International coalition classifies 25 subtypes of uveitis, an inflammatory eye disease

NIH-funded classification criteria will facilitate clinical research for new therapies

2021-06-07

(Press-News.org) An international coalition of eye researchers used machine learning to develop classification criteria for 25 of the most common types of uveitis, a collection of over 30 diseases characterized by inflammation inside the eye. Together, these diseases are the fifth leading cause of blindness in the United States. The Standardization of Uveitis Nomenclature (SUN) Working Group, funded by the National Eye Institute (NEI), published its classification criteria in the American Journal of Ophthalmology. NEI is part of the National Institutes of Health.

"In the past, clinical research in the field of uveitis has been hampered by the lack of widely-accepted and validated diagnostic criteria," said Douglas A. Jabs, M.D., M.B.A., the SUN project leader and professor of epidemiology and ophthalmology, Johns Hopkins Bloomberg School of Public Health, Baltimore. "These classification criteria are a major step forward for epidemiological studies, translational studies, pathogenesis research, outcomes research, and clinical trials. They hopefully will yield better disease-specific approaches to diagnosis and treatment."

In uveitis, inflammation can be seen in the anterior chamber (anterior uveitis), vitreous (intermediate uveitis), choroid, or retina (posterior uveitis), or all of these (panuveitis). Disease course, complications of uveitis, and the effect on vision vary dependent on the specific disease. Some uveitis appears abruptly and resolves. But many cases are recurrent or chronic, requiring long-term therapy. Symptoms may include floaters, vision loss, pain, and light sensitivity. Uveitis can strike at any age and can have a major impact on quality of life.

Until recently, classification of uveitis was based on the primary location of inflammation. However, types of uveitis affecting the same anatomic location can have different causes, courses, prognoses, and treatment needs. Previous work by the SUN Working Group demonstrated that even uveitis experts can disagree on diagnosis, making apples-to-apples comparisons difficult when conducting clinical research.

"The agreement among uveitis experts on the diagnosis of individual diseases was modest at best. So, we set off to try to provide clarity, using informatics, formal consensus techniques, and technology to assist in classifying each uveitic disease," said Jabs.

The SUN Working Group, a team of nearly 100 international uveitis experts from more than 20 countries and 60 clinical centers, worked together throughout the project, which was conducted in four phases: informatics, case collection, case selection, and machine learning. The researchers used machine learning, a type of artificial intelligence, to help them identify the important characteristics that distinguished each disease.

The informatics phase involved standardizing language to describe each type of uveitis and the mapping of terms to individual diseases. In the case collection phase, the team entered 5,766 cases into a database, averaging 100-250 of each uveitis type. During the case selection phase, committees of nine uveitis experts reviewed the cases and used formal consensus techniques to determine whether they were a specific identifiable disease. Only cases with a more than 75% agreement among experts were included in the final database. The resulting cases (4,046) were put through machine learning using multiple approaches on a subset of the cases ("training set") and the performance of the criteria determined on a second subset of the cases (the "validation set").

The overall performance of the criteria was over 90% within uveitic class, suggesting that the criteria can be used in clinical and translational research. The final step was approval of the proposed criteria by the SUN Working Group.

"The SUN Working Group is excited about this unprecedented effort coming to fruition and the publication of this work, as it should provide the basis for future clinical research in the field of uveitis." concluded Dr. Jabs.

INFORMATION:

The work was supported by grant R01 EY026593-05.

Visit the NEI's online information about uveitis.

References:

1. Trusko B, Thorne J, Jabs DA, Belfort R, Dick A, Gangaputra S, Nussenblatt R, Okada A, Rosenbaum J. The Standardization of Uveitis Nomenclature (SUN) Project. Development of a clinical evidence base utilizing informatics tools and techniques. Methods Inf Med 2013;52:259-65.

2. Jabs DA, Dick A, Doucette JT, Gupta A, Lightman S, McCluskey P, Okada AA, Palestine AG, Rosenbaum JT, Saleem SM, Thorne JE, Trusko B, for the Standardization of Uveitis Nomenclature Working Group. Interobserver agreement among uveitis experts on uveitic diagnoses: The Standardization of Uveitis Nomenclature experience. Am J Ophthalmol 2018;186:19-24.

3. The Standardization of Uveitis Nomenclature Working Group. Development of classification criteria for the uveitides. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

4. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for cytomegalovirus anterior uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

5. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for herpes simplex virus anterior uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 8, 2021

6. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for varicella zoster virus anterior uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

7. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for Fuchs uveitis syndrome. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

8. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for juvenile idiopathic arthritis-associated chronic anterior uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

9. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for spondyloarthritis/HLA-B27-associated anterior uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

10. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for tubulointerstitial nephritis with uveitis syndrome. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

11. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for multiple sclerosis-associated intermediate uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

12. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for pars planitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 8, 2021

13. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for intermediate uveitis, non-pars planitis type. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 8, 2021

14. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for acute retinal necrosis syndrome. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

15. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for cytomegalovirus retinitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

16. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for syphilitic uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 8, 2021

17. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for toxoplasmic retinitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

18. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for tubercular uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

19. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for acute posterior multifocal placoid pigment epitheliopathy. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 8, 2021

20. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for birdshot chorioretinitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

21. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for multiple evanescent white dot syndrome. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

22. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for multifocal choroiditis with panuveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

23. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for punctate inner choroiditis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

24. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for serpiginous choroiditis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

25. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for Behçet disease uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

26. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for sarcoidosis-associated uveitis. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

27. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for sympathetic ophthalmia. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

28. The Standardization of Uveitis Nomenclature Working Group. Classification criteria for Vogt-Koyanagi-Harada disease. Am J Ophthalmol 2021; in press. Journal Pre-Proof Published online: April 9, 2021

NEI leads the federal government's research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.

NIH...Turning Discovery Into Health®

[Attachments] See images for this press release:

ELSE PRESS RELEASES FROM THIS DATE:

High blood lead levels found in indigenous peoples in Peruvian Amazonia

2021-06-07

Lead is a toxic metal, and its widespread use has led to significant environmental pollution and public health problems in many parts of the world. This has led the WHO to include it on a list of ten chemicals that cause serious health problems. However, lead poisoning continues to affect many population groups. A study published today in open access in the journal Environment International found high levels of lead in indigenous people in Peruvian Amazonia living near areas where oil extraction takes place. The research was led by Cristina O'Callaghan-Gordo, a professor and researcher in Health Sciences Studies at the Universitat Oberta de Catalunya (UOC) and the Barcelona ...

Conserving coastal seaweed: a must have for migrating sea birds

2021-06-07

As Australia officially enters winter, UniSA ecologists are urging coastal communities to embrace all that the season brings, including the sometimes-unwelcome deposits of brown seaweed that can accumulate on the southern shores. While tidal seaweed (or sea wrack) may seem unsightly - especially at beach-side tourist destinations - new research from the University of South Australia shows that it plays a vital role for many migratory seabirds and should be protected. In the first study of its kind, UniSA researchers show that beach-cast seaweed provides shelter, ...

The molecular underpinnings of immune cell migration

2021-06-07

Osaka, Japan - In a new study, researchers from Osaka University discovered a novel molecular mechanism by which immune cells migrate to fight off infections. These findings may help in understanding the development of certain immune deficiency disorders and establish novel therapies against them. Immune cells represent a diverse group of cells. Some circulate in the blood stream and migrate to infected tissues after receiving signals from damaged tissues. Others reside in tissues to take up the invading microbe, migrate to lymph nodes and activate an immune response. Therefore, to function effectively, the immune system's activities ...

Fragility fractures cost European health care systems €56.9 billion annually

$Fragility fractures cost European health care systems €56.9 billion annually$

2021-06-07

June 7, 2021 - Nyon, Switzerland -- A new report by the International Osteoporosis Foundation (IOF) draws attention to the burden of osteoporosis and the gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis across Europe. 'SCOPE 2021: a new scorecard for osteoporosis in Europe' provides detailed findings for the 27 countries of the European Union as well as Switzerland and the United Kingdom (referred to as 'EU27+2'), covering key indicators for four domains: burden of disease, policy framework, service provision and service uptake. Professor John A. Kanis, IOF Honorary President and lead author of SCOPE, stated: "Osteoporosis is a major concern in Europe as it results in 4.3 million fragility fractures and health ...

Antarctica: How have temperatures varied since the last glacial period?

2021-06-07

Scientists have established the most reliable estimates to date of past temperature variations in Antarctica. They highlight significant differences in behaviour between West and East Antarctica. This study makes it possible to test and consolidate future climate projections. Antarctica has experienced significant temperature changes, especially since the last glacial period. An international collaboration including scientists from the CNRS1 has now challenged previously accepted estimates of these variations, using new measurements published on June 4, 2021 in Science. Their study highlights differences in behaviour between East and West Antarctica, connected in particular ...

Protein identified as new therapeutic anti-viral target for COVID-19

2021-06-07

New research identified a novel interaction between the SARS-CoV-2 spike protein and the galectin-3-binding protein (LGALS3BP) which could be a new therapeutic anti-viral target. The research also found the presence of detectable viral RNA in blood in COVID-19 patients is a strong predictor of mortality. The paper, published today in Nature Communications, was led by a group of researchers from King's College London, Guy's and St Thomas' NHS Foundation Trust and King's British Heart Foundation Centre. The research was funded by the NIHR Guy's and St Thomas' Biomedical Research Centre and supported by grants from BHF. In the study, authors analysed close to 500 blood samples from patients ...

Researchers find toxin from maple tree in cow's milk

2021-06-07

Cows can pass on the hypoglycin A toxin through their milk, a study by the Martin Luther University Halle-Wittenberg (MLU) and the Leibniz Institute of Plant Biochemistry (IPB) in Toxins shows. The substance can cause severe symptoms in humans and animals. Small amounts of the toxin were detected in the raw milk of cows that grazed in a pasture exposed to sycamore maple. The team calls for further investigations to realistically assess the potential dangers. High concentrations of hypoglycin A can be found in unripe akee and lychee fruit and in the seeds and seedlings of various maple trees. These include, for example, the sycamore maple, which is common throughout Europe. The toxin can cause severe illness in humans. In 2017, a team of researchers in India ...

International travel may spread destination-specific antimicrobial resistance genes

2021-06-07

Travellers abroad may pick up bacteria and other vectors containing genes conferring antimicrobial resistance which remain in the gut when returning to their home country, according to a study published in Genome Medicine. A team of researchers at Washington University, USA and Maastricht University, Netherlands investigated the presence of antimicrobial resistance (AMR) genes in the human gut microbiome by analysing the faecal samples of 190 Dutch travellers before and after travel to destinations in Northern Africa, Eastern Africa, Southern Asia ...

SMART researchers develop method for rapid, accurate detection of viruses

2021-06-07

RApid DIgital Crispr Approach (RADICA) is a molecular rapid testing methodology that allows absolute quantification of viral nucleic acids in 40-60 minutes. RADICA is four times faster and significantly less expensive than conventional polymerase chain reaction (PCR) methods as it does not require costly equipment for precise temperature control and cycling. Method has been tested on SARS-CoV-2 synthetic DNA and RNA, Epstein-Barr virus in human B cells and serum, and can be easily adapted to detect other kinds of viruses. Singapore, 7 June 2021 - Researchers from Critical Analytics for Manufacturing Personalized-Medicine (CAMP), an Interdisciplinary Research Group (IRG) at the Singapore-MIT ...

Evolutional history of metal chalcogenide supertetrahedral clusters

2021-06-07

Nanoclusters, which consist of several or even thousands of atoms, represent an important intermediate state between microscopic atoms and macroscopic matter. A profound comprehension of the composition, structure, and properties of nanoclusters is crucial for exploring or extending their functional applications. Among the numerous types of nanoclusters, metal chalcogenide supertetrahedral clusters (MCSCs) have attracted great attention since the 1980s for their uniform sizes, well-defined structures, and semiconductor properties. Notably, because ...

LAST 30 PRESS RELEASES:

Global cervical cancer vaccine roll-out shows it to be very effective in reducing cervical cancer and other HPV-related disease, but huge variations between countries in coverage

Personalised “cocktails” of antibiotics, probiotics and prebiotics hold great promise in treating a common form of irritable bowel syndrome, pilot study finds