We came across an article, published in Medpage (an on-line source for latest medical news), which was published in October 2010. It highlighted the fact that uveitis treatment in the US falls short of recommendations. It is based on a paper presented to the American Academy of Ophthalmology by Nguyen Q, et al and this paper can be found at:
“A cross-sectional study of the current treatment patterns in noninfectious uveitis among specialists in the United States” AAO 2010; Abstract PA037.
The study was based on the responses from a number of consultants in the US. The response from these consultants showed that most ophthalmologists do not rely on evidence-based treatment guidelines for uveitis and a survey showed that their practice patterns often deviated substantially from the guideline recommendations.
It also showed that steroids were used more intensively and immunosuppressants less intensively than recommendations and guidelines called for.
Also, 75% of the respondents said they either did not use or or were unaware of guidelines issued by two expert groups in 2000 and 2005.
The reason for the guidelines is because of the side effects of steroids and the knowledge that has been gained to date of what works on uveitis (we with Birdshot need immunosuppressants to try and get us into remission – steroids only control the inflammation and do not play a part in retraining our immune systems). The guidelines were also introduced because it had been noted that people on long term steroids doubled their risk of cardio vascular disease (heart attacks).
The full article can be found at:
Obviously, what we are concerned about is what is happening in the UK! So, below is a list of points to think about.
Points to note
- Most of the treatment in the US was with steroids at far higher doses and for a far longer duration than recommended in the guidelines – we do not want you to be needlessly worried.
- Although this study relates to the US, it may equally apply to the UK.
- There are no guidelines produced in England and Wales for our specialists to follow although Scotland is in the process of producing their own guidelines via their own clinical network
- If you have been on high doses of steroids for more than three months and not been offered other immuno-suppressant type drugs you should ask your consultant about why this is and seek another opinion if you are not satisfied with their answers to your questions.