Imagine having a disease that required you to have injections in the eye every six weeks. A tiny implant is making a big difference for patients who face that treatment.
Gloria Woodward is stunned that the implant saved her vision.
“I’ve been doing good, a lot better, a lot better," she says. "I’m seeing things I haven’t seen in years.”
Gloria has uveitis, a chronic inflammation in her eyes. The disease is not well understood and there’s no cure but keeping it under control is critical.
Dr. Pauline Merrill says, "If it’s not controlled one way or the other it’s very likely to blur your vision. And it can, in severe cases, cause you to go blind.”
This is traditionally treated with steroids in pill form or in eye drops. But some patients, like Gloria, need regular steroid injections right in the eye.
Dr. Merrill says, "I have one patient who had 20 injections around the eye over the past few years and was understandably not too excited about continuing.”
She might not have to thanks to the implant called retisert. It sits in the eye and slowly releases steroid medication for 1,000 days.
"So instead of doing an injection of steroid into the back of the eye every six weeks or three months or whatever, now you can do a small surgical procedure,” Dr. Merrill says. "And then you have the steroid controlling the uveitis for almost three years.”
Studies show that retisert helped decrease inflammation from uveitis and improve vision. The downside is an increased risk for cataracts and glaucoma.
The implant is designed with a tiny reservoir that releases a steady flow of fluocinolone for 30 months. Retisert, made by Bausch and Lomb, was approved by the FDA in April 2005.
Supplemental Information
Fast Facts:
Uveitis is an inflammation of the middle layer of the eye.
About 38,000 Americans develop uveitis every year.
Some people with uveitis require steroid medications, through pills or eye injections, to control the disease. Long-term use of steroids can cause severe side effects.
The FDA has recently approved a new implant, called retisert™, that delivers small doses of steroids directly into the back of the eye.
Uveitis
Uveitis is an inflammation of the area of the eye called the uvea. The uvea is the middle layer of the eye and is made up of the iris (the colored portion of the eye), the ciliary body (a group of blood vessels and muscles that change the shape of the eye for focusing vision) and the choroid (a membrane filled with blood vessels and nerve cells that sense light and color). One or both eyes can be affected.
Uveitis can be classified into one of three types, depending upon the location of the inflammation. Anterior uveitis affects the iris or the iris and ciliary body. It is the most common form of uveitis. Intermediate uveitis affects the ciliary body and the very front edge of the retina (the light sensitive film at the back of the eye). It is the second most common form of the disease. Posterior uveitis is an inflammation of the choroid. The condition may also affect the retina and the optic nerve.
Symptoms of UVEITIS depend on the location of the disease. Patients with anterior UVEITIS may experience sensitivity to light, glared vision, pain or redness in or around the eye, and problems focusing. Intermediate and posterior UVEITIS may cause floaters in the visual field and blurry vision. Eventually, UVEITIS can lead to glaucoma, cataracts, macular edema, retinal detachment or vision loss.
According to Prevent Blindness America, about 38,000 Americans develop UVEITIS every year. The condition can occur at any age, but is most commonly seen in men and women in their 40s. Up to 15 percent of cases of blindness can be attributed to uveitis. The condition has many different causes. Some cases are caused by a virus, fungus, parasite or bacteria. Eye trauma or immunologic diseases (like juvenile rheumatoid arthritis) can also cause uveitis. In some cases, the cause is unknown.
Treating Uveitis
There are several different types of treatment for uveitis. Steroid eye drops to reduce pain and inflammation are often useful for anterior uveitis. However, for those with chronic symptoms or posterior uveitis, eyedrops aren’t effective (the drops can’t reach this area). Patients may require injections of steroids around the outside of the eyeball. The injections last about six weeks to three months and must be repeated if symptoms persist. For severe cases, doctors may prescribe steroids through a pill or IV line.
Although steroids can be very effective in treating uveitis, long-term use can have some serious side effects. Patients may experience sudden increases in appetite, weight gain, nausea, heartburn, mood changes, high blood pressure, diabetes, bone loss and an increased risk for infection.
Retisert™ for Uveitis
In April, the FDA approved a new treatment for chronic, non-infectious posterior uveitis, called Retisert™ (fluocinolone acetonide, by Bausch & Lomb). Retisert is a tiny implant containing a steroid medication. To place the device, the eye is numbed with an injection of anesthesia. Next, a tiny incision is made in the white of the eye, just below the iris. The implant is then placed in the back of the eye (behind the lens and in front of the retina) and sutured to the white of the eye.
Once in place, minute amounts of steroid medication seep out from a hole in the implant, bathing the eye in medication. The device slowly releases the steroid for about 1,000 days (about two-and-a-half years). Studies have shown patients who receive Retisert experience a dramatic decrease in eye inflammation. In addition, for some of the patients, visual acuity improved significantly.
Patients who receive Retisert are still at risk for complications associated with long-term use of steroids. Most patients eventually develop cataracts (usually within two to three years) and many will develop glaucoma. However, these conditions are treatable with surgery and other medications. By placing the steroid medication directly into the eye, patients avoid the need for repeated eye injections and systemic side effects from oral or intravenous steroids.
Researchers are currently comparing the use of the fluocinolone acetone implant with standard therapy. The study is called the MUST (Multicenter UVEITIS Steroid Treatment) Trial.
Web Resources
For information about the Multicenter Uveitis Steroid Treatment (MUST) trial, click here.
Trial information is also available from Bausch & Lomb's Web site.
For information on uveitis:
American Optometric Association Web site
Ocular Immunology and Uveitis Foundation Web site
Prevent Blindness America Web site
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