Nazima Ali1, Sophia Zagora2, Oren Tomkins-Netzer3,4, Rachael Niederer1

Purpose: To analyse the predictors of visual outcome in Vogt-Koyanagi-Harada (VKH) disease.
Design: Retrospective study.
Methods: Setting: Multicentre clinics (New Zealand, Australia and Israel). Study population: 351 eyes of 178 subjects with VKH were evaluated between 2000 and 2022. Procedures: Clinical and demographic data were analysed from a database.
Measures: Treatment modalities and success of therapy, complications and risk of recurrence of VKH, risk factors for vision loss.
Results: A total of 351 eyes of 178 subjects were included for analysis with a mean follow up of 6.9 years. Mean age was 38.8 years ± 14.9 and 123 were female (69.1%). Disease-modifying anti-rheumatic drugs were used in 84 patients (47.2%). Recurrence occurred in 109 patients (61.2%) with a median time to first recurrence of 904 days (95% confidence interval 414-1410). Choroidal neovascular membrane occurred in 12 patients (6.7%), optic neuropathy in 6 patients (3.4%), scleritis in 14 patients (7.9%), glaucoma in 31 patients 17.4%) and cataract in 54 patients (30.3%). Vision loss ≤ 6/15 occurred in 39 patients (21.9%). Vision loss was associated with poorer presenting vision (odds ratio 2.882, p = 0.001) and recurrence (odds ratio 5.948, p = 0.001).   
Conclusions: VKH is a distinct clinical entity with various known complications leading to poor visual outcome. Timely detection of the condition and initiation of immunosuppressive treatment is crucial. Poorer presenting vision and recurrence disease were associated with loss of vision.