UVEITIS IS A COMPLEX INFLAMMATORY DISEASE of the eye that poses a significant risk of permanent vision impairment and blindness if left untreated. Characterized by symptoms including eye pain, redness, decreased vision and light sensitivity, uveitis can stem from various causes, ranging from autoimmune disorders to infections. Treatment is often complex and has to be tailored to each patient’s distinct inflammatory profile.
Understanding the need for specialized support, Duke Eye Center is home to the Duke Multidisciplinary Uveitis Clinic, distinguished for its innovative treatment protocols and collaborative, consolidative approach. By integrating rheumatology with ophthalmology, patients benefit from comprehensive care for the entire spectrum of inflammation control.
The collective efforts of skilled specialists have positioned the clinic at Duke Eye Center as a leader in uveitis care. Glenn Jaffe, MD, Robert Machemer M.D. Distinguished Professor of Ophthalmology and Division Chief Vitreoretinal Disease, emphasizes the importance of this unique model, stating, “It is crucial to have rheumatologists and ophthalmologists working side by side. Patients with uveitis often have systemic diseases that require a comprehensive treatment approach with immunosuppressive medications, and that’s exactly what we provide here at Duke.”
The clinic’s foundation is built on the understanding that the diagnosis and management of uveitis is complex and may be part of an autoimmune condition which impacts other parts of the body. Uveitis often coexists with systemic diseases like sarcoidosis, multiple sclerosis, vasculitis and psoriatic arthritis. This underscores the importance of a comprehensive patient-centered approach to addressing both ocular health and autoimmune issues simultaneously. The Duke Multidisciplinary Uveitis Clinic facilitates this integrated method by bringing together rheumatologists and ophthalmologists in the same room to consult and treat patients concurrently, streamlining the diagnostic and therapeutic processes.
A Comprehensive and Coordinated Approach
Unfortunately, it is common for patients with uveitis to experience lengthy delays when attempting to coordinate care across different specialties. Traditional models often necessitate separate appointments for ophthalmology and rheumatology, leading to gaps in communication that can jeopardize patient outcomes and lead to inadequate treatment.
“The complexity and chronicity of uveitis demands constant collaboration. We identified that many patients were struggling to manage their conditions due to poor communication between specialists,” said Amol Sura, MD, assistant professor of ophthalmology. “By working together in the same room, we eliminate those barriers.”
At the Duke Multidisciplinary Uveitis Clinic, patients see both their uveitis specialist and a rheumatologist, allowing for coordinated discussion of treatment strategies and adjustments. This integrated process is particularly beneficial for patients with multifaceted medical histories, where the relationship between ocular and systemic diseases impacts care decisions. Rex McCallum, MD, FACR, professor of medicine, underscores, “This is a model that works well for our patients. We simplify the process significantly, making it not only efficient but also effective.”
The clinic’s structure is built on a foundation of trust, knowledge-sharing and continuous education. Its physicians actively engage cross functionally, ensuring that they remain at the forefront of uveitis research and treatment advancements. Their shared mindset has not only led to a rise in patient volumes across several adjoining states but has also enriched the education of fellows and trainees, bolstering Duke’s reputation as an elite training ground for future leaders in ocular inflammation.
Unique Facilities and Expedited Diagnosis
Well-appointed facilities at Duke Eye Center enable the robust treatment patients undergo at the uveitis clinic. For example, an on-site blood collection facility allows for on-premises testing to identify underlying systemic causes of uveitis. This capability, along with others such as imaging, enables the clinic to deliver timely diagnoses and treatments, eliminating the need to defer care while waiting for follow-up testing at another location.
“One of the greatest advantages of the Duke Uveitis Clinic is our ability to access diagnostic resources without delay,” said Dilraj Grewal, MD, associate professor of ophthalmology, “We’re able to complete blood tests, imaging and fluid samples all on the same day, expediting the path to diagnosis and disease control.”
This comprehensive framework also includes simultaneous follow-up appointments with both specialists, fundamentally transforming the traditional patient experience. Frequent assessments enable consistent monitoring of disease progression, allowing necessary adjustments to occur fluidly and without unnecessary lapses. With uveitis often requiring frequent patient visits — typically every three to five months — this consolidated model is a paradigm shift that decreases patient barriers to care, improves communication and prompt care coordination to improve outcomes for people with uveitis.
Leading the Charge in Uveitis Research
The team at the Duke Multidisciplinary Uveitis Clinic is committed to enhancing the understanding of uveitis through groundbreaking research initiatives. For over three decades, the clinic’s specialists have played pivotal roles in clinical trials that have reshaped the treatment landscape.
To achieve further advancements and improve patient outcomes, a comprehensive uveitis registry is in development. This landmark initiative will meticulously track patient outcomes, including quality of life metrics, treatment efficacy and safety. By prioritizing patient needs and preferences, the registry will aim to identify innovative avenues for research and optimize disease management tactics. As Lisa Carnago, FNP-C, expressed, “Our goal is to capture the perspective of patients and understand what truly matters to them. This will guide us not only in refining therapies and improving quality of care but also in understanding the holistic impact of uveitis on their lives.”
This registry will be a historic change to the way patient data is analyzed and utilized. Unlike traditional registries that often focus solely on clinical outcomes, the Duke uveitis registry will incorporate patient experiences, perceived quality of life factors and social determinants of health using multiple methods. This comprehensive approach will empower researchers and clinicians to tailor treatments more precisely to the individual needs and concerns of each patient.
One of the clinic’s primary objectives is to investigate how various therapeutic regimens and interventions influence patient quality of life over time. By engaging patients in an ongoing dialogue, the registry aims to inform clinicians and significantly enhance individuals’ well-being beyond clinical measures. “Our aspiration is to advance a holistic understanding of the disease, incorporating patient insights into their treatment preferences and priorities,” asserts Sura. “This authentic, patient-centered approach will truly set us apart and drive improvements in uveitis care.”
The Duke Multidisciplinary Uveitis Clinic stands committed to managing the complexities of uveitis while understanding the patient’s perspective. By fostering collaboration among specialists and streamlining the care process, the clinic stands at the forefront of improving patient outcomes and delivering research advancements. The impending uveitis registry will deepen our understanding of this intricate disease, ensuring patient voices are central to evolving treatment strategies. At Duke Eye Center, we are dedicated to our mission of curing eye disease worldwide and improving the lives of those battling complex eye diseases. With the continuing support of our community, we look forward to continuing to lead the charge in pioneering comprehensive, patient-centered uveitis care.