Colorado Retina: Uveitis

Uveitis refers to inflammatory and infectious diseases in and around the eye. These conditions are often associated with systemic diseases, including sarcoidosis, lupus, multiple sclerosis, and rheumatoid arthritis. Colorado Retina is a tertiary referral center for patients with these complex diseases, seeing patients from Colorado and seven surrounding states from Montana to New Mexico. In many cases uveitis is treated with immunosuppression therapy to prevent additional flares and damage, and Colorado Retina is proud to offer these treatments, including an intravenous infusion suite in our Parker, Colorado office. We work closely with rheumatology, neurology, infectious disease, and many other subspecialists to create a network of physicians dedicated to the treatment of uveitis and autoimmune eye disease.

TYPES OF UVEITIS

Neuroretinitis from Bartonella infection

There are many different conditions that comprise uveitis. Iritis, or anterior uveitis, is the most common, located in the front of the eye in the anterior chamber. Pars planitis, or intermediate uveitis, creates floaters and blurred vision through inflammatory damage to the vitreous, in the middle of the eye. Posterior uveitis, or inflammation in the retina and choroid, can severely impact vision and encompasses a number of diseases, including retinal vasculitis, birdshot chorioretinopathy, VKH, and the "white dot syndromes". We also see patients with scleritis, which is inflammation in the wall of the eye, and patients with inflammation in the eyelids or behind the eye (ocular cicatricial pemphigoid, orbital pseudotumor).

Risk Factors, Causes & Symptoms

Birdshot chorioretinopathy, associated with HLA-A29 gene

Some of these diseases can be associated with certain genes (HLA-B27, HLA-A29), some with autoimmune diseases (sarcoidosis, lupus, rheumatoid arthritis), and less commonly from infections like tuberculosis and syphilis. Part of your evaluation at Colorado Retina will include laboratory testing to evaluate for all of these risk factors, though 40-50% of cases are not associated with a known cause (idiopathic) and localized only to the eyes. Symptoms vary depending on which part of the eye is affected; inflammation in the front of the eye typically causes pain, redness, and light sensitivity, while inflammation in the back of the eye more commonly causes floaters, flashes, and dark patches within the visual field.

Testing & Diagnosis

Fluorescein angiography to evaluate retinal vasculitis

Your initial evaluation at Colorado Retina will include a detailed history and examination, including reviewing notes from prior ophthalmologists and other specialists. You may receive additional diagnostic testing with optical coherence tomography (OCT) and fluorescein angiography to better determine your diagnosis. Colorado Retina also provides specialty testing, including electroretinography (ERG), visual field testing, and ICG (indocyanine green) angiography, some of which may be helpful in monitoring uveitis over the course of time

Treatment

Infliximab (Remicade) intravenous infusion for a patient with birdshot chorioretinopathy

There are a number of excellent treatment options for uveitis. Historically, most uveitis has been treated with steroids. These are available as drops, injections, oral formulations (liquids, pills), and intravenous medications. Over the past couple decades, the gold standard in treating uveitis has been with steroid-sparing immunomodulatory therapies, the same medications used by rheumatologists to treat a variety of autoimmune diseases. There are also a number of surgical options available, depending on the disease. Colorado Retina Associates’ uveitis specialists will coordinate with specialty surgeons for cataract, glaucoma, orbital, and retinal surgery, if these are required. Uveitis is often a chronic, long-term disease that requires years of treatment, with the goal of a durable long-term remission.

Meet Your Specialists

Dr. Mark Dacey | MD

Dr. Mark Dacey is very active in the field of uveitis on local, national, and international levels. He has written many peer-reviewed articles in major journals and been invited to speak at national and international uveitis symposiums. He has been a primary investigator on many of the major uveitis studies in the past decade, including several active clinical research trials, to bring cutting-edge technologies to Colorado patients. Dr. Dacey has also served as an advisor and consultant, working closely with companies to develop and bring these exciting new technologies to become available to our patients.

Learn More

Dr. Ashleigh Levison | MD

Dr. Ashleigh Levison, in addition to her work in medical and surgical treatment of retinal disease, also cares for patients with uveitis, also known as inflammatory diseases of the eye. Dr. Levison grew up in the world of medicine, as both her parents practiced, she always knew she too wanted to be a doctor. Why uveitis? Levison says, “Because most people identify vision as their most important and valued sense. It is amazing to be able to save and protect the sight of my patients”. Dr. Levison is actively involved in the academia community, she has published several educational papers and often travels to share her advanced research and knowledge of uveitis with her ophthalmic colleagues.

Learn More