The Association Between Uveitis and Optic Neuritis in Central Nervous System Demyelinating Disorders: A...

Uveitis and optic neuritis related to demyelinating disease share similar immune mechanisms and can have deleterious visual consequences. Data on uveitis incidence in patients with central nervous system (CNS) demyelinating diseases remain limited. Our objective was to assess the 5-year incidence of uveitis among patients with CNS demyelinating diseases with and without optic neuritis.

Retrospective cohort study using a health records aggregate. We identified patients aged ≥18 years using diagnostic codes to arrange into 3 study groups: a composite CNS demyelinating disease cohort, a multiple sclerosis (MS) cohort, and a neuromyelitis optica/myelin oligodendrocyte glycoprotein antibody-associated disease cohort, each stratified by presence or absence of optic neuritis. We matched each study group based on demographics, clinical comorbidities, medications, and encounter visits.

After matching, the 5-year cumulative incidence of any uveitis among patients with optic neuritis in the CNS demyelinating disease group was 1.09% (95% confidence intervals [CI] 0.950-1.25) compared with 0.610% (95% CI 0.501-0.743) in those without optic neuritis (log-rank P < 0.0001), with a hazard ratio (HR) of 1.99 (95% CI 1.57-2.52). The 5-year cumulative incidence of any uveitis among patients with optic neuritis in patients with MS was 0.986% (95% CI 0.846-1.15) compared to 0.543% (95% CI 0.437-0.676) in those without optic neuritis (log-rank P < 0.0001), with a HR of 1.95 (95% CI 1.51-2.53). Although patients with neuromyelitis optica/myelin oligodendrocyte glycoprotein antibody-associated disease showed similar trends, there was no statistical significance. Intermediate uveitis demonstrated the strongest associations with optic neuritis across study groups.

Optic neuritis is a clinically meaningful risk factor for uveitis in patients with CNS demyelinating disease, underscoring the need for careful ophthalmic surveillance in this population.