Background/aims There is a paucity of high-level evidence to support the management of childhood uveitis, particularly for those children without juvenile idiopathic arthritis uveitis (JIA). We undertook a modified Delphi consensus exercise to identify agreement in the management of chronic anterior uveitis (CAU), the most common manifestation of childhood disease.
Methods A four-round, two-panel process was undertaken between June and December 2017. Paediatric uveitis specialists identified through multiple sources, including a multicentre network (the Paediatric Ocular Inflammation Group), were invited to participate. They were asked whether they agreed with items derived from existing guidelines on the management of JIA-U when extrapolated to the population of all children with CAU. Consensus was defined as agreement greater than or equal to 75% of respondents.
Results 26 of the 38 (68%) invited specialists participated with the exercise, and response rates were 100% for rounds one to three, and 92% for round four. Consensus was reached on 23 of the 44 items. Items for which consensus was not reached included management at presentation, use of systemic and periocular steroids for children with severe disease and the role of conventional steroid sparing immunosuppressants beyond methotrexate.
Conclusion The areas of management uncertainty at the level of the group, as indicated by absence of consensus, reflect the areas where the evidence base is particularly poor. Our findings identify the key areas for the future research needed to ensure better outcomes for this blinding childhood ocular inflammatory disorders.
- delphi technique
- disease management
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Collaborators Members of the POIG Uveitis Delphi Group: Eibhlin McLoone, Eye and Ear Clinic, Royal Victoria Hospital, Belfast, UK. Jessy Choi, Department of Ophthalmology, Sheffield Children Hospital NHS Foundation Trust and Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK. Michael P Clarke, Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK. Alastair K Denniston, Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK. Harry Petrushkin, Department of Ophthalmology, Great Ormond Street Hospital, London, UK, Moorfields Eye Hospital, London, UK. Patrick Watts, Departments of Ophthalmology, University Hospital Wales, Cardiff, UK. Usman Mahmood, Hull and East Yorkshire Hospitals NHS Trust. Brinda Muthusamy, Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Joe Abbott, Birmingham Women’s & Children’s Hospitals, Birmingham, UK. Archana Pradeep, Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK Department of Ophthalmology Rosemary Lambley, Nottingham University Hospitals NHS Trust, Nottingham, UK Department of Ophthalmology. Katya Tambe, Nottingham University Hospitals NHS Trust, Nottingham, UK. Ed Hughes, Brighton and Sussex University Hospitals NHS Trust, Sussex Eye Hospital, Brighton, UK. Richard WJ Lee, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, UK; Institute of Ophthalmology, University College London, London, UK; University of Bristol, Bristol, UK. Ailsa E Ritchie, Department of Ophthalmology, St. Thomas' Hospital, London, UK. Laura Steeples, Manchester Royal Eye Hospital, Manchester University Hospitals NHS Trust. Nicholas Jones, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK; Manchester Royal Eye Hospital, Manchester University Hospitals NHS Trust. Catherine Guly, University Hospitals Bristol NHS Foundation Trust Bristol, UK. Dhanes Thomas, Moorfields Eye Hospital, London, UK. Srilakshmi M Sharma, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Miles Stanford, Department of Ophthalmology, St. Thomas' Hospital, London, UK. Erika Damato, Birmingham Midland Eye Centre, Birmingham, UK. Elizabeth Graham, Department of Ophthalmology, St. Thomas' Hospital, London, UK.
Contributors All authors were involved in study design, data acquisition and interpretation of analysis, critical review of the work and gave final approval. All members of the Delphi group contributed to data acquisition and interpretation, critical review of the work and gave final approval. ALS undertook analysis and drafted the manuscript.
Funding C Guly and JA have received fees from AbbVie (as speaker and advisory board member). AVR is cochief investigator of the Sycamore study, which is funded by the National Institute of Health Research and Arthitis Research UK, and has received Honoraria/Consultancy and speaker fees from Abbvie, Lilly, UCB, SOBI and Novartis.
Competing interests AV Ramanan is Co-Chief Investigator of the Sycamore study which is funded by NIHR and ARUK, and has received Honoraria/Consultancy and speaker fees from Abbvie, Lilly, UCB, SOBI and Novartis. C Guly and JA have received fees from AbbVie (as speaker and advisory board member).
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.