Vogt-Koyanagi-Harada Syndrome in a Canadian First Nations Population

ABSTRACT

Purpose

To characterize presentations, characteristics and outcomes of uveitis in Vogt-Koyanagi-Harada (VKH) syndrome in a North American First Nations (FN) population.

Methods

Charts of 27 Canadian FN patients with VKH uveitis were retrospectively reviewed to characterize demographics, disease characteristics, management, complications and visual outcomes.

Results

Average age at uveitis onset was 30.9 ± 13.8 years. Twenty-six patients 10 (96.3%) were female. Nine patients (33.3%) demonstrated complete VKH, 8 (29.6%) incomplete, and 10 (37%) probable VKH. Systemic associations included integumentary (19 patients, 70%), neurologic (17 patients, 63%), and auditory (13 patients, 48%) findings. Initial rates of mild, moderate and severe vision loss were 19 eyes (35.2%), 12 eyes (22.2%), and 23 eyes (42.6%), respectively, compared with final rates of 19 eyes (35.2%), 14 eyes (25.6%) and 21 eyes (38.9%), respectively. Average change in visual acuity was 15 0.1 ± 6.3 Snellen lines. Rates of immunomodulatory therapy (IMT) use (10 patients, 37%) fell short of targets.

Conclusions

VKH may cause potentially severe uveitis in this population. Comorbidities including tuberculosis and diabetes, in addition to unique cultural, linguistic and geographic factors, may necessitate complex, individualized management strategies.

KEYWORDS:

• Uveitis
• Vogt-Koyanagi-Harada
• VKH
• First Nations
• Aboriginal
• Indigenous
• Canada
• rural
• immunomodulatory therapy
• immunosuppression

Highlights

• VKH is an important cause of uveitis in North American First Nations patients.

• VKH may cause severe presentations of uveitis in this population.

• The low rate of IMT use achieved in this population falls short of targets.

Comorbidities including tuberculosis and diabetes may complicate management.

Acknowledgments

The authors have no financial conflicts of interest to disclose.

The authors would like to thank Ms. M.L. Schmuck (affiliated with the Faculty of Health Sciences Education Research, Innovation and Theory Program, McMaster University, Hamilton, Ontario), who contributed to the statistical analyses performed.

Conflicts of Interest Statement

The authors have no conflicts of interest to disclose.