Specialists team up to deliver best care and keep watch on harsh medications
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At the age of 19, Helen Diponio found herself with a vision-threatening disease called uveitis. Her eyesight was blurry, filled with floaters, and getting worse. After several years of treatment elsewhere she undertook the research that led her to Susan G. Elner, M.D., Director of Kellogg's Uveitis Service. Now 35 years old, Mrs. Diponio-Lamb has been coming to the Kellogg Eye Center for the past 11 years. She was fortunate to find the right doctor and the coordinated care needed to help her manage this complex and chronic autoimmune disease.
Uveitis is an inflammation of the eye that may affect either the front or the back of the eye or both. It may be difficult to diagnose correctly and treat effectively. Because uveitis can result in significant vision loss it must be treated promptly. In some cases it is related to other systemic diseases. In many cases it is chronic and requires therapy with oral prednisone or immunosuppressant drugs.
Dr. Elner sees many patients with this inflammatory eye disease. Along with her diagnostic expertise, she also understands the importance of coordinating care with a highly trained rheumatologist who helps monitor patients needing immunosuppressant drugs.
After confirming the diagnosis, Dr. Elner started Mrs. Diponio-Lamb on steroids, the typical first line treatment. Because uveitis is often chronic, patients may be on steroids for long periods of time—a problem because side effects can be uncomfortable, even dangerous, if not watched carefully. Steroids can cause obesity, mood disturbances, diabetes, and osteoporosis, in addition to other ailments. "We try to reduce these risks by substituting steroid-sparing medicines if the patient requires long-term steroids," says Dr. Elner. "That's when we call on the expertise and experience of our colleagues in rheumatology. We also monitor our patients very carefully as we wean them off the steroids, looking for signs of reactivation."
In Mrs. Diponio-Lamb's case, Dr. Elner communicates regularly with University of Michigan rheumatologist, Dr. Vladimir Ognenovski, who administers and reads the monthly blood tests, discusses possible changes with Dr. Elner, and sees the patient twice a year. He and Dr. Elner collaborated closely when Mrs. Diponio-Lamb decided to become pregnant and knew her medications would have to change.
"These collaborations are critical to the patient's health," says Dr. Elner. "They need both of us. I treat the eye disease, the rheumatologist helps us manage the medicines necessary to control the eye disease and watches for related autoimmune diseases."
Almost every other month, Mrs. Diponio-Lamb travels a couple of hours each way to the University of Michigan to see either Dr. Elner or Dr. Ognenovski. These visits are both for routine monitoring as well as for flare-ups of the uveitis, which reduce her vision. Dr. Elner has been able to treat these successfully with immunosuppressant drugs and steroid injections.
"I can't say enough good things about Dr. Elner," declares Mrs. Diponio-Lamb. "She is professional, kind, and patient. She answers all my questions carefully. She is a good teacher and a good doctor. I know I'm getting cared for properly."
For more information, see the Retina, Uveitis & Ocular Oncology Clinic at the Kellogg Eye Center.
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