One of the major challenges confronting those living with or working with uveitis is the lack of sensitive and objective markers of disease activity. This is a problem in both routine clinical practice and in the assessment of treatments for uveitis through clinical trials.
Why does it matter?
- In clinic, the lack of quality outcome measures may lead to poor treatment decisions which resulting in either under-treatment or over-treatment.
- In trials, the lack of quality outcome measures may lead to a treatment appearing to ‘fail’ even when it was effective due to the inability of the trial to reliably detect its effect.
Why is it difficult to measure disease activity in uveitis?
Uveitis is a ‘mixed bag’ of conditions in which inflammation may affect the eye in many different ways. There is no single sign of inflammation that reliably indicates disease activity in all patients with all forms of uveitis.
Additionally the measurement of most of these signs of inflammation is based on clinical assessment. Even where scoring systems exist for these signs of inflammation (such as vitreous haze, or AC cells), these are subjective leading to considerable variation between observers and so reducing their reliability. Additionally clinical assessment cannot reliably detect small differences, limiting our ability to adjust treatment and reducing the sensitivity of clinical trials to detect the effect of a drug.