Vitamin D deficiency and non-infectious uveitis: A systematic review and Meta-analysis
Autoimmunity Reviews December 2023 https://doi.org/10.1016/j.autrev.2023.103497
William Rojas-Carabali a b c 1, Juan Sebastián Pineda-Sierra a 1, Carlos Cifuentes-González a 1, María Sofía Morales a, Paula Tatiana Muñoz-Vargas a, Luisa Fernanda Peña-Pulgar a, María Alejandra Fonseca-Mora a, Danna Lesley Cruz d, Ikhwanuliman Putera i j k l, Lucia Sobrin e, Rupesh Agrawal b c f g h, Alejandra de-la-Torre a
Highlights
- Recent publications have linked vitamin D with non-infectious uveitis (NIU).
- Hypovitaminosis D has been associated with 2.5 times more chance to develop NIU.
- In this study, vitamin D levels were found to be lower at any time before NIU onset.
- Hypovitaminosis D shows an OR of 2.04 (p < 0.00001) for NIU development.
- Evidence on hypovitaminosis D impact in NIU still inconclusive.
- Consider screening for hypovitaminosis D in NIU patients or at-risk individuals.
Background
Vitamin D plays a critical role in immunomodulation, and its deficiency is implicated in the pathogenesis of several autoimmune diseases. Nevertheless, its relationship with non-infectious uveitis (NIU), an inflammatory ocular disorder, remains inconclusive.
Methods
A systematic search was conducted in three databases from database inception until May 8, 2023, to investigate the potential relationship between vitamin D deficiency and non-infectious uveitis. We included observational studies reporting the measurement of vitamin D levels in patients with NIU and healthy controls without restriction of language or date of publication. Three pairs of authors independently screened the title and abstracts for potential eligibility and then in full text. A third author resolved disagreements. Three pairs of independent reviewers abstracted the data from the fully reviewed records and evaluated the risk of bias. We followed The MOOSE and PRISMA guidelines. Random effects meta-analyses were used for primary analysis. Studies not included in the meta-analysis were summarized descriptively. This review was registered in PROSPERO: CRD42022308105.
Findings
Of 933 records screened, 11 studies were included, and five were meta-analyzed, encompassing 354 cases and 5728 controls (mean participant age ranging from 7.1 to 58.9 years). Patients with vitamin D deficiency exhibited an Odds Ratio of 2.04 (95% CI = 1.55–2.68, P < 0.00001) for developing NIU compared to controls. Overall, potential sources of bias were low across most studies.
Interpretation
Our findings suggest that vitamin D may play an essential role in the pathophysiology of NIU. While the included studies demonstrated generally low potential bias, additional rigorous prospective studies are necessary to confirm these findings and further elucidate the underlying mechanisms involved. Vitamin D supplementation could represent a possible therapeutic strategy for preventing or managing NIU if substantiated. Clinicians should consider screening for and addressing vitamin D deficiency in patients with or at risk for NIU.
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