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July 5, 2016/Ophthalmology

Race Against Vision Loss in Inflammatory Eye Disease

A multidisciplinary approach

Redness in the eye caused by anterior chamber inflammation

By Rula Hajj-Ali, MD, and Sunil Srivastava, MD

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Time is of the essence for patients with uveitis. Severe cases of this uncommon disease must receive prompt treatment in order to prevent vision loss. Uveitis accounts for 10 to 15 percent of legal blindness in the United States and has major economic and social impacts. At Cleveland Clinic, the Department of Rheumatic and Immunologic Diseases partners with the Cole Eye Institute to fast track evaluation and treatment and potentially save patients’ sight

Uveitis: a common cause of blindness

Uveitis is characterized by inflammation of the uvea and is anatomically classified into anterior, intermediate, posterior and panuveitic types. Uveitis has a variety of etiologies, including infections, systemic inflammatory conditions and autoimmune inflammatory disease confined to the eyes. Although 30-40 percent of uveitis patients have an associated systemic immune-mediated disease, a large number of uveitis cases do not fit into any well-defined diagnostic category and are labeled idiopathic.

Rheumatologists most commonly see uveitis in patients with ankylosing spondylitis, juvenile rheumatoid arthritis, Behçet’s disease and any of the HLA B-27 associated seronegative spondyloarthropathies. Even for patients without a systemic inflammatory diagnosis, a rheumatologic referral is warranted to manage the very aggressive immunosuppressive agents sometimes required to treat uveitis.

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High magnification view revealing numerous inflammatory cells in the eye

Multidisciplinary clinic, research, education

Cole Eye’s leading ophthalmologists see an average of 100 unique patients weekly for uveitis. Our rheumatologists team with Cole Eye staff to create advanced evaluations and treatment plans for complex uveitis patients. Our combined efforts have led to accurate ocular and systemic diagnoses and more favorable outcomes for our patients.

Our partnership with Cole Eye also includes clinical trials and other research to help us understand how inflammatory eye diseases develop, and to explore the effectiveness of newer and more established medications for treatment. Our colleagues at Cole Eye are advancing imaging diagnostics to improve identification of disease activity at a very early stage. We are working together to evaluate novel therapeutics to improve treatment effectiveness and reduce complications. Cole Eye is also evaluating the genetic etiology of these complex diseases to one day better understand their underlying mechanisms.

Another important goal of this unique collaboration is to train and educate physicians at various levels of experience on how to approach, diagnose and treat these conditions. This includes regular, specialized conferences and lectures. Trainees from Cole Eye rotate with rheumatologists in order to improve their knowledge of systemic inflammatory diseases and the use of immune-modulating agents in the treatment of uveitis.

Ultimately, we hope to reduce morbidity through more effective diagnosis and better identification of appropriate therapies.

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Read more about coordinated care for Cleveland Clinic uveitis patients.

Dr. Hajj-Ali is a staff physician in the Center for Vasculitis Care and Research and the R.J. Fasenmyer Center for Clinical Immunology in the Department of Rheumatic and Immunologic Diseases.

Dr. Srivastava is a staff physician in the Cole Eye Institute.

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