A randomised feasibility study of imaging-based uveitis screening for children with juvenile idiopathic arthritis

Brief Lay background

Eye inflammation is a common condition and can happen at any age. It occurs in response to infection, allergies, irritation, injury or trauma to the eyes. But it can also happen in people who have an autoimmune condition where their immune system mistakenly starts to attack healthy tissues.

Eye inflammation can affect different parts of the eye, including the lining of the eye, which is known as uveitis.

What problem/knowledge gap does it help address

For children with uveitis, sight loss can occur following uncontrolled inflammation, most often due to late detection. Half of all children with uveitis also have an inflammatory joint condition called juvenile idiopathic arthritis. Therefore, children with this joint condition should be screened every three months for uveitis using a slit lamp examination, operated by a specially trained ophthalmic clinician.

There are currently significant shortages of ophthalmic clinicians across the UK. For example, 73% of advertised paediatric ophthalmologist posts are unfilled. This means those at risk of childhood uveitis may not have cases detected, diagnosed and then treated until irreversible damage has occurred.

Aim of the project

To conduct a feasibility study comparing the current routine practice of using slit lamp examination with imaging-based methods in the detection of uveitis in children.

Key procedures/objectives

1. Recruit children recently diagnosed with juvenile idiopathic arthritis that are eligible for uveitis screening.
2. Following an initial routine slit lamp examination, all participants will be assessed according to national guidance, involving a visual function assessment and examination either using routine care or imaging-based methods. Detections of uveitis will lead to referrals for further assessment by a specialist team.
3. Images from the second group will be analysed for signs of inflammation by the research team and using artificial intelligence (AI).
4. Investigations of barriers to uveitis monitoring and study procedures will be conducted to inform a future long-term study using the following groups:
   1. A subset of recruited participants and their parents;
   2. Clinicians from the UK’s Paediatric Ocular Inflammatory Group;
   3. Relevant patient charities. 

Potential impact on people with sight loss

Developing effective imaging-based surveillance for children at risk of uveitis could alleviate current shortages of specialists who deliver eye examinations. If the number of late diagnoses is reduced, this could reduce the number of children at risk of sight loss from uveitis.