How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?

The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam every one to two years after age 65. I would say that these guidelines depend more on eminence than evidence.

Sarcoidosis frequently involves the eye. Roughly 30% of individuals develop uveitis, and a much higher percentage have some element of dryness. From time to time, I am referred a patient with sarcoidosis for a routine eye exam. I'm afraid that my experience falls far short of statistical significance, but I can't recall finding something th...

The 2020 American Thoracic Society Clinical Practice Guideline for the Diagnosis and Detection of Sarcoidosis approached the issue of ocular screening in its 3rd question. There were 18 published articles reviewed, finding an overall prevalence of ocular findings in 26% of sarcoidosis patients referred to examination. These patients were both symptomatic and non-symptomatic at the time of referral. 78% of patients with ocular sarcoidosis that was confirmed on exam had symptoms, meaning that 22% of ocular sarcoidosis was clinically silent at the time of diagnosis. Given this, the guideline recommends that all patients with sarcoidosis receive a baseline screening exam at the time of diagnosis, whether they are symptomatic or not. If this is ...

I fully agree with Dr. @Dr. First Last's circumspection. His answer also comports with the guidance of the American Thoracic Society on the Diagnosis and Monitoring of Sarcoidosis. Similarly, based on a non-statistical set of my own experience, I cannot recall any patient who had creeping silent ocular sarcoidosis that warranted therapeutic attention later after a normal baseline screen. These patients develop symptoms.

It is useful to consider that patients on long-term steroids should have some degree of ocular screening for steroid complications, but that is a different issue.

Useful to consider that patients on long-term steroids should have some degree of ocular screening for steroid complications.