.

Emory University, Atlanta, GA: Sunil Srivastava, MD (Director); Alicides Fernandes, MD. Former members: Deborah Gibbs, COMT; Daniel F. Martin, MD.

Johns Hopkins University, Baltimore, MD: James P. Dunn, MD (Director); Ellen Arnold, BS; Jeff Boring, COA; Diane M. Brown, MSN, RN; Alison G. Livingston, BSN,RN, Kisten Nolan, BSN, MPH, RN; Terry Reed, COA. Former members: Marie-Lynn Belair, MD; Stephen G. Bolton, CRNP; Joseph B. Brodine; Lisa M. Brune, BSN, RN; Anat Galor, MD; Adam Jacobowitz, MD; Meera Kapoor; Sanjay Kedhar, MD; Henry A. Leder, MD; Yavette Morton; George B. Peters, MD, MBA; Priscilla Soto; Ricardo Stevenson, MD; Michelle Tarver-Carr, MD, PhD; Yue Wang, MD; Stephen Kim, MD.

Massachusetts Eye Research and Surgery Institute, Cambridge, MA: C. Stephen Foster, MD (Director); Angelica Contero; Linda Bruner; Kayleigh Fitzpatrick; David M. Hinkle, MD; Jyothir Johnson; Danielle Marvell; Jennifer Pinto. Former members: Sarah Acevedo, MD; Fahd Anzaar, MD; Tom Cesca;Karina Q. Lebron, MD; Chandra Morgan; Nita Patel, MSW; Janet Sprague; Taygan Yilmaz.

National Eye Institute, Bethesda, MD: H. Nida Sen, MD, MHSc (Director); Denise Cunningham, CRA; Chloe Gottlieb, MD; Darryl Hayes, COA; Dessie Koutsandreas, BS, COA; Nupura Krishnadev, MD; Annal D. Meleth, MD; Richard Mercer, COT; Robert B. Nussenblatt, MD; Patti R. Sherry, BSN; Gregory L. Short, COMT; Alana Temple, BSN. Former members: Allison Bamji, RN; Hanna Coleman, MD; Geetaniali Davuluri, MD; Lisa Faia, MD; Guy V. Jirawuthiworavong, MD; Julie C. Lew, MD; Dominic Obiyor, BSN; Cheryl H. Perry, BSN; Natalia Potapova, MD; Eric Weichel, MD; Keith J. Wroblewski, MD; Steven Yeh, MD.

New York Eye & Ear Infirmary, New York, NY: Paul A. Latkany, MD (Director); Jason Badamo; Jenny Gallardo; Monica Lorenzo-Latkany, MD; Robert Masini; Susan Morell; Ann Nour; Meredith Sanchez; Kate Steinberg. Former members: Kenneth M. Boyd; Jacek Jarczynski; Mirjana McGrosky.

Royal Victorian Eye & Ear Hospital, East Melbourne, Australia: Richard J. Stawell (Director); Lisa Breayley; Julie Ewing; Carly D’Sylva; Lauren Hodgson; Ignatios Koukouras; Lyndell Lim; Cecilia Ling; Rachel McIntosh, Andrew Newton; Richard Smallwood; Ehud Zamir. Former members: Nicola Hunt; Lisa Jones; Suzanne Williams.

Rush University Medical Centre, Chicago, IL: Pauline T. Merrill, MD (Director); Pam Hulvey; Elaine Kernbauer; Scott Toennessen; Denise L. Voskuil-Marre, BS. Former members: Bruce Gaines; Christina Giannoulis; Heena S. Khan, BA; Sarah J. Levine.

Texas Retina Associates, Dallas, TX: Robert C. Wang, MD (Director); Hank Aguado; Sally Arceneaux; Kimberly Cummings; Gary E. Fish, MD; Keith Gray; Nick Hesse; Susie Howden; Diana Jaramillo; Michael Mackens; Karin Mutz; Brenda Sanchez. Former members: Jean Arnwine; David Callanan, MD.

United Kingdom Institute of Ophthalmology, London, UK: Susan Lightman, PhD, FRCOphth (Director); Simon R.J. Taylor, PhD, FRCOphth; Jiten Morarji. Former members: Kate Edwards, Timothy Stubbs, Hamish Towler, Rebecca Tronnberg.

University of California at Los Angeles, Los Angeles, CA: Gary N. Holland, MD (Director); Robert D. Almanzor, COA; Jose Castellanos, COT; Jean Pierre Hubschman, MD; Ann K. Johiro, NP; Michael A. Kapamajian, MD; Ralph D. Levinson, MD; Susan S. Ransome, MD. Former members: Christine R. Gonzales, MD; Anurag Gupta, MD; Peter J. Kappel, MD.

University of California at San Diego, San Diego, CA: William R. Freeman, MD (Director); Denine E. Cochran, COT, CCRC; Igor Kozak, MD; Vivian Nguyen; Stephen F. Oster, MD; Debbie Powell, BBA. Former members: Tom Clark, BSc, CRA; Joshua Hedaya, MD; Tiara Kemper; Jacqueline M. LeMoine; Megan E. Loughran, BA; Luzandra Magana; Francesca Mojana, MD; Victoria Morrison, MD.

University of California at San Francisco, San Francisco, CA: Todd P. Margolis, MD (Director); Nisha Acharya, MD; David Clay; Claire M. Khouri, BA; Mary Lew, BA; Jay Stewart, MD; Ira G. Wong, MD. Former members: Salena Lee, BA, OD.

University of Illinois at Chicago, Chicago, IL: Debra A. Goldstein, MD (Director); Marcia Niec; Misel Ramirez; Howard H. Tessler, MD. Former members: Catherine E. Crooke; Dimitry Pyatetsky, MD.

University of Miami, Miami, FL: Janet L. Davis, MD (Director); Thomas Albini, MD; Aura Pacini; David A. Pinto. Former members: Daniela Castaño; Macy Ho; Jaclyn L. Kovach, MD; Susan Pineda; Richard C-S Lin, MD; Jackie K-D Nguyen, MD; Kimberly E. Stepien, MD; Claudia Teran.

University of Michigan, Ann Arbor, MI: Susan G. Elner, MD (Director); Rebecca Brown, COA; Linda Fournier, COA; Julie R. Gothrup, COA; Richard Hackel; Moella Hesselgrave, COA; Robert Prusak; Stephen J. Saxe, MD. Former members: Melissa Bergeron, COA; Reneé Blosser, COMT; Carrie Chrisman-McClure; Deanna Sizemore, COA.

University of Pennsylvania, Philadelphia, PA: John H. Kempen, MD, PhD (Director); Jim Berger; Joan DuPont; Sheri Grand; Dawn McCall; Albert M. Maguire, MD; Laurel Weeny; Daniel Will, MD; Wei Xu. Former members: Tim Hopkins, MD; Monique McRay.

University of South Florida, Tampa, FL: Peter Reed Pavan, MD (Director); JoAnn Leto; Lori Mayor; Kim McDonald; Scott E. Pautler, MD; Wyatt Saxon; Judy Soto. Former members: Maria Ortiz; Dee Dee Szalay.

University of Southern California, Los Angeles, CA: Amani Fawzi, MD; (Director); Lupe Cisneros, COA; Elizabeth Corona; Jackie Douglass; Dean Eliott, MD; Margaret Padilla Narsing A. Rao, MD. Former members: Alexia Aguirre; Lawrence Chong, MD; Rahul Khurana, MD; Jennifer Lim, MD; Rachel Mead; Sylvia Ramos; Julie H. Tsai, MD.

University of Utah, Salt Lake City, UT: Albert Vitale, MD (Director); Paul S. Bernstein, MD, PhD; Bonnie Carlstrom, COA; James Gilman, CRA; Sandra Hanseen, COA; Paula Morris, CRA; Diana Ramirez; Kimberley Wegner, BS, CRC.

Virginia Eye Consultants, Norfolk, VA: John D. Sheppard, MD, MMSc (Director); Brianne Anthony; Lisa Franklin; Krista Hamelin; Stephen V. Scoper, MD; Jeanette Fernandez, COMT; Lisa Felix-Kent, COA; Rebecca Marx. Former members: Nancy Crawford; Rebecca De La Garza; R. Denise Cole; Jen Martin; Gregory Schultz, DD; Joseph Webb, BS Pamela Yeager.

Vitreoretinal Consultants, Houston, TX: Rosa Y. Kim, MD (Director); Matthew S. Benz, MD; David M. Brown, MD; Eric Chen, MD; Richard H. Fish, MD; Shayla Hay; Jame Major, MD, PhD; Laura Shawver; Tien P. Wong, MD.

Washington University, St. Louis, MO: P. Kumar Rao, MD (Director); Rhonda Weeks. Former Members: Rajendra S. Apte, MD; Kevin J. Blinder, MD; Pam Light; Gaurav K. Shah, MD; Russell VanGelder, MD, PhD.

Committees

Executive Committee: Douglas A. Jabs, MD, MBA (Chair); Michael M. Altaweel, MD; Janet T. Holbrook, PhD; John H. Kempen, MD, PhD; Natalie Kurinij, PhD.

Steering Committee: Douglas A. Jabs, MD, MBA (Chair); Robert D. Almanzor, COA; Michael M. Altaweel; Diane Brown; James P. Dunn, MD; James Gilman; Janet T. Holbrook, PhD; Gary N. Holland, MD; John H. Kempen, MD, PhD; Rosa Y. Kim, MD; Natalie Kurinij, PhD; Nancy Prusakowski, MS; Jennifer Thorne, MD. Former members: Stephen G. Bolton, RN, BSN; Lisa M. Brune, RN, BSN; Tom Clark, CRA; Larry Hubbard, MAT; Daniel F. Martin, MD; Robert B. Nussenblatt, MD.

Data, Safety and Monitoring Committee: Janet Wittes, PhD (Chair); William E. Barlow, PhD; Marc Hochberg, MD; Janet T. Holbrook, PhD; Douglas A. Jabs, MD, MBA; Natalie Kurinij, PhD; Alice T. Lyon, MD; Michael M. Altaweel, MD; Alan G. Palestine, MD; Lee S. Simon, MD; Harmon Smith, PhD. Former members: James T. Rosenbaum, MD.

Surgical Quality Assurance Committee: John H. Kempen, MD, PhD (Chair); James P. Dunn, MD; Glenn J. Jaffe, MD. Former members: Daniel F. Martin, MD.

Medical Therapy Quality Assurance Committee: Jennifer E. Thorne, MD; PhD (Chair); Nisha Acharya, MD; Douglas A. Jabs, MD, MBA; John H. Kempen, MD, PhD; Paul A. Latkany, MD; Robert B. Nussenblatt, MD; Albert Vitale, MD. Former members: Russell VanGelder, MD, PhD.

Visual Function Quality Assurance Committee: Robert D. Almanzor, COA (Chair); Judith Alexander, BA, CCRP; Jeffrey A. Boring, COA; Deborah Gibbs, COMT; Salena Lee, OD, FAAO; Jennifer E. Thorne, MD, PhD (Advisor). Former members: Wai Ping Ng, BS.

Glaucoma Committee: David Friedman, MD (Chair); Anna Adler, MS; Alyce Burke, MPH; Janet T. Holbrook, PhD; Joanne Katz, ScD; John H. Kempen, MD, PhD; Nancy Prusakowski, MS; Susan Reed; Jennifer E. Thorne, MD, PhD. Former members: Nicholas Cohen; Sanjukta Modak, MS; Wai Ping Ng, BS.

Statistical Analysis Committee: Elizabeth Sugar, PhD (Chair); Lea Drye, PhD; Kevin Frick, PhD; Janet T. Holbrook, PhD; JoAnn Katz, ScD; Thomas Louis, PhD; Mark L. Van Natta, MHS. Former members: Sanjukta Modak, MS; David Shade, JD.

Resource Centers

Chairman’s Office: Mount Sinai School of Medicine, New York, NY: Douglas A. Jabs, MD, MBA (Study Chairman); Yasmin Hilal, MHS; Melissa A. Nieves, BA; Karen Pascual, MBA; Jill S. Slutsky, MPA. Former members: Maria Stevens, CM; Colby Glomp

University of Pennsylvania, Philadelphia, PA: John H. Kempen, MD, PhD (Study Vice-Chairman).

Coordinating Centre, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD: Janet Holbrook, PhD, MPH (Director); Anna Adler, MS; Judith Alexander; Jeff Boring; Alyce Burke, MPH; Karen Collins; John Dodge; Lea Drye, PhD; Cathleen Ewing; Kevin Frick, PhD; David Friedman, MD, PhD; Rosetta Jackson; Joanne Katz, ScD; Andrea Lears; Hope Livingston; Thomas Louis, PhD; Curtis Meinert, PhD; Jill Meinert; Vinnette Morrison; Deborah Nowakowski; Nancy Prusakowski, MS; Dave Shade, JD; Rochelle Smith; Karen Steuernagle; Elizabeth Sugar, PhD; Jennifer Thorne, MD, PhD; James Tonascia, PhD; Mark Van Natta, MHS; Richard Zheng. Former members: Paul Chen; Nicholas Cohen, MS; Sanjukta Modak, MS; Wai Ping Ng; Weijiang Shen; Charles Shiflett; Ada Tieman, MBA.

Fundus Photograph Reading Centre, University of Wisconsin, Madison, WI: Michael M. Altaweel, MD; Wendy K. Benz, PhD; Geoffrey Chambers, MS; Debra J. Christianson, BS; Amitha Domalpally, MD; Jacquelyn Freund, MS; Vonnie Gama; Sapna Gangaputra, M.D.,MPH; Kathleen E. Glander, BBA; Anne Goulding, BA; Jeffrey M. Joyce, MS; Christina N. Kruse, BA; Dawn J. Myers, BS; Susan Reed, BS; James L. Reimers, BA; Amy Remm, BS; Ruth A. Susman, BS; Dennis Thayer; Erika Treichel, DVM; Kelly J. Warren, RN, BS, MSES, Sheila M. Watson, BS, DVM; James K. White, BME; Tara Wilhelmson, BS. Former members: Margaret A. Fleischli, AB, DVM; Dennis Hafford; Susan E. Harris, MS; Larry D. Hubbard, MAT; Kristine A. Johnson; Lauren Nagle; Gwyn E. Padden-Lechten, BS; Alyson Pohlman, BA; Peggy Sivesind; Mary K. Webster, BS; Grace Zhang, BA.

National Eye Institute, Bethesda, MD: Natalie Kurinij, PhD.