Proportion, Incidence, and Pattern of New-Onset Uveitis in Patients Aged 60 and Above: A Systematic Review

Uveitis is commonly regarded as a disease of young and middle-aged adults, with new-onset cases in older individuals frequently attributed to masquerade syndromes, particularly of neoplastic origin. However, few studies have examined the epidemiology or clinical patterns of new-onset uveitis in adults aged 60 years and older. We conducted the first systematic review to evaluate the proportion, incidence, and clinical features of uveitis in this demographic.

A systematic search of MEDLINE and Embase was conducted in September 2024. Studies published from January 2005 to September 2024 were included if they reported on the proportion or etiology of incident uveitis in patients aged 60 and above. Screening was conducted independently in duplicate. Descriptive statistics (median percentages [interquartile range (IQR)]) were used to summarize findings.

Forty studies met inclusion criteria, encompassing 262 716 patients. The proportion of patients aged 60 and older was 23.0% (IQR:14.6%). Developed countries reported higher proportions than developing countries (26.6% [IQR: 17.6%] versus 14.1% [IQR: 10.3%], p = 0.006). The mean incidence among six studies was 159.8 per 100 000 person-years. Anterior uveitis was the most common anatomical subtype (59.8% [IQR: 23.2%]). Leading etiologies included idiopathic, herpetic, sarcoidosis, tuberculosis, and HLA-B27-associated uveitis, with infectious etiologies reported more frequently in developing regions. Masquerade syndromes accounted for 4.9% (IQR: 4.1%) of cases, 94.9% of which were neoplastic, most commonly lymphoma. Risk of bias tools were not uniformly applicable, limiting quality assessment.

These findings suggest that uveitis is both prevalent and distinct in presentation, warranting age-specific diagnostic consideration.