Prevalence and predictors of ocular manifestations of RA: is there a need for routine screening?

Background: People with rheumatoid arthritis (RA) have an increased risk for eye problems caused by associated conditions or medication side-effects. Consequent visual impairment may increase the risk of falls or difficulties self-administering medications.

Aims: The aim of the present study was to estimate the prevalence and predictors of ocular manifestations and visual impairment in a local sample of people with RA. The Visual Functioning Questionnaire (VFQ-25) was evaluated as a screening tool in people with RA.

Methods: Seventy-five participants with RA attended a visual screening clinic. Demographic, medication and disease characteristics were recorded, a full ophthalmological assessment was performed by an expert ophthalmologist and the VFQ-25, Health Assessment Questionnaire and Self-administered Comorbidity Questionnaire were completed.

Results: Twenty-nine participants (38.7%) had impaired visual acuity; this was correctable by appropriate refraction in 93.1%. The prevalence of cataracts was 22.7% and this was predicted by older age and steroid use. An abnormal Schirmer's test, suggesting dry eyes, was seen in 70.7% of participants but only 12.0% were using artificial tears. Answers to the VFQ-25 suggested misinterpretation of questions as relating to disability attributed to arthritis rather than caused by visual impairment.

Conclusions: Visual impairment does not appear to be particularly prevalent in RA, obviating the need for a screening programme. Utilization of the VFQ-25 as a screening tool in RA requires further consideration. The high prevalence of cataracts in participants on steroids emphasizes the need to prescribe the minimum required dose. The high prevalence of dry eyes suggests that a Schirmer's test should be performed regularly, with prescription of artificial tears if required.