LAUSR

OBJECTIVE To compare the risk of blindness and vision-threatening ocular comorbidities in patients with Behçet's disease (BD) vs the general population. METHODS Using 2002-2017 Korea National Health Insurance Service database, we did a population-based cohort study comparing newly-diagnosed BD patients and age- and sex-matched non-BD controls at a 1:5 ratio. The primary outcome was blindness defined as a best-corrected visual acuity of ≤ 20/500 in the better-seeing eye. Secondary outcomes were vision-threatening ocular comorbidities (cataract, glaucoma, and retinal disorders) that require surgical interventions and incident uveitis. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). We performed subgroup analyses by sex and BD diagnosis age. RESULTS We included 31 228 BD patients and 156 140 controls. During a follow-up of 9.39 years, the incidence rate of blindness per 1000 person-years was 0.24 in BD and 0.02 in controls with the HR [95% CI] of 10.73 [7.10-16.22]. The HR [95% CI] for secondary outcomes was 2.06 [1.98-2.15] for cataract surgery, 5.43 [4.57-6.45] for glaucoma surgery, and 2.71 [2.39-3.07] for retinal surgery. The HR [95% CI] of incident uveitis was 6.19 [5.83-6.58]. Males suffered a disproportionately higher risk of blindness than females due to greater severity than lower incidence of uveitis. The risk of uveitis and blindness decreased as BD diagnosis ages increased. CONCLUSION In this large population-based cohort study, BD patients compared with the general population have a 10.73-fold risk of blindness in 10-years and also a substantially higher risk of diverse ocular comorbidities that pose potential threats to vision.