Causes of Visual Loss in Uveitis: A Retrospective Study at a Tertiary Referral Centre

The purpose of the study is to determine the causes of visual loss in patients with uveitis attending a tertiary referral clinic and to assess the relative contribution of uveitis-related inflammation versus its complications, stratified by uveitis subtype.

This retrospective, cross-sectional study reviewed the medical records of 442 patients attending the uveitis service at St Paul's Eye Unit, Royal Liverpool University Hospital. Demographic data, uveitis classification, laterality, systemic treatment, and visual outcomes were extracted from MediSIGHT, an electronic medical records system. Visual impairment was classified using the most recent recorded visual acuity, and causes of visual loss were analysed descriptively.

Among 442 patients (mean age 52 years; 51.6% female), 148 (33.5%) had visual loss in at least one eye, including 64 (14.5%) with moderate visual impairment, 13 (2.9%) who were sight-impaired, and 71 (16.1%) who were severely sight-impaired. Cystoid macular oedema (33.1%) and cataract or aphakia (24.3%) were the most common causes, together accounting for 57.4% of visual loss. Visual loss occurred most frequently in posterior uveitis (53.1%), compared with anterior uveitis (19.6%; p < 0.001). Bilateral inflammation was associated with higher rates of visual loss than unilateral disease (41.3% vs 26.9%; p = 0.002).

Visual loss remains a common outcome in patients with uveitis, most frequently arising from disease-related complications such as cystoid macular oedema and cataract. Posterior uveitis and panuveitis are associated with the highest risk of impairment. These findings highlight the ongoing burden of uveitis-related visual morbidity within tertiary care settings.