Optometrists don’t often see Vogt-Koyanagi-Harada (VKH) disease in practice, but new findings might allow earlier detection when it does appear. Researchers recently developed a new set of diagnostic criteria for VKH using data from Chinese patients. When evaluated against the current Revised Diagnostic Criteria (RDC) for VKH, first discussed in 1999 and disseminated in 2001, the new criteria show higher sensitivity and negative predictive value.
The new study’s proposed Diagnostic Criteria for VKH Disease (DCV) were conceived from a case-control study that reviewed medical records of 634 VKH patients and 623 patients with non-VKH uveitis from southern China. Of these, 52.9% were male, and the mean age at disease onset was 38.6. The researchers used statistical analysis to create a three-class model of disease status and identify 21 clinical findings relevant in VKH. Variables with a high positive rate in the early-phase or late-phase VKH group or with high specificity constituted the essential parameters.
To evaluate the criteria, researchers then used data from an additional 537 patients with a definite VKH diagnosis and 525 patients with non-VKH uveitis, all of whom were from northern China.
The researchers found the DCV’s sensitivity was 94.4% compared with 71.9% for the RDC. Likewise, the negative predictive value was 94.3% for the DCV vs. 76.6% for the RDC. However, the new set’s specificity and positive predictive value were not different from those of the RDC.
The study notes that the new criteria, developed using a retrospective analysis, should be evaluated in prospective studies in other racial and ethnic populations.
Because it is a better-defined set of diagnostic criteria, researchers conclude that the DCV’s use could result in improved diagnosis of VKH disease. Among other limitations, the RDC “did not separate patients into early and late disease, which have very different clinical manifestations,” wrote Douglas Jabs, MD, in a commentary accompanying the study.
|Yang P, Zhong Y, Du L, et al. Development and evaluation of diagnostic criteria for Vogt-Koyanagi-Harada Disease. JAMA Ophthalmol. July 5, 2018. [Epub ahead of print].|