Uveitis — inflammation inside the eye — is a cause of vision loss in the United States. Clinical studies funded by NEI provide doctors, patients, and caregivers with the information they need to make informed health care decisions. And the results of these studies inform future research to identify effective treatments for uveitis.
Putting decades of eye health research into context
Scientific research is cumulative, with new breakthroughs advancing the field and changing the landscape. And given NEI’s long history of research, results that were groundbreaking decades ago may be less directly relevant today. The studies showcased here represent landmarks in eye health research that laid the groundwork the treatments, diagnostic tools, and prevention options that exist today.
In 2005, researchers started the NEI-funded MUST (Multicenter Uveitis Steroid Treatment, NCT00132691) Trial to compare 2 treatment options for people with uveitis. Researchers recruited 255 people with uveitis and randomly assigned them to receive 1 of 2 uveitis treatments:
- Standard treatment with steroid and immunosuppressant pills — systemic treatments that affect the whole body
- Treatment with a steroid eye implant (fluocinolone acetonide implant) — a local treatment that only affects the eye
The MUST Trial set the standard of care for uveitis. It showed that for most people, standard treatment with steroid and immunosuppressant pills is safer and more effective than steroid implants.
In 2013, researchers started the NEI-funded FAST (First-line Antimetabolites for Steroid-sparing Treatment, NCT01829295) Trial to compare 2 steroid-sparing immunosuppressant treatments for uveitis. These treatments change the body’s immune response to make it easier for steroids to work properly. The FAST Trial recruited 216 people with uveitis and randomly assigned them to receive 1 of 2 immunosuppressant treatments:
- Mycophenolate mofetil
The FAST Trial was the first head-to-head comparison of these 2 treatments. It showed that methotrexate is as effective at treating uveitis — and in some cases, more effective — than mycophenolate.
In 2015, researchers started the NEI-funded POINT (PeriOcular vs. INTravitreal Corticosteroids for Uveitic Macular Edema Trial, NCT02374060) to compare 3 treatments for uveitic macular edema, a common complication of uveitis. The POINT Trial recruited 192 people with uveitic macular edema and randomly assigned them to receive 1 of 3 steroid treatments:
- Periocular (near the eye) triamcinolone acetonide injections
- Intravitreal (inside the eye) triamcinolone acetonide injections
- Intravitreal injections to place implants that slowly release dexamethasone inside the eye over several months
The POINT Trial was the first head-to-head comparison of these 3 steroid treatments. It showed that intravitreal delivery of either steroid was more effective than periocular delivery at controlling uveitic macular edema and preserving vision.
In 2017, researchers started the NEI-funded MERIT (Macular Edema Ranibizumab v. Intravitreal anti-inflammatory Therapy, NCT02623426) Trial to compare 3 treatments for uveitic macular edema, a common complication of uveitis. The most common treatment for this condition is corticosteroids to reduce inflammation and swelling of the retina. However, intravitreal (inside the eye) corticosteroid injections can increase the pressure in the eye, raising the risk of glaucoma. The MERIT trial recruited 194 people with well-controlled uveitis — but persistent or recurring macular edema — and assigned them to receive 1 of 3 intravitreal injections of:
- Dexamethasone — an additional corticosteroid
- Ranibizumab — anti-vascular endothelial growth factor (anti-VEGF)
- Methotrexate — anti-inflammatory
The MERIT Trial was the first study to compare different treatments for persistent or recurring macular edema in patients with uveitis. It showed that despite the risk, intravitreal corticosteroid injections are the most effective treatment for this condition — lowering retinal swelling and improving vision better than ranibizumab or methotrexate injections.