Researchers present new monitoring option for intermediate uveitis

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Optical coherence tomography angiography could also identify patients at risk of disease progression

A green eye looks out underneath a digital interface of a target. Image credit: © ra2 studio – stock.adobe.com

A joint research team out of Bonn, North Rhine-Westphalia, Germany, published the findings. Image credit: © ra2 studio – stock.adobe.com

Uveitis is responsible to 5% to 10% of blindness worldwide, and intermediate uveitis is often associated with a chronic course of the disease and the need for immunosuppressive therapy. Intermediate uveitis primarily causes inflammation of the vitreous body, but blood flow to the retina can also be restricted. Those affected by the rare disease, may experience blurred vision and streaks in front of the eye, but experience no pain.

In a recent study, researchers at the Eye Clinic of the University Hospital Bonn (UKB) and the University of Bonn, North Rhine-Westphalia, Germany, tested optical coherence tomography angiography as a new imaging monitoring method.1 Details of the monitoring protocol were shared in a news release.2

According to the study, published in Nature Scientific Reports, the blood flow in the retinal vessels is associated with the severity of inflammation and allows conclusions to be drawn about the future course of the disease. The researchers found this method could be used to monitor intermediate uveitis and identify patients at risk of a future worsening of the disease.2

Maximilian Wintergerst, MD, from the UKB Eye Clinic, also conducts research at the University of Bonn. He highlighted the study in the news release.

“Intermediate uveitis in particular is often associated with a long course of the disease and the need for immunosuppressive therapy," Dr Wintergerst said.

Uveitis occurs when the vitreous body in the eye becomes inflamed. However, the retinal vessels can also be inflamed, as the research group at the UKB and the University of Bonn was able to show in preliminary work.1

Early detection of deterioration is important

"It is important to recognise an increase in inflammatory activity in good time," Dr Wintergerst said in the news release.

The researchers noted that this allows treatment to be adjusted if necessary, which can preserve visual acuity and prevent further complications. Currently, there are only a few objective parameters that can be used to reliably detect a worsening of the disease. Most criteria for assessing disease activity are based on clinical examination and are comparatively subjective and not always reliable. As a result, researchers from the UKB Eye Clinic and colleagues from Medical Biometry at the University Hospital Bonn investigated new high-resolution imaging-based methods to determine disease activity and complications in uveitis.

"Objective markers of inflammatory activity could not only improve monitoring in everyday clinical practice, but would also provide additional quantitative endpoints for future randomised clinical trials," Dr Wintergerst pointed out.

"Optical coherence tomography angiography enables non-contact, non-invasive examination of the retina and the underlying choroid,” Dr Wintergerst explained. “The retina is scanned successively using harmless, weak laser light, which allows tomographic images of the individual retinal layers to be generated.”

The collaborative research team compared several images taken in quick succession. Blood flow could be detected, which enabled investigators to draw conclusions about the blood supply to the retinal vessels. The researchers then calculated the blood flow density of the central retina and analysed how this differs between eyes with stable disease, eyes with an increase in disease activity and eyes with a decrease in disease activity.1

Overall, the researchers examined a total of 52 study participants and were able to show that the blood flow density differed between the three groups examined. An increase in disease activity was associated with a decrease in blood flow density, while a decrease in disease activity was associated with an increase in blood flow density.

Predicting disease’s course

According to the news release, the Bonn researchers used a statistical model which included over 300 eye examinations to investigate the predictive power of current blood flow density for the future course of the disease. This showed that a reduced blood flow density was significantly associated with a future deterioration in central visual acuity.2

Robert Finger, MD, PhD, co-author of the study and now director of the Eye Clinic at the University Medicine Mannheim (UMM), explained that the data could provide more insight.

"In future, the data obtained could enable us to identify patients with a high risk of disease progression at an earlier stage, for example in order to monitor them particularly closely," Finger said in the news release. “We could use this parameter as an endpoint in future randomised clinical trials in order to potentially generate better evidence for the treatment of this rare disease."

Frank Holz, MD, director of the UKB Eye Clinic, noted that the findings could also improve the monitoring of the disease.

"In the current study, we show how objective parameters for disease activity in uveitis can be determined using high-resolution, digital non-invasive imaging," Holz concluded in the news release. "This is an important prerequisite for improving the monitoring of uveitis in the future."

The study was funded by the BONFOR-GEROK program of the Medical Faculty of the University of Bonn and the Ernst and Berta Grimmke Foundation (funding code 3/22).2

Reference:

1. Wintergerst, M.W.M., Merten, N.R., Berger, M. et al. Vessel density on optical coherence tomography angiography is prognostic for future disease course in intermediate uveitis. Sci Rep 14, 2933 (2024). https://doi.org/10.1038/s41598-023-49926-0
2. New monitoring option for rare eye disease. EurekAlert! Accessed February 9, 2024. https://www.eurekalert.org/news-releases/1033525
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