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Epidemiology of Uveitis
Incidence and Prevalence of Scleritis and
Episcleritis In Veterans Affairs Medical Centers
of the Pacific Northwest
ASCRS 2008 - Chicago Michael Lloyd, MD, Eric B.
Suhler, MD, MPH Dept of Ophthalmology, Portland
VA Medical Center Casey Eye Institute, OHSU,
Portland Oregon
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Introduction

• Epidemiology is the study of factors
• leading to disease in populations. It serves as
  
• the foundation and logic of interventions made in
  the interest of public health.
• Although rare, scleritis is a significant public
  health problem because
• It can be the presenting sign of life- and
  sight-threatening disease
• it is associated with high rates of vision loss
  (9 with diffuse, 26 with nodular, 74 with
  necrotizing, and 84 with posterior scleritis)
• -30 of people with necrotizing scleritis will
  be dead within 8 years of presentation without
  treatment

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Introduction
There is no population-based literature on the
epidemiology of scleritis, but a few
referral-based studies exist Williamson 1974
8 years at Southern General Hospital in
Glasgow 8 scleritis cases out of 9600 new
referrals Watson and Hayreh 1976 10 years at
Moorfields 207 episcleritis and 159 scleritis
cases in 10 years of a special scleritis
clinic Foster 1993 11 years at Mass Eye and
Ear 94 episcleritis and 172 scleritis cases out
of 6600 new referrals
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Methods
We sought to ascertain the incidence and
prevalence of scleritisvia by a large,
population-based study using the VA centralized
database (CHIPS) as our model We searched for
any encounter within FY04 coded for scleritis or
episcleritis at any VAMC in Oregon or Washington
state Each case was independently reviewed by an
ophthalmologist using standardized criteria to
document location, onset, continuity, laterality,
and associated diagnoses according to the SUN
criteria Jabs et al, AJO 1995 Questionable
cases were reviewed by a second ophthalmologist
specializing in uveitis
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Methods
Scleritis cases had to have some combination of
pain, scleral injection, edema, or thinning.
Episcleritis cases required episcleral
injection and discomfort and could not be
associated with discharge.
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Methods
A case that had active disease which was well
controlled with medication would be included as
prevalent Cases with documented inflammation in
the past, but no current therapy or inflammation
during the study period were classified as
inactive prevalent and not included in the
calculations Cases with inadequate documentation
in any area were classified as indeterminate
and not included in the calculations
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Results
Total population surveyed 152,267 Cases with
ICD9 codes reviewed - 519 Incident scleritis
cases in FY04 2 (1.3 cases/100,000
person-years) Prevalent scleritis cases in FY04
12 (7.88 cases/100,000 population)
Incident episcleritis cases in FY04 12
(7.22 cases/100,000 person-years) Prevalent
episcleritis cases in FY04 19 (12.48
cases/100,000 population)
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Results
Cases by age group and gender
Scleritis average age 61
25-44 25-44 45-64 45-64 65 65 Total Total
Incident Prevalent Incident Prevalent Incident Prevalent Incident Prevalent
M 0 1 2 5 0 5 2 11
F 0 0 0 1 0 0 0 1
Total 0 1 2 6 0 5 2 12
Episcleritis average age 54
25-44 25-44 45-64 45-64 65 65 Total Total
Incident Prevalent Incident Prevalent Incident Prevalent Incident Prevalent
M 2 4 4 8 4 4 10 16
F 0 0 2 3 0 0 2 3
Total 2 4 6 11 4 4 12 19
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Results
Number of associated disorders
Scleritis Scleritis
Associated Disorder Number of patients
Rheumatoid Arthritis 3
Anklyosing Spondylitis 1
Gout 1
Polymyalgia rheumatica 1
Fibromyalgia 1
idiopathic 5
Episcleritis Episcleritis
Associated Disorder Number of patients
idiopathic 19
not known to be reported as associated with
scleritis
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Discussion
This is the first population-based study to
describe the epidemiology of scleritis and
episcleritis There are some weaknesses in our
study -difficulty in diagnosing episcleritis
second hand - still likely to underestimate
episcleritis cases -homogeneous population does
not reflect the wider public health (elderly
white men are over- represented) -documentation
was insufficient to further classify cases into
diffuse, nodular, necrotizing, etc
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Discussion
Our data confirm the behavior of scleritis
and episcleritis as two different
disorders. -Although rare, scleritis tends to
be more chronic and is much more likely to be
associated with a systemic autoimmune disorder
(50 of cases) -Episcleritis is more common,
but shorter-lived no progression was noted
from episcleritis to scleritis - Likely more
frequent in women more frequent in the 45-65
age group with scleritis occurring in a slightly
older population
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