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Induction of Ocular Surface Inflammation and Collection of Involved Tissues
Published on: August 4, 2022
Pediatric Ocular Surface Inflammatory Diseases: Clinical Features and Practice Patterns
Simon S M Fung1, Tanya Boghosian2, Claudia Perez3
1Department of Ophthalmology, University of California San Francisco, San Francisco, CA.
Insights
Pediatric ocular surface inflammatory diseases (POSID) management shows over-reliance on corticosteroids and underuse of immunomodulators. This leads to progressive complications like amblyopia, highlighting the need for improved treatment strategies.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Real-world Evidence
Background:
- Pediatric ocular surface inflammatory diseases (POSID) encompass conditions like blepharokeratoconjunctivitis (BKC), herpes simplex keratoconjunctivitis (HSK), and vernal keratoconjunctivitis (VKC).
- Understanding real-world practice patterns and complications is crucial for optimizing care in children.
Purpose of the Study:
- To characterize nationwide real-world practice patterns and complications of pediatric ocular surface inflammatory diseases (POSID).
- To identify risk factors for amblyopia in children with POSID.
Main Methods:
- Retrospective cohort study of patients younger than 18 years diagnosed with POSID using a US health insurance claims database (2018-2019).
- Analysis of clinical data from 6 months pre- to 3 years post-index visit.
- Multivariate logistic regression to determine amblyopia risk factors.
Main Results:
- HSK presented higher baseline corneal scarring (7.5%) and ulceration (5.5%) rates compared to BKC and VKC.
- High-potency topical corticosteroids were frequently prescribed, while topical immunomodulators were underused (1.7%).
- Amblyopia prevalence increased to 4.5% over 3 years, with stromal scarring and high-potency corticosteroid use as independent risk factors.
Conclusions:
- POSID subtypes have distinct clinical features and management differences, with progressive complications over time.
- Current nationwide practice shows over-reliance on corticosteroids and underuse of immunomodulators, diverging from guidelines.
- Earlier recognition, steroid-sparing therapies, and sustained inflammation control are needed for better outcomes in pediatric ocular surface inflammatory diseases.
Purpose:
To characterize nationwide real-world practice patterns and complications of pediatric ocular surface inflammatory diseases (POSID) using a large US health insurance claims database.
Methods:
This retrospective cohort study analyzed patients younger than 18 years diagnosed with POSID in the Optum Labs Data Warehouse between 2018 and 2019. Blepharokeratoconjunctivitis (BKC), herpes simplex keratoconjunctivitis (HSK), and vernal keratoconjunctivitis (VKC) were identified by ICD codes. Clinical data from 6 months before to 3 years after the index visit were assessed. Multivariate logistic regression identified risk factors for amblyopia.
Results:
Among 6116 children (67.1% aged 5-15 years; 56.6% male), HSK showed the highest baseline rates of corneal scarring (7.5%) and ulceration (5.5%), compared with BKC (2.3%, 2.7%) and VKC (1.1%, 0.9%) ( P < 0.001). High-potency topical corticosteroids were more frequently prescribed for BKC (17.8%) than HSK (15.0%) or VKC (14.2%) ( P = 0.02), while topical immunomodulators were used in only 1.7% of cases despite recommendations. Amblyopia prevalence rose from 2.5% to 4.5% over 3 years, with stromal scarring at diagnosis (odds ratio 2.43, 95% confidence interval 1.40-4.24) and high-potency corticosteroid use (odds ratio 1.60, 95% confidence interval 1.17-2.18) as independent risk factors.
Conclusions:
POSID subtypes exhibit distinct clinical features, significant differences in management, and progressive complications over time. Nationwide patterns show over-reliance on corticosteroids, underuse of immunomodulators, and gaps between guideline recommendations and practice, underscoring the need for earlier recognition, steroid-sparing therapy, and sustained inflammation control.
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