By Alan L. Wagner, MD

It’s well known that skin cancer is the most common of all cancers, and that melanoma, which accounts for only two percent of these cancers, causes a large majority of skin cancer deaths.  Over the past twenty years, those cancers and deaths have increased between three and five-fold. It’s less well recognized that there has been a similar increase in the incidence of melanoma of the eye and in its sequelae: from loss of vision to loss of life. Approximately 50 percent of patients with choroidal melanoma (also called uveal melanoma) will develop metastasis by 10 to 15 years after diagnosis.

Just about everyone knows someone who suffers the pain of arthritis, whether with intermittent soreness or complete immobility.

When the body’s immune system attacks the eye, it can feel very much like the pain and other symptoms of arthritis. And it too can be intermittent, or cause total blindness.  It’s called uveitis, and it’s the third leading cause of blindness in first and second world countries.

As many as 38,000 people develop uveitis in the United States every year. Most importantly, almost 15 percent of all blindness in the US arises from uveitis.

Our eye has three layers, and the middle one, just inside of the white part of the eye that we are used to seeing, is called the uvea (which is Latin for grape), because the pigmented middle layer makes the eye look like a Concord grape. We know the front part of uvea as the iris – the blue/brown/hazel of the eye.  The layer of the uvea extends to the back of the eye as the ciliary body and choroid. When the uvea is targeted by the immune system, it’s known as uveitis, sometimes called iritis or choroiditis.

Our bodies fight infection by sending white blood cells, antibodies, and other proteins to kill, stop, or control the offender. This response makes the area swollen and red – think what it feels like to have Strep Throat. The body’s immune response to that infection is inflammation. Inflammation of the uvea, uveitis, can come from infections, or a confused immune system that attacks its own body bringing about the same sort of swelling, soreness, and redness to the eye. When those same white blood cells and proteins invade the gel filling the eye, called vitritis, our vision becomes cloudy, and we see “floaters”.

Uveitis is not contagious, and most cases are not associated with any form of infection. However, some of the infections that can cause uveitis (syphylis and tuberculosis) are very contagious and must be treated to bring about resolution of the inflammation.

The symptoms of uveitis can begin slowly, or quickly. It can be a one time event, or recur frequently. The most frequent symptoms are:

• Pain

• Redness

• Blurred/poor vision

• Light sensitivity

• Floaters

The diagnostic process and treatment plan for a patient with recurrent or severe uveitis frequently requires a comprehensive ocular and systemic evaluation. In many cases, genetic testing is required. At the Wagner Macula Retina Center, we work collaboratively and lead a team of specialists to help the patient and their primary care giver to provide seamless, continuous, care.

Just like with arthritis, the more inflammation, the more damage. To stop the inflammation and reduce the chances for damage to the eye, uveitis treatments can range from using drops, placing steroids around or into the eye, to systemic medicines or enrolling into research studies.

Time is heart, time is brain, and time is eye. Any time vision is threatened by a recent change or for any reason whatsoever, expert evaluation is a must.

Alan L. Wagner, MD, FACS founded the Wagner Macula & Retina Center in 1987. He completed medical school at Vanderbilt University School of Medicine, residency at EVMS and a fellowship at Weill Cornell University Medical Center. wagnerretina.com