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UPFRONT: Dispelling Concerns About Treating Uveitis

In 2017, uveitis is the new “black” when it comes to retina. The sheer number of pathways and approaches being tested in clinical studies is staggering. Also, of the minuscule number of FDA approvals this year, one was for adalimumab in uveitis, and a phase 3 clinical program for intravitreal sirolimus had a positive read-out. This is a very exciting time in the management of uveitis. Yet, most retina specialists treat the management of uveitis as though it were the plague, quickly shuttling patients out of their clinic to a uveitis specialist.

The excuses not to manage uveitis are good: no access to specialty lab testing services, no access to rheumatologists to manage infusion of biologics, no formal uveitis training. However, often the decision to refer comes down to unwillingness or inability to spend the time to look closely at the patient’s history, especially systemic history, and to perform careful and focused diagnostic testing and imaging, as well as concern about making a mistake. I am fortunate enough to have 4 uveitis specialists in the hallways around me at Cole Eye Institute, and the one thing that I have learned from them is that it is fine to start work-up and treatment without a clear diagnosis. As retina specialists, we are so used to knowing exactly what we are treating; but, in the world of uveitis, this is often not the case until well into the follow-up.

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Toward this end, in this issue we are debuting a new column highlighting key topics in uveitis — Uveitis Corner, edited by Sunil Srivastava, MD. We hope this will bring our readers up to speed about what is happening in the field with topical pieces. We plan to include case discussions, management options, and imaging tricks, among other topics in this area. In this issue, we also explore the new kid on the block, sirolimus, with one of the leading researchers in the field. As this drug may be available early next year, understanding the mechanism of action and in whom the drug may work is very important.

With the advent of these newer therapies, will the treatment of uveitis return to the bread-and-butter retina specialist? Only time will tell. For now, having a steroid-sparing therapy for noninfectious posterior uveitis is encouraging. RP