The Role of Ageing in the Clinical Presentation of Uveitis

PURPOSE

The primary aim of this study was to determine age-related patterns of uveitis entities. Secondary aims included age-related patterns of uveitic treatments and complications.

DESIGN

Retrospective clinical cohort study.

METHODS

4395 participants presenting with uveitis to a single center from January 2009 to December 2023 were included.

RESULTS

The median age at presentation was 45.1 years (IQR 32.2-60.3). Infections were more frequent in both younger (0-19 years) and older (≥60 years) participants. Toxoplasmosis was the most frequent cause of infectious uveitis in younger (0-19 years; 12.5%) participants and herpes zoster virus was the most prevalent cause of uveitis in adults 40+ years of age (40-59 years, 7.1%; 60-79 years, 20.5%; 80+years, 38.6%). Tumor-related uveitic masquerades demonstrated a significant association with increasing age (P <.001). Younger individuals were more likely to require steroid-sparing immunosuppression (P <.001) and more likely to require a switch from initial DMARD therapy (P <.001). Older subjects were more likely to develop cystoid macular edema, raised intraocular pressure and cataract (P <.001), while younger subjects were more likely to develop posterior synechiae (P =.001), papillitis (P <.001) and choroidal neovascular membrane (P =.002).

CONCLUSIONS

Age appears to be a key factor influencing the underlying etiology and clinical course of uveitis. Investigations should be tailored to the clinical presentation and consideration of the individuals presenting age may provide clues as to the underlying cause of disease and to guide treatment.