Objective Measures of Intraocular Inflammation in Pediatric Anterior Uveitis

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PROJECT SUMMARY Anterior uveitis is the most common form of intraocular inflammation in children. Children tend to have more chronic courses than adults and thus require more frequent examinations for screening and monitoring of inflammation. Clinical grading of anterior chamber (AC) inflammation, both cell and flare, is currently performed at the slit lamp utilizing the widely accepted Standardization of Uveitis Nomenclature (SUN) Working Group criteria. However, this system has limitations since it is non-continuous and semi-quantitative. A rapid, reproducible, and quantitative technique to evaluate inflammation is of paramount importance in children as they are often unable to cooperate with prolonged examination at the slit lamp. This K23 Mentored Patient-Oriented Career Development Award proposal seeks to evaluate objective measures of intraocular inflammation to improve the diagnosis and monitoring of anterior uveitis in children. This award will provide Dr. Edmund Tsui, a uveitis specialist and Assistant Professor at the Stein Eye Institute at the University of California, Los Angeles, with the protected research time and formal coursework towards a Master’s of Science in Clinical Research to establish himself as an investigator in patient-oriented research in uveitis. This award will provide Dr. Tsui with the support to achieve the following goals: 1) to learn biostatistics and epidemiology, 2) to become skilled at image acquisition, processing and analysis, 3) to learn about the design and implementation of clinical trials. Dr. Tsui has assembled an outstanding multi-disciplinary team of mentors to ensure that he will achieve these goals. His mentorship team consists of Dr. Gary N. Holland (Professor of Ophthalmology and an expert in pediatric uveitis), Dr. Srinivas R. Sadda (Professor of Ophthalmology and a world-leader in ophthalmic image processing and analysis), and Dr. Deborah K. McCurdy (Professor of Pediatrics, Division of Pediatric Rheumatology and an expert in pediatric arthritis). We will pursue the following specific aims: 1) develop a standardized, reproducible technique using anterior- segment optical coherence tomography to quantify AC cells, 2) longitudinally evaluate AC flare using laser flare photometry, and 3) create a predictive risk stratification model based on objective measures of intraocular inflammation. The long-term goal is that these results would support the use of objective measures in routine clinical practice and as endpoints in clinical trials. Ultimately, earlier detection and improved monitoring of uveitis in children can prevent permanent vision loss and disability. This research will lead to the submission of an R01 grant prior to the end of the K23 award to enable Dr. Tsui to become an independent clinician-scientist.