Ocular Inflammatory Disease is a name for more than one hundred different ailments of the eye. They are characterized by redness, light sensitivity, brow pain, spots or floaters in the visual field, and loss of vision. Uveitis is one small group of these diseases.
Uveitis is an inflammation of the uveal tract of the eye. The uveal tract is responsible for generating the fluid inside the eyeball. Left untreated, it causes blindness. Uveitis is a rare disease, caused by several different factors. It can be a part of the symptoms of other diseases. Crohn's Disease, Multiple Sclerosis, Systemic Lupus Erythmosis, Ankylosing Spondylitis, and certain types of thyroid disease all are known causes of Uveitis. Many times, there is no reason or cause for Uveitis, and so it is classified as idiopathic.
Uveitis is the third leading cause of preventable blindness in the world. Many times, a patient who is diagnosed with this disease is treated with only steroid drops. Eye drops do not penetrate the eye; they sit on top of it, and they may reduce spillover inflammation from the inflamed uveal tract. Only systemic drugs, such as oral prednisone, can reduce the inflammation caused by this disease. Steroids, however, cannot be the only treatment; long-term use of steroids causes many unwanted side effects, not the least of which is osteoporosis, a weakening of the bones, and insulin-dependent diabetes. Immune modulation therapy is needed to control this disease and save the patient's sight.
All this sounds simple enough. The problem with this disease is that it is a rare disease that few ophthalmologists know how to treat. A doctor may have a hundred or more patients in his practice, and one of them may have uveitis. That one patient is most likely the only patient the doctor will ever see who has the disease. Many doctors are so overwhelmed by the number of patients they see every day, as well as HMOs restrictive payment practices, that they become disinterested in learning how to treat the uveitis patient. The patient is given bottle after bottle of steroid drop, and bottle after bottle of dilating drops to keep the muscle of the iris from cramping. The pupils often end up getting stuck in a dilated position, or stuck to the cornea in such a way that they are no longer round, and this also destroys the patient's vision. Steroid drops, such as prednisone, cause cataracts after prolonged use, and they can slowly eat away at the cornea, causing scarring and blindness. Doctors who treat this group of illnesses are even more rare than the disease. There are less than a hundred and fifty ophthalmologist in the world who treat Uveitis, especially Intermediate Uveitis. Intermediate Uveitis is also known as Pars Planitis, because the pars plana, which is responsible for the generating of the fluid contained within the eyeball, is inflamed.
Patients with Ocular Inflammatory Diseases go through a range of issues, daily, which affect the entire family. Lights must be dimmed when the disease is in an active, flaring state, because light is so offensive to the patient. Light sensitivity is so severe that patients often go through the day in a dim environment, for fear of retreating to a dark room and being unable to function.Driving becomes impossible because the field of vision is decreased, or altered so that the vison is too impaired to drive. Glaucoma, both high and low-pressure, caused by chronic steroid use, causes loss of visual field, and loss of vision. Patients even become agoraphobic, afraid to leave the safe confines of home, for fear of having a severe attack, or because they become so tired of embarrassing themselves in public. When a person cannot see, they are in a serious situation. Depression and grief set in because patients can no longer enjoy almost any of their former interests.It is very difficult to find transportation, and difficult to navigate parking lots, stores, doctor's offices, etc., because the patient cannot see well, but is not considered "blind enough" for mobility training, much less a guide dog. Patients who were once very social are now uncomfortable in these settings. Patients who were not as social or even very shy, become reclusive without proper care for their disease; these patients often slip through the cracks of depression screening tools used by primary care doctors.
Ocular Inflammatory Disease is misunderstood by many members of the healthcare community. It is misunderstood by the families and friends of the patients dealing with these diseases, because it is not an obvious disability, like total blindness. Often patients are told to get new glasses, or accused of "faking" an illness, just to get out of work, or some other obligation. OID patients need support and understanding. They also need proper medical care, and mobility training needs to be given to those with lost peripheral vision. It is difficult to move around, and to continue normal activity when a person has one or more of these diseases, and the lack of understanding in the medical community is frustrating and can be very upsetting.
Ocular Inflammatory Disease is the third leading cause of preventable blindness in the developed world, yet it gets the least media attention. More awareness, more understanding, more help and support are needed by the patients who suffer with these insidious disease processes. More research, more funding for research, and more screening of patients are needed if we are ever to eradicate this disease. If you would like to donate to the cause, or gain more knowledge about OID, please visit: The Ocular Immunology and Uveitis Foundation. There you will find a wealth of information, and if you are a patient with one of these illnesses, a wealth of information and support can be found, not the least of which is the knowledge that you are not alone.
