Consensus disease definitions for ophthalmic immune-related adverse events of immune checkpoint inhibitors

Consensus disease definitions for ophthalmic immune-related adverse events of immune checkpoint inhibitors

Blog Article

Ophthalmic immune-related adverse events (Eye-irAEs) from immune checkpoint inhibitors can cause visual morbidity.The absence of standardized definitions for Eye-irAEs not only impedes the development of evidence-based treatments but also progress in translational research.The objective of this study was to develop consensus guidance for an approach to Eye-irAEs.

Four ophthalmic physicians (uveitis specialists and neuro-ophthalmologists) drafted Eye-irAE consensus guidance and definitions, which were reviewed by the multidisciplinary Eye-irAE definition panel.The panel was divided into Group A (Neuro-ophthalmology/Orbital Disease) and Group B (Uveitis/Ocular Surface Disease).A modified Delphi 6-0 igora vibrance consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy.

For each disorder, five diagnostic components were evaluated: symptoms, examination findings, laboratory studies/imaging findings, diagnostic criteria, and treatment.Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free-text comments.Aggregated survey responses were incorporated into revised definitions.

Consensus was based on numeric ratings using the RAND Corporation/ University of California Los Angeles Health Services Utilization Study (RAND/UCLA) Appropriateness Method with prespecified definitions.29 panelists from 25 academic medical centers voted on 114 rating scales (66 neuro-ophthalmic/orbital disease components, 48 uveitis/ocular surface disease components); of these, 86.3% (57/66) in Group A and 89.

6% (43/48) in Group B reached first-round consensus.After revisions, all items except 6.1% (4/66) in Group A and 1.

6% (1/60) in Group B received second-round consensus.Consensus definitions were achieved for 10/11 neuro-ophthalmic/orbital disorders: optic neuritis, inflammatory optic disc edema, arteritic ischemic optic neuropathy, optic perineuritis, orbital inflammation, thyroid eye disease-like orbital inflammation, cavernous sinus syndrome, oculomotor mononeuritis, trochlear mononeuritis, and abducens mononeuritis.Consensus definitions were achieved for 9/10 uveitis/ocular surface disorders: anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, Vogt-Koyanagi-Harada-like syndrome, sarcoidosis-like syndrome, acute macular neuroretinopathy, dry eye disease, and here scleritis.

These disease definitions establish a standardized classification for Eye-irAE, highlighting differences between irAEs and other inflammatory disorders.Importantly, diagnostic certainty does not always align directly with the need to treat as an Eye-irAE.Given the consensus from this representative panel group, it is anticipated the definitions will be used broadly across clinical and research settings.