DETECTION AND LOCALIZATION OF RETINAL BREAKS IN ULTRAWIDEFIELD FUNDUS PHOTOGRAPHY USING a YOLO v3 ARCHITECTURE-BASED DEEP LEARNING MODEL.

PURPOSE: We aimed to develop a deep learning model for detecting and localizing retinal breaks in ultrawidefield fundus (UWF) images. METHODS: We retrospectively enrolled treatment-naive patients diagnosed with retinal break or rhegmatogenous retinal detachment and who had UWF images. The YOLO v3 architecture backbone was used to develop the model, using transfer learning. The performance of the model was evaluated using per-image classification and per-object detection. RESULTS: Overall, 4,505 UWF images from 940 patients were used in the current study. Among them, 306 UWF images from 84 patients were included in the test set. In per-object detection, the average precision for the object detection model considering every retinal break was 0.840. With the best threshold, the overall precision, recall, and F1 score were 0.6800, 0.9189, and 0.7816, respectively. In the per-image classification, the model showed an area under the receiver operating characteristic curve of 0.957 within the test set. The overall accuracy, sensitivity, and specificity in the test data set were 0.9085, 0.8966, and 0.9158, respectively. CONCLUSION: The UWF image-based deep learning model evaluated in the current study performed well in diagnosing and locating retinal breaks.

Swept-source optical coherence tomography angiography of retinal occlusive vasculitis following brolucizumab administration: a case report.

BACKGROUND: We present a case of retinal occlusive vasculitis following brolucizumab administration and the first report of optical coherence tomography angiography (OCTA) findings after treatment. CASE PRESENTATION: A 71-year-old man complained of vision loss in the left eye 6 weeks after brolucizumab injection. His visual acuity was counting fingers, and examination revealed 1 + anterior chamber cells with 2 + vitreous cells. Fundus examination demonstrated vitreous haze, retinal whitening, and vascular sheathing. Fluorescein angiography revealed filling defects in the retinal arteries and veins, and OCTA showed extensive capillary nonperfusion. Under the diagnosis of brolucizumab-associated intraocular inflammation (IOI) and retinal occlusive vasculitis, topical, sub-Tenon, and systemic corticosteroids were administered. After the treatment, visual acuity improved to 20/200, and OCTA revealed gradual improvement in capillary dropout; however, with the limited improvement of reperfusion in the perifoveal areas. CONCLUSIONS: Prompt evaluation and intensive corticosteroid treatments are required for brolucizumab-associated IOI. OCTA imaging provides detailed information on microvascular changes in the retinal vascular plexuses in brolucizumab-associated retinal occlusive vasculitis.

Incidence and Prevalence of Pediatric Noninfectious Uveitis in Korea: A Population-Based Study.

BACKGROUND: Uveitis is less common in children than in adults; however, pediatric uveitis has a relatively severe disease course that affects the quality of life. Although it is important to understand the epidemiological characteristics of pediatric uveitis, few studies have been conducted in large populations without referral bias. This study investigated the nationwide incidence and prevalence of pediatric uveitis in South Korea according to period, age, anatomic type, and systemic associations. METHODS: This nationwide population-based cohort study used data from the Korean National Health Insurance Service from 2002 to 2018. This study included patients younger than 19 years of age with noninfectious uveitis with at least three claims of diagnostic codes of uveitis on separate days with at least once claim of prescription codes of steroid and immunosuppressive agents. All the cases were classified as anterior or non-anterior uveitis, and the overall incidence and prevalence were estimated by age, sex, and period. Patients with noninfectious uveitis were categorized by the presence of associated systemic conditions. RESULTS: A total of 10,862,616 patients over 128,688,078 person-years were evaluated from 2005 to 2016. Overall, 5,368 cases of anterior uveitis and 604 cases of non-anterior uveitis were identified. The incidence and prevalence of pediatric noninfectious uveitis were 4.64 per 100,000 person-years (95% confidence interval [CI], 4.52-4.76) and 8.25 per 100,000 persons (95% CI, 8.09-8.41). Both the incidence and prevalence of pediatric uveitis increased with age. Anterior uveitis accounted for 84.7% of pediatric noninfectious uveitis prevalent cases (6.99 per 100,000 persons). Cases of juvenile idiopathic arthritis (JIA)-associated uveitis accounted for 8.7% (926 cases) of pediatric noninfectious uveitis cases with a prevalence of 0.72 per 100,000 (95% CI, 0.67-0.77). The proportion of systemic associations was higher and JIA-related uveitis accounted for 11.2% (803 cases) of recurrent or chronic noninfectious uveitis cases with a prevalence of 0.62 per 100,000. CONCLUSION: This is the first population-based study investigating the largest population of pediatric patients with uveitis in Korea. The nationwide incidence and prevalence of pediatric noninfectious uveitis in 2005-2016 were 4.64 per 100,000 person-years and 8.25 per 100,000, respectively. The proportion of JIA in pediatric noninfectious uveitis was 8.7%. These population-based study findings provide a better understanding of the public health burden and aid in the planning of health-care strategies for pediatric patients with uveitis.

Microbial diagnosis of endophthalmitis using nanopore amplicon sequencing.

OBJECTIVES: We investigated whether nanopore amplicon sequencing of aqueous humor was capable of rapid pathogen identification in infectious endophthalmitis. METHODS: 5 cases of culture-positive bacterial endophthalmitis and 3 cases of fungal endophthalmitis (1 culture-positive and 2 presumed) were included. DNA was extracted from the aqueous humor and vitreous specimen, and PCR of bacterial rDNA (16S) and fungal rDNA (ITS1 and D1/2/3) was performed. Then, nanopore amplicon sequencing was performed for 2 h. The results of amplicon sequencing were compared to those of conventional culture studies. RESULTS: In all cases, pathogens were identified by amplicon sequencing of aqueous humor specimens. In 3 cases of bacterial endophthalmitis, the identified microbes were confirmed by culture studies of both aqueous humor and vitreous specimens. In 2 cases of bacterial and 1 case of fungal endophthalmitis, the identified pathogens were confirmed only by culture studies of vitreous specimens. In all cases, amplicon sequencing identified pathogen in a shorter turnaround time than culture studies. In 2 cases with negative culture results, amplicon sequencing of aqueous humor identified fungal pathogens. CONCLUSIONS: Our data demonstrates the potential of amplicon nanopore sequencing using aqueous humor to enable rapid, sensitive and less invasive microbial diagnosis of endophthalmitis.

Explaining the Rationale of Deep Learning Glaucoma Decisions with Adversarial Examples.

PURPOSE: To illustrate what is inside the so-called black box of deep learning models (DLMs) so that clinicians can have greater confidence in the conclusions of artificial intelligence by evaluating adversarial explanation on its ability to explain the rationale of DLM decisions for glaucoma and glaucoma-related findings. Adversarial explanation generates adversarial examples (AEs), or images that have been changed to gain or lose pathologic characteristic-specific traits, to explain the DLM's rationale. DESIGN: Evaluation of explanation methods for DLMs. PARTICIPANTS: Health screening participants (n = 1653) at the Seoul National University Hospital Health Promotion Center, Seoul, Republic of Korea. METHODS: We trained DLMs for referable glaucoma (RG), increased cup-to-disc ratio (ICDR), disc rim narrowing (DRN), and retinal nerve fiber layer defect (RNFLD) using 6430 retinal fundus images. Surveys consisting of explanations using AE and gradient-weighted class activation mapping (GradCAM), a conventional heatmap-based explanation method, were generated for 400 pathologic and healthy patient eyes. For each method, board-trained glaucoma specialists rated location explainability, the ability to pinpoint decision-relevant areas in the image, and rationale explainability, the ability to inform the user on the model's reasoning for the decision based on pathologic features. Scores were compared by paired Wilcoxon signed-rank test. MAIN OUTCOME MEASURES: Area under the receiver operating characteristic curve (AUC), sensitivities, and specificities of DLMs; visualization of clinical pathologic changes of AEs; and survey scores for locational and rationale explainability. RESULTS: The AUCs were 0.90, 0.99, 0.95, and 0.79 and sensitivities were 0.79, 1.00, 0.82, and 0.55 at 0.90 specificity for RG, ICDR, DRN, and RNFLD DLMs, respectively. Generated AEs showed valid clinical feature changes, and survey results for location explainability were 3.94 ± 1.33 and 2.55 ± 1.24 using AEs and GradCAMs, respectively, of a possible maximum score of 5 points. The scores for rationale explainability were 3.97 ± 1.31 and 2.10 ± 1.25 for AEs and GradCAM, respectively. Adversarial example provided significantly better explainability than GradCAM. CONCLUSIONS: Adversarial explanation increased the explainability over GradCAM, a conventional heatmap-based explanation method. Adversarial explanation may help medical professionals understand more clearly the rationale of DLMs when using them for clinical decisions.

A RANDOMIZED PAIRED-EYE TRIAL OF INTRAVITREAL DEXAMETHASONE IMPLANT FOR CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA.

PURPOSE: To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implant in retinitis pigmentosa patients with cystoid macular edema (CME). METHODS: In this randomized, noncontrolled, paired-eye, single crossover clinical trial, one eye of retinitis pigmentosa patients with bilateral CME with central macular thickness of >250 µm was randomized to intravitreal DEX implant while the fellow eye was observed. Both eyes were started on topical dorzolamide. At Month 6, DEX implant was eligible for both eyes when CME was >250 µm. Patients were followed up until Month 12. Primary outcome measures were the central macular thickness and best-corrected visual acuity changes from baseline at Month 2. RESULTS: Fourteen patients with bilateral RP-CME were included. Study eyes showed significant central macular thickness decrease (median, -147.5 µm; P = 0.001) and best-corrected visual acuity improvement (median, +6 letters; P = 0.001) at Month 2, but not at Month 6. Intravitreal DEX implant at Month 6 produced comparable efficacy to baseline treatment in 11 fellow eyes and 12 study eyes. Topical dorzolamide did not show significant therapeutic efficacy. During 12 months, elevated intraocular pressure of >21 mmHg and cataract progression were observed in 14.3% and 40.0% of study eyes. CONCLUSION: Intravitreal DEX implant can both reduce macular thickness and improve vision in RP-CME, while repeated injection is required.

Case of catastrophic antiphospholipid syndrome presenting as neuroretinitis and vaso-occlusive retinopathy.

BACKGROUND: Ocular involvement in catastrophic antiphospholipid syndrome (CAPS), a rare, life-threatening form of antiphospholipid syndrome (APS) that results in multiorgan failure and a high mortality rate, has rarely been reported. CASE PRESENTATION: A 15-year-old girl presented with sudden vision blurring in both eyes. She had marked optic disc swelling and macular exudates in the right eye and intra-arterial white plaques, a few retinal blot hemorrhages, and a white ischemic retina in the left eye. Systemic examination revealed she had acute kidney injury with thrombotic microangiopathy (TMA), multiple cerebral infarcts, valvular dysfunction, and a high titer of triple aPL. Thus, she was diagnosed with CAPS involving the brain, eyes, heart, and kidneys. Plasma exchange and the administration of glucocorticoids, immunoglobulin, warfarin, and rituximab brought a sustained recovery of the TMA, visual symptoms, and echocardiographic findings. CONCLUSIONS: Ocular involvement of both vaso-occlusive retinopathy, an APS-related thrombotic microangiopathy, and neuroretinitis, a non-thrombotic microangiopathy, can occur as an initial presentation of CAPS.

CHOROIDAL THICKNESS AFTER FULL-FLUENCE AND HALF-FLUENCE PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To compare clinical outcomes after full-fluence and half-fluence photodynamic therapy (PDT) in chronic central serous chorioretinopathy, focusing on changes in subfoveal choroidal thickness (SFCT) using enhanced depth imaging optical coherence tomography. METHODS: Retrospective, comparative interventional case series. RESULTS: In the full-fluence (n = 25) and half-fluence groups (n = 43), SFCT decreased from 351 ± 70 µm and 362 ± 63 µm at baseline to 276 ± 65 µm and 322 ± 70 µm at 3 months and remained at 267 ± 66 µm and 318 ± 76 µm at 12 months, respectively (all P < 0.001, for each comparison with baseline). The change in SFCT was greater in the full-fluence group than in the half-fluence group (P = 0.001). In the half-fluence group, SFCT was thicker in the treated eye than in the fellow eye (P = 0.045), whereas in the full-fluence group, the difference in SFCT was not significant (P = 0.209). Best-corrected visual acuity and central retinal thickness improved after PDT in both groups (all P < 0.001). However, the differences between the groups were not significant (P = 0.873 and P = 0.124, respectively). CONCLUSION: The results at 1 year show that full-fluence PDT reduces SFCT more than half-fluence PDT, and that SFCT after half-fluence PDT was still thicker than that in the fellow eye. The clinical implications of this finding for long-term outcomes including recurrence rate remain to be elucidated.

Myelinated nerve fiber-associated local scleral excavation and induced axial myopia.

PURPOSE: To investigate the association between the distributions of local scleral excavation and myelinated nerve fibers (MNF) and to elucidate the pathogenic mechanism of axial myopia in eyes with MNF. METHODS: In six eyes of six pediatric patients with MNF, the distribution of the MNF on fundus photography was compared with the regional excavation of the sclera on linear scans across the fovea and a peripapillary circular scan of spectral domain optical coherence tomography. RESULTS: The tilting of Bruch membrane on vertical scan of spectral domain optical coherence tomography was associated with the major distribution of MNF (κ = 1, Cohen's kappa coefficient). The area of MNF of 12 clock-hour segments and focal scleral excavation on circular scan of spectral domain optical coherence tomography were significantly correlated (P < 0.001, generalized estimating equation). The deepest direction of the circular scan was correlated with the direction of MNF vector defined as the average of the MNF direction weighted by the MNF area along 12 clock-hour segment (P < 0.036, Spearman correlation test). CONCLUSION: Localized scleral excavation was strongly associated with the distribution of the MNF. This result indicates that the retinal areas deprived of visual stimulation by the MNF contribute to the development of axial myopia through local effects on the underlying sclera in early life.

Squinting and photophobia in intermittent exotropia.

PURPOSE: To report factors associated with preoperative squinting, defined as transient eye closure in bright light, and photophobia and the factors affecting improvement of these symptoms postoperatively in intermittent exotropia. METHODS: In this retrospective study, patients (N = 99) were divided into groups according to the presence (n = 54) or absence (n = 45) of preoperative squinting and the presence (n = 64) or absence (n = 35) of photophobia. Clinical characteristics, including overaction or underaction of the oblique muscle and fundus intorsion and extorsion, were compared between the two groups. The squinting and photophobia groups were further categorized into two subgroups each according to postoperative improvement. The extended list of characteristics, including the duration from onset to surgery, postoperative angle of deviation, and fusion, was compared between the two subgroups. RESULTS: Preoperatively, 54 (54.5%) and 64 (64.6%) patients had squinting and photophobia, respectively. The coincidence of squinting and photophobia was marginally significant (p = 0.05). Postoperatively, squinting and photophobia disappeared in 64.8 and 59.4% of the patients, respectively. The photophobia group had a younger onset age of strabismus than the nonphotophobia group (39.3 vs. 56.4 months; p = 0.03). Good fusional status at the near range was more common in the nonsquinting group than in the squinting group (74.3 vs. 47.6%; p = 0.02). Superior oblique overaction was significantly more common in the squinting group than in the nonsquinting group (11.1 vs. 0%; p = 0.03). Early surgical correction and successful outcomes were associated with squinting improvement (p = 0.001 and p = 0.02, respectively). CONCLUSIONS: More than 50% of patients with intermittent exotropia had squinting or photophobia, and approximately 60% of symptomatic patients experienced improvement postoperatively. The onset of strabismus, near fusion, superior oblique overaction, and fundus intorsion were related to these symptoms. Early surgery and successful eye position realignment were beneficial for improving squinting postoperatively.

Therapeutic Intra-arterial Hyaluronidase Infusion for Ophthalmic Artery Occlusion Following Cosmetic Facial Filler (Hyaluronic Acid) Injection.

Although dermal/subcutaneous injection of filler into the face is a popular aesthetic surgery, severe complications related to arterial occlusion, including skin necrosis and visual loss, have been reported. Herein, we report a case of intra-arterial hyaluronidase infusion in the ophthalmic artery and other arteries supplying the facial skin following hyaluronic acid injection at the glabella and nasal ala. Despite direct hyaluronidase infusion into the ophthalmic artery, retinal arterial perfusion was not restored, but branches of the ophthalmic and facial arteries were recanalised. Skin discoloration was normalised, and partial recovery of retinal and choroidal perfusion and complete recovery of ocular movement were achieved.

Plasma Antiretinal Autoantibody Profiling and Diagnostic Efficacy in Patients With Autoimmune Retinopathy.

PURPOSE: To evaluate plasma antiretinal autoantibody (ARA) profiling and diagnostic efficacy for autoimmune retinopathy (AIR). DESIGN: A multicenter, diagnostic evaluation study. METHODS: Forty-nine patients with a clinical diagnosis of AIR, disease controls including 20 patients with retinitis pigmentosa (RP), and 30 normal controls were included. Plasma samples from patients were analyzed for the presence of 6 ARAs, including recoverin, α-enolase, carbonic anhydrase II, heat shock protein 60, aldolase C, and cone-rod homeobox/cone-rod retinal dystrophy 2 using western blotting. RESULTS: Autoantibody detection rates against cone-rod homeobox/cone-rod retinal dystrophy 2, heat shock protein 60, and aldolase C in AIR were 67.3%, 40.8%, and 42.9%, respectively, which were higher than those in RP and normal controls (P < .001, P < .001, and P = .007, respectively), but recoverin, α-enolase, and carbonic anhydrase II were not different from other control groups (P = .117, P = .774, and P = .467, respectively). Among ARAs, antirecoverin antibody was the most specific, as it was found in 3 (6.1%) patients with AIR and none of the control groups. As the number of detected ARAs increased, the probability of AIR increased (odds ratio: 1.913; P < .001; 95% confidence interval: 1.456-2.785). The positive number of ARAs was significantly higher when photoreceptor disruption was observed on optical coherence tomography, or severe dysfunction was observed in electroretinography (P = .022 and P = .029, respectively). CONCLUSIONS: The profiles of ARAs in the AIR group were different from those in the RP and normal controls. The higher number of positive ARAs suggests a higher possibility of AIR diagnosis. ARAs should be used as adjunct tools for the clinical diagnosis of AIR.

Progression pattern of myopic maculopathy according to the severity of diffuse chorioretinal atrophy and choroidal thickness.

This observational cohort study aimed to evaluate the progression pattern of diffuse chorioretinal atrophy (DCA) according to its severity. Highly myopic eyes with DCA were graded according to its extent in the 532-nm (green) and 633-nm (red) wavelengths images of the Optos ultra-widefield scanning laser ophthalmoscope at baseline: grade 1 and 2 were defined when increased reflectance at peripapillary region, not beyond the fovea, were observed in red laser image only and in both laser images, respectively; grade 3 and 4 were defined when increased reflectance beyond the fovea were observed in red laser image only and in both laser images, respectively. A total of 307 eyes (221 patients) were included, and progression of myopic maculopathy during follow-up of ≥ 3 years was evaluated. The mean visual acuity and subfoveal choroidal thickness (CT) differed among DCA grades (P = 0.015 and P < 0.001); a higher DCA grade had worse visual acuity and thinner choroid. During follow-up, development of patchy atrophy (PA) was observed in 3.2%, 5.5%, 12.8%, and 23.2% (P < 0.001), while changes in lacquer crack (LC) and/or development of myopic macular neovascularization were observed in 20.6%, 29.1%, 33.3%, and 15.8% (P = 0.061) of 63, 110, 39, and 95 eyes with DCA grade of 1, 2, 3, and 4 at baseline, respectively. New LC formation tended to occur in eyes with thicker CT at baseline compared to PA development and progression of pre-existing LC. In highly myopic eyes with DCA, progression pattern of myopic maculopathy is different according to its severity and CT at baseline. Grading based on separated wavelength images of ultra-widefield scanning laser ophthalmoscope is useful to evaluate the severity and prognosis of DCA in Asian patients with high myopia.

Risk factors for myopic choroidal neovascularization-related macular atrophy after anti-VEGF treatment.

PURPOSE: The study aimed to evaluate risk factors for macular atrophy (MA) associated with myopic choroidal neovascularization (mCNV) during long-term follow-up after intravitreal anti-vascular endothelial growth factor (VEGF) treatment in highly myopic eyes. METHODS: The medical records of patients who received intravitreal injection of anti-VEGF agents as mCNV treatment and were followed-up for more than 36 months were retrospectively reviewed. The risk factors for the development of mCNV-MA, which is the fovea-involving patchy atrophy lesion adjacent to mCNV, were investigated using the Cox proportional hazard model. RESULTS: A total of 82 eyes (74 patients) were included in the study. The mean age at anti-VEGF treatment was 56.3 ± 12.5 years (range, 26-77), and the mean follow-up period was 76.3 ± 33.5 months (range, 36-154). During follow-up, mCNV-MA developed in 27 eyes (32.9%), and its occurrence was estimated to be 24.5% at 3 years and 37.3% at 5 years after the first anti-VEGF treatment. Old age (hazard ratio [HR] = 1.054, 95% confidence interval [CI]: 1.018-1.091; P = 0.003) and greater CNV size at baseline (HR = 2.396, CI: 1.043-5.504; P = 0.040) were significant factors for mCNV-MA development. Eyes with a thinner subfoveal choroid were more likely to show faster enlargement of the mCNV-MA during follow-up. CONCLUSIONS: In mCNV eyes treated with intravitreal anti-VEGF agents, older age and greater mCNV size at baseline were risk factors for the development of MA during long-term follow-up, which was associated with a poor visual prognosis.

Role of Ultra-widefield Imaging in the evaluation of Long-term change of highly myopic fundus.

PURPOSE: To evaluate the impact of posterior staphyloma identified using ultra-widefield fundus imaging on the long-term progression of myopic maculopathy in highly myopic patients. METHODS: In this observational cohort study, highly myopic patients who were followed up for at least 5 years using ultra-widefield fundus imaging were analysed for fundus abnormalities and the progression of myopic maculopathy based on the International Meta-analysis of Pathologic Myopia classification. RESULTS: This study included 390 eyes (210 patients) with the mean follow-up period of 69.2 ± 7.5 months (range, 60-88). Posterior staphyloma was identified in 198 eyes (50.8%) in the baseline ultra-widefield fundus images. The border of staphyloma was not identified within 50° view circle corresponding to conventional fundus photography in 42 eyes (21.2%) with staphyloma, most of that were wide macular type. Progression of myopic maculopathy during follow-up was observed in 202 eyes (51.8%), and eyes with staphyloma were more likely to show progression compared to those without (142/198 [71.7%] versus 60/192 [31.3%]; p < 0.001). In multivariable regression analysis, the presence of posterior staphyloma was an independent risk factor for the progression of myopic maculopathy (p = 0.005). One or more peripheral retinal lesions were observed in 302 eyes (77.4%) and 321 eyes (82.3%) in the baseline and final ultra-widefield fundus images, respectively. CONCLUSION: Posterior staphyloma was associated with the long-term progression of myopic maculopathy. With a wider field of view, ultra-widefield fundus imaging is useful for identifying the posterior staphyloma and monitoring the progression of myopic maculopathy in highly myopic patients.

Decreased choroidal and scleral thicknesses in highly myopic eyes with posterior staphyloma.

In this cross-sectional study, we investigated choroidal thickness (CT) and scleral thickness (ST) in highly myopic eyes and their associations with ocular factors. Patients underwent widefield swept-source optical coherence tomography (OCT) to measure the CT and ST at the subfovea and 3000 µm superior, inferior, temporal, and nasal to the fovea and macular curvature. A total of 237 eyes (154 patients) were included. At all five measurement points, thinner CTs and STs were associated with longer axial lengths (r = - 0.548 to - 0.357, all P < 0.001) and greater macular curvatures (r = - 0.542 to - 0.305, all P < 0.001). The CT and ST were significantly thinner in eyes with posterior staphyloma than in those without at all measurement points (all P ≤ 0.006) but did not differ between eyes with the wide macular and narrow macular type of staphyloma. Eyes with myopic maculopathy of category ≥ 3 according to the International Meta-Analysis for Pathologic Myopia classification had significantly thinner CTs and STs than those with category ≤ 2 (all P ≤ 0.005). In highly myopic eyes, a decrease in the CT and ST was more pronounced in eyes with more structural changes, such as longer axial length, steeper macular curvature, and the presence of posterior staphyloma.

Incidence and Risk Factors for Blindness in Uveitis: A Nationwide Cohort Study from 2002 to 2013.

Purpose: To investigate the incidence and risk factors of blindness in uveitis.Methods: From a national sample cohort (n = 1,025,340), we selected 9,036 new-onset uveitis patients. Incidences of unilateral and bilateral blindness (visual acuities ≤20/400) were estimated and socioeconomic and clinical risk factors for unilateral blindness in uveitis patients were identified.Result: Incidence of unilateral and bilateral blindness was 2.93 and 0.42 per 1,000 person-years, respectively. The risk factors for unilateral blindness were age >40 (hazard ratio [HR], 2.77, 95% CI [confidence interval], 1.11-6.92) and low household income (HR, 1.50; 95% CI, 1.02-1.98) in uveitis overall, and Behçet's disease (HR, 4.49; 95% CI, 1.59-12.71) in non-anterior uveitis, respectively.Conclusions: Low household income and Behçet's disease influence the risk of blindness in uveitis patients. These findings will help in assessing blindness-related socioeconomic burdens and planning health-care strategies for uveitis patients.