Latest Alternate Uveitis Treatment Option

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1. Uveitis Symptoms and the Latest Alternative Approved Treatments
2. FAST FACTS
3. Uveitis Treatment with Steroids and Other Medications
4. Steroid Eye Drops Dosage Risks and Alternatives
5. Uveitis Alternative Approach
6. Best Uveitis Alternative Treatment
7. Inflammation Control is Central to Avoiding Risks of Eye Damage
8. REFERENCES

1. UVEITIS SYMPTOMS ALTERNATIVE TREATMENT OPTIONS

What are the symptoms and causes of uveitis?

Uveitis Symptoms

Uveitis Symptoms Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include:

  • Blurred vision
  • Floaters which are dark floating spots in your vision
  • Eye pain
  • Redness of the eye
  • Sensitivity to light (photophobia)
  • Halo effect around lights is a very good indicator!!
  • Can occur in one eye  or both eyes
  • Uveitis is the third leading cause of preventable blindness in the world. Patients need to KNOW THE RISKS OF STEROID USE.

    Many people (22%) who suffer from this group of diseases lose their vision via practices well within their control!

    Aggressive early treatment for rapid recovery is important in order to avoid permanent or severe eye damage, and a lifetime of expensive medical complications.

Depending on how severe it is, recurrence may take place.

Uveitis is an Intraocular Inflammatory condition resulting from an Infection or Autoimmune response in the body that results in swelling (due to inflammation in the internal layers of the eye), which damages tissue in the eye(s).

Uveitis may be caused by problems or diseases occurring in the eye or it can be part of an inflammatory disease affecting other parts of the body and can happen to people of all ages.

Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many times.

Uveitis is usually classified by where it occurs in the eye.

What is anterior uveitis?

A. Anterior Uveitis (Iritis) – Iritis is the most common type of uveitis affecting the front layers of the eye (the uvea). It occurs mostly among young and middle-aged people. It can occur both in healthy individuals and people who are suffering from infectious diseases.

You may be more prone to anterior uveitis if you have:

  • Arthritis, including ankylosing spondylitis (AS).
  • Autoimmune diseases, such as sarcoidosis or juvenile idiopathic arthritis.
  • Gastrointestinal disorders, such as inflammatory bowel disease (IBD).
  • Prior infections with the herpes virus (cold sore or genital herpes) or the chicken pox virus.

What diseases are associated with uveitis?
What is intermediate uveitis?

B. Intermediate Uveitis (Cyclitis) – Cyclitis or Vitritis causes inflammation in the vitreous- the fluid-filled space inside the eye. It is the least common type of Uveitis (15%). Seen among young adults.

About one in three people with Intermediate Uveitis also have:

What is posterior uveitis?

C. Posterior Uveitis (Chroditis and Retinitis) – Posterior uveitis is the least common form of Uveitis, but it is the most serious type of Uveitis. It affects the back of the eye – including the retina, choroid, and optic nerve.

This type can cause recurrent symptoms that last months or years. Potential causes include:

  • Birdshot chorioretinopathy.
  • Viral etiologies such as herpes virus or chicken pox virus.
  • Lupus.
  • Sarcoidosis.
  • Syphilis.
  • Tuberculosis

What is panuveitis?

D. Panuveitis or Diffuse Uveitis – Panuveitis occurs and affects all the layers or parts of the eye. Rarely seen. This can cause severe damage to the Retina and therefore raises the chances of permanent vision loss. Treatment options need to chosen carefully.

Potential causes include:

  • Bacterial or fungal retinitis.
  • Viral retinitis.
  • Toxoplasmosis.
  • Lupus.
  • Sarcoidosis.
  • Syphilis.
  • Tuberculosis (TB).
Classification of Uveitis

2. FAST FACTS

What to avoid with Uveitis?

Why do I keep getting Uveitis?

Uveitis and Lifestyle
It has been suggested that in many patients the Immune system may be slightly off. Combined with stress, alcohol, poor diet, and lack of sleep this could be the catalyst for Idiopathic Uveitis.

Smoking and Uveitis
Patients who smoke or have a smoking history have more Uveitis activity, which does not bode well for the loss of vision. Often stopping smoking could be the turning point in regaining control of the infection.

Diet and Uveitis
Simple Carbohydrates, such as pies, pastries, cakes, and desserts are simply deleterious to Uveitis suppression.

69.9%

Statistically, women are more susceptible to Uveitis than men. The majority of which are of working age; and the subsequent Socioeconomic costs are tremendous.

22%

Research data implies that approximately 22% of patients meet the criteria for legal blindness at some point in their follow-up.

3 Million

Some Research suggests that there are approximately 3 million people living with Uveitis.

10-15%

Uveitis, or inflammation of the Uvea, is responsible for between 10% and 15% of all cases of blindness and for 30,000 new cases of legal blindness in the United States alone.

64.5%

Visual loss of Uveitis patients is mainly caused by Chronic Inflammation and secondary Cataract and Glaucoma due to Steroid use.

3. UVEITIS TREATMENT WITH STEROIDS AND MEDS

How is uveitis treated with steroids?

Although the initial events leading to uveitis are not always clear, the eventual loss of vision has always been ascribed to the ocular tissue damage caused by the amplification of the inflammatory processes. [3032]

Topical steroids are often the first-line as inhibitory agents in the treatment of uveitis.

Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and reduce vision loss.

Treatments depend on the type of uveitis a patient displays.

Some forms of uveitis take a long time to go away. Some come back after treatment. Depending on the disease type, treatments include:

  • Antibiotics, antivirals or antifungals: These medications treat uveitis caused by an infection.
  • Eye drops: Dilating (widening) the pupils with eye drops can reduce pain and swelling. Eye drops can also keep the iris and lens from sticking together, a complication that can occur with anterior uveitis. Your healthcare provider may also prescribe eye drops to relieve pressure in the eye (ocular hypertension).
  • Steroidal anti-inflammatories: Medications that contain corticosteroids (steroids) to try and alleviate eye inflammation. These medications come in many forms: drops, ointments, oral pills, injections inside or around the eye, intravenous (IV) infusions or a capsule that your eye healthcare provider surgically implants inside the eye. SEVERE SIDE EFFECTS are likely. Which is why Clinicians worldwide are questioning the use of Steroids as new safe and effective therapies become available.
  • Immunosuppressants: These medications calm the immune system’s response to autoimmune disease or systemwide inflammation. Your provider may prescribe these drugs if uveitis affects both eyes, doesn’t respond to steroids or threatens your vision. You may take the medication orally as a pill, as an injection or through an IV infusion into a vein.

Certain immunosuppressants can increase your risk of cancer.

  • In some cases, surgical procedures may also be prescribed such as vitrectomy and the implantation of a device into the eye in order to release medication.

Anterior uveitis treatments

Cortisone (Steroid Treatment) is becoming more controversial as alternate therapies become available.

Regardless of the presentation, the Conventional treatment for Uveitis is -eye drops – mostly in the form of steroid therapy as the first option for treating patients with non-infectious uveitis because it can suppress the hallmark inflammation.

Many doctors agree that treating the eye aggressively and early can help avoid complications and vision loss. Treating hourly with Pred Forte or every 2 hours with Durezol (difluprednate).

Intermediate, posterior, and panuveitis treatments

Dr Glenn Jaffe at Duke University starts with the anterior uveitis and says: “I treat aggressively in the beginning, it makes it easier for me to get the patient off the drops, as opposed to treating less aggressively and prolonging the treatment duration. I begin to taper the treatment once the anterior chamber is quiet.”

Local therapy options include a posterior sub-Tenon’s steroid injection or intravitreal steroids. However, I usually start with a posterior sub-Tenon’s injection. I can always go to an intravitreal injection later, if needed. As retinal specialists, we are almost programmed to treat people with intravitreal injections, but with a uveitis patient you can often achieve the treatment you need with a periocular steroid injection, which has the advantages of less risk for endophthalmitis and/or an increase in intraocular pressure. Having said that, though, if the inflammation is severe, or if the patient doesn’t respond to a periocular steroid injection, I’d use an intravitreal steroid.” For the intravitreal steroid route, Dr. Glenn Jaffe says that, at this point in the therapy, he prefers either an intravitreal injection of triamcinolone acetonide (1 mg in 0.1 ml) or a short-acting sustained drug delivery system such as Ozurdex (dexamethasone implant), which lasts six weeks to three months.

At a certain point, however, steroids will have to be ceased, and continued inflammation suppression is achieved by steroid-sparing therapy.

Some practice guidelines suggest that immunosuppressive therapy may be appropriate as the first therapeutic option in some cases of uveitis, including sympathetic ophthalmia, Vogt-Koyanagi-Harada disease and Behçet’s disease with retinal vasculitis, and in some rheumatologic disorders, such as Wegener’s granulomatosis, Behçet’s disease or polyarteritis nodosa, which affects the posterior segment.

However, immunosuppressive therapy requires close and careful follow-up, and there are systemic concerns that general ophthalmologists may not be aware of. For that reason, referral to a uveitis specialist may be warranted.

Referral may also be called for if the disease course is particularly violent, if it affects the retina, or if uveitis recurs every time the steroid is tapered down or eliminated. Dr. C. Stephen Foster (a leading specialist) suggested referral after 6 months of steroid use and that the timing of the referral can be of critical importance.

“Delayed referral is too common, and a change in practice patterns is going to be necessary if we are going to have any significant hope of reducing the prevalence of blindness secondary to uveitis,” Dr. Foster said. “Too often, the uveitis specialist who gets the referral, gets the case, after sufficient damage has been done that precludes the patient ever seeing well again.”

4. Steroid Eye Drops Dosage Risks and Alternatives

The side-effects and risks of steroid treatment for uveitis?

INTRAOCULAR PRESSURE

The side-effect and risks of steroid eye drops increase with usage. The link between Inflammation, Increased Eye Pressure (Optic Nerve Damage), and Steroid Side-Effects (like Secondary Glaucoma and Cataracts) cause irreversible visual impairment. This occurs because of long-term dependence on steroid therapy, whether by oral medication or eye drops, vis-à-vis either poorly controlled inflammation or a distinct and significant rise in eye pressure caused by steroids themselves.

Long-term steroid use may lead to:

OCULAR SIDE-EFFECTS

What are the ocular side-effects?

1. GLAUCOMA

Figure 1: A fundus photo of the optic nerve showing increased cupping, a risk factor for glaucoma.

Glaucoma is a condition in which there is damage to the optic nerve, often related to elevated intraocular pressure (IOP).

The result of this damage is a progressive, permanent vision loss.

The risk of steroid-induced glaucoma depends on the duration of use and potency of the steroids themselves as well as the individual’s baseline risk for glaucoma.6-8 

It is impossible to evaluate IOP changes constantly, and therefore avoid the moment at which this will occur and therefore the subsequent damage to the eye.

2. CATARACTS

Figure 2. Example of a posterior subcapsular cataract, the type of cataract that often forms from chronic steroid use. Photographer: James Gilman, CRA, FOPS, Moran Eye Center11

Long-term steroid Chronic Uveitis eye drop use is associated with an accelerated development of cataracts, andreduced vision. While the mechanism of cataract development in this setting is not well understood, it is thought to involve steroid-induced changes in gene transcription within lens epithelial cells.10

Classically, the type of cataract associated with steroid use is called a posterior subcapsular cataract, which forms in the back of the lens (Figure 1).11

3. DELAYED WOUND HEALING AND RISK OF INFECTION

Fluorescein staining of a dendritic ulcer

Figure 3: Fluorescein staining of a dendritic ulcer, pathognomonic for herpetic keratitis.  This is a type of corneal ulcer where steroids are absolutely contraindicated due to the risk of worsening the infection.

Steroids are often used in conjunction with topical antibiotics in ocular infections such as corneal ulcers. However research has identified that steroids inhibit growth factors critical in wound healing.12 Therefore local ocular infections treated with steroids may become worse, especially viral infections such as herpetic keratitis.12

While local steroid therapy is valuable in infections of the eye, owing to their ability to reduce inflammation and scarring, these benefits must be weighed against the risk of recurrent infection and poor wound healing and require the close monitoring of an eye specialist.

5. UVEITIS Alternative Approach

The best alternative approach is with Ocusolve Eye Drops.

SEE DIRECT COMPARISON here.

Many people who suffer from this group of diseases lose their vision via an alternative approach well within their control!

Better education of Eye Care Providers, including Uveitis and Glaucoma Specialists, about this blinding disease and the ramifications of improper therapy, is vital to bridging the gaps in treatment that exist for many of these patients.

The number of providers who understand this premise is thankfully growing. However, there still are providers who do a great disservice to their patients.

Providers who are overly concerned about the dangers of systemic therapy for uveitis and then continue to pour steroid drops on uveitis, to mask symptoms (keeping symptoms “quiet”), only to let resulting glaucoma, cataract, or eye pressure changes (and subsequent optic nerve damage) ravage the eye.

Research shows that the use of healing, regenerative therapy, like OcuSolve Eye Drops, is an imperative:

Solid control of Ocular Inflammation can lessen the risk of perpetual vision loss from secondary glaucoma, cataract or optic nerve damage- directly caused by or related to this inflammation. And this absolutely must be achieved off of all steroids, achieving “steroid free remission” of inflammation. “ – Dr Stephen Anesi

Glaucoma is the ‘sneak thief’ of vision, a blinding disease of the optic nerve, or the structure that connects your eye and brain and allows you to see.

  • It causes irreversible vision loss which,
  • at first, is usually completely unnoticed by the patient,
  • asymptomatic, because it affects the ‘peripheral’ vision,
  • but slowly progresses until significant central vision loss occurs

Some forms of uveitis are more prone to developing glaucoma, including both infectious causes, such as some types of virus-associated uveitis, and non-infectious causes, like juvenile idiopathic arthritis-associated uveitis.

The most common reason why glaucoma causes vision loss is because of high pressure in the eye. It is primarily a problem with fluid balance in the eye which creates the pressure – “too much fluid in” or “not enough fluid out”. In uveitic glaucoma, several other factors may be in play, including scarring and poor blood flow due to chronic inflammation. Scarring may cause abnormalities in the “outflow” pathway of fluid from the eye, leading to higher pressure.

Abnormal blood flow and blood vessel inflammation can also damage outflow pathways, but may also pose a threat to oxygen delivery to the retina and optic nerve (ischemia), which can also cause irreversible damage. At times, active inflammation is felt to be the cause of high eye pressure, as may happen in herpes simplex iritis – simply treating the inflammation causes the eye pressure to return to normal.

6. Best Alternative Treatment for Uveitis

Ocusolve is the latest and most effective Treatment for Uveitis

Ocusolve is the best alternative treatment for Uveitis
  • You can use OcuSolve™ for all forms of inflammation and infection control. OcuSolve™ Eye Wash has several mechanisms of action:
    • Ocusolve is a soothing anti-inflammatory (and anti-itch) treatment taking care of redness.
    • Gives long-lasting antimicrobial cover.
    • OcuSolve™ combats biofilms. A biofilm is a colony of microbes that exude sticky material which forms a matrix or grid. T
    • It’s estimated that almost 70% of all infections that require treatment are due to biofilm formation. This film forms in order to protect the microbes colony
    • Ocusolve’s REGEN BIO-HOCI molecule penetrates and disrupts the biofilm and microbial cell membranes.
    • OcuSolve™ is thus able to create a challenging environment for invasive pathogenic Conjunctivitis.
    • Ocusolve’s REGEN BIO-HOCI is an Oxygen rich solution. Each Oxygen species has a distinct mode of action and capability:
    • which is a potent antimicrobial capable of eradicating antibiotic-resistant strains of bacteria, viruses and fungus.
    • without promoting the emergence of newly resistant strains of infection

    Several studies have shown that BIO-HOCl (in OcuSolve) has a broader and more potent antimicrobial spectrum, than any conventional prescribed treatment.

Secondary Glaucoma, secondary Cataract and Optic Nerve damage are most common causes of avoidable visual impairment in patients with Chronic Uveitis, which we believe is a treatable entity. The relationship with chronic inflammatory activity and the ease with which this can be treated, confirms the importance of a safe and effective anti-inflammatory Bettamed™ Ocusolve’s inclusion in any treatment regime.

Bettamed OcuSolve Eye Drops are a life-altering advance in Uveitis Care. Our patented ECA Technology, mimics the same Oxychlorine composition as that manufactured by neutrophils in the body’s immune system.

Bettamed Ocusolve (with Hypochlorous Acid) is naturally produced by our white blood cells and is an essential part of our immune system. This process is called phagocytosis and is one of nature’s symbiotic actions- with no evidence of induced microbe resistance.5

Bettamed OcuSolve™ with (HOCl) exhibits potent broad-spectrum antimicrobial activity, including antibiotic-resistant strains of bacteria (including MRSA and VRE), viruses, fungi and spores- as demonstrated in numerous studies1,2,5,6,8,12,13, while reducing inflammation and increasing Oxygen (O2) in treated tissue.

There are no concerns about ocular toxicity with HOCL, in fact it has been found to be non-irritating and non-sensitising in various animal safety models.5

Bettamed OcuSolve™ is bio-compatible, non-toxic and non-sensitizing, making it safe for regular use.

As part of the immune response to microbial proliferation, mast cells flood the infection site, contributing to inflammation.

A significant portion of HOCl’s potency is derived from its anti-inflammatory effects, as a result of its modulating effect controlling mast cell response.

A study by Medina-Tamayo et al43 suggests a neutral PF Superoxidised Solution (SOS), acts like a mast cell membrane stabilizing inhibitor, inhibiting the cell machinery for granule secretion, without altering the signal transduction pathways. Additionally, many studies, including Sakarya et al44 demonstrate that HOCl induces significant healing, as well as a substantial reduction in signs of inflammation.

In 2013, Pelgrift et al45 proposed that HOCL is both antimicrobial and anti-inflammatory, which accounts for the reduction in pruritis in dermatology.

A study by Bongiovanni46 investigated the micro-circulatory integrity (oxygenation) of patients with venous leg ulcers and its effect on time to wound healing. Exposure of the Venous leg ulcers to HOCl elevated TcPO2 levels for up to 72 hours after exposure, which increased time to wound healing between 2-180 days.

The added advantage is that the dissolved Oxygen (O2) in Bettamed Ocusolve eye drops, improves Oxygen balance for infection control, creating a reversal of the tissue damage and possible vision loss caused by uncontrolled inflammatory processes.47,48,49

7. Inflammation Control is Central to Risk Reduction and Eye Damage

The best Anti-inflammatory approach is central to treatment of uveitis and avoids the risks of eye damage

  1. Uncontrolled Uveitis allows inflammation to remain active- which causes increased Intraocular Pressure.
  2. Steroid Therapy (both Systemic and topical drops) increased Intraocular Pressure.

The “elephant in the room” being that the Opthalmologist makes weekly or biweekly appointments to “monitor” IOP- which is impossible unless the patient is monitored in real-time. Thus, optic nerve damage, is not actually monitored, but rather, observed after-the-fact… ie. too late.

the risks of long term uveitis

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  1. Medina-Tamayo J, Sanchez-Miranda E, Balleza-Tapia H, et al. Super-oxidized solution inhibits IgE-antigen-induced degranulation and cytokine release in mast cells. Int Immunopharmacol. 2007;7(8):1013-1024.
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