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Ask Dr. Dan B. Your Own Question
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I was diagnosed with chronic uveitis (systemic origin

Customer Question

I was diagnosed with chronic uveitis (systemic origin unknown) about 6 years ago and originally treated with ototic steroid drops every hour on the hour for about 6 months then weaned down to less and less . I was also treated with Xibrom eye drops. (other medical condition-cluster headaches caused me to be on oral and nasal sterods for about 3 years intermittently. Then, I was diagnosed with glaucoma and cataracts (persumably from long term steroid use). Now I see a specialsist who is treating the uveitis with 15 mg metheltresate 1x.wk and 1 mg. folic acid per day. The uveitis has been under control for about 5 months. I was also diagnosed about 4 years ago with glaucoms and cataracts (presumably caused by long term steroid use). I have synekia between the lens and cornea. My glaucoma pressures range between 21 and last visit 24 in one eye. The specialsist will not perform cataract surgery until I have remained without inflammation for at least 6-9 months, and he as well as all the opthalmologists I have seen consider this surgery extremely risky. No one has actually told me that I will go blind, however, two doctors have alluded to it. I want to know the straight truth as to the probablilty I will go blind in order to make provisions in my life for this handicap.
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

Hello and thanks for your question. You have done a good job detailing your history and I believe you have provided me with as complete a picture as possible without me being able to examine your eyes, see the other measurements in your chart, or study your visual field reports.

Your history of eye problems sounds quite difficult and the prospects for future eye problems quite harrowing. I have treated numerous patients with very similar clinical courses to yours and if there's one thing I've learned through treating these patients it is that no two patients have the same result, clinical course, or severity of symptoms.

In light of this, I would have to say that depending on how advanced your visual field loss is and in correlate, how much damage your optic nerve has sustained, will likely be the main determining factor in if / when you go blind. Not knowing the specifics of these details, it would be difficult for me to even give you a general idea of what your prognosis might be. I will say, though, that the speed with which you may be suffering visual field loss and optic nerve damage can often be used as surrogate prognostic factor. If there has been significant and rapid visual field loss, then this portends a more likely course to blindness.

On the opposite side, however, of the many people like yourself whom I have treated, almost all of them are able to achieve a quiet enough stage in their uveitis that they can have their cataracts taken out and this contributes a tremendous amount to their visual recovery. There are also newer steroids such as Durezol and also newer ways to deliver steroids than ever before. In addition, many of these patients are also successfully controlled on steroid-sparing agents such as the methotrexate you are on. Because of the success for most of these patients that I've treated, I would also expect that you, too, are likely to achieve a baseline level of inflammation suppression that may hopefully stave off further vision loss. Many patients as they get past the age of 60 see that their uveitis tends to weaken to the point that it does not continue to cause further active inflammation, enabling problems like their glaucoma and/or retinal edema to be more successfully treated.

While doing cataract surgery in your case is risky, so is losing your vision risky to your overall life expectancy. In my mind, every effort should be done to enable you to undergo cataract surgery, even if it means an aggressive treatment plan to get your eyes quiet prior to the surgery. If there is one thing I've learned as an ophthalmologist, it is that when people lose significant vision, even in just one eye, their quality of life declines to the point that it can hasten depression and dementia, which in turn can actually shorten their life expectancy. Maintaining as active and healthy a lifestyle as possible throughout your eye problems will do much to stave this off, but just as important as this is retaining your vision.

Knowing what I know about you, do I think you will go blind (meaning vision worse than 20/200 or a visual field constricted to less than 10 degrees in either eye)? I think the odds of this happening in one eye are not small. However, I think your odds of maintaining useful vision in one and/or both eyes are even greater.

I wish I could give you some percentages of rates of blindness from research studies, but there are no large-scale, randomized, double-masked, controlled studies elaborating on the rates of visual acuity loss and/or visual field loss in chronic uveitis. In addition, even if there were, the course of chronic uveitis is so different for everybody, especially given the different causes and the different patient factors that affect the clinical course of uveitis (patient age, overall health prior to onset, lifestyles, etc.).

I hope that's been helpful. If you have other questions or want some clarification from my comments I'd be happy to continue to provide them to you at your request.

I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.

If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter; this allows part of the funds that you have deposited to the website to be released for my efforts to assist you. This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.

Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. Thanks for your inquiry!

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Dr. Dan B. and other Eye Specialists are ready to help you
Customer: replied 6 years ago.

I have accepted your answer and thank you for your frankness.

You indicated that maintaining an active and healthy lifestyle for those with loss of sight or the potential thereof statistically aids in staving off depression and dementia . Unfortunately, I have been chronically depressed for about 14 years due to another health problem--chronic, daily cluster headaches, which forced me to request a leave of absence from the CT Bar, due to the excruciating and debilitating pain. I have sought treatment from many physicians and specialsists and have found no relief. I have tried at least 40 different medications of combinations of these with little to no reprieve. I am among the 2% of those who suffer from this condition that experience daily episodes unlike the norm, whereby the episodes occur in "clusters" and then the individual usually experiences periods from a month to a year pain-free. I have been prescribed narcotics as the last resort, but do not take them as prescribed, which would be everyday due to my deep fear of addiction, which would to me would only cause another problem which I would have to deal with. Therefore, oftentimes I simply writhe in pain for the duration of the episode and wait for the next. Further, I was diagnosed with breast cancer stage II in December and underwent a bilaterial mastectomy and the intial procedure for reconstruction with skin stretchers 4 weeks ago. I begin a 5-6 month period of chemontherapy this Thursday. The two types of chemotherapy I will be on are aggressive and harsh with quite difficult side effects. Further, my mother has stage IV cancer )breast) which was now matastecized into the bones and as of a scan last week--the brain. She is going to need alot of care as she begins radiation (brain) and intavensous chemo this week also. She has been on oral chemo for three years. So, as you can see I am facing horrific problems, personal, financial and physical. I asked you this question as I am deciding whether to go through with the chemo or ust let it go. I have no family other than my mother, a very negaitve future in terms of my eyesight and the suffering of chemo. Further, even after the chemo, I still will not be able to engage in gainful employment due to the cluster headaches. It simply does not seem practical to undergo such suffering when the future holds even greater and further suffering as well as the fact that once my mother passes, I will not have enough financial resources to live. I am on supplemental social security disability and receive about 700.00 per month. I am ineligible for regular social security as I did not apply within the 3 yrs from the onset of my disability as I believed I would be able to find treatment for the cluster headaches and return to practice as an attorney.. I have exhausted every avenue trying to find further assistance. However, it is not available in my case. So, as I have said, I not only am suffering with the three eye conditions, potential blindness, cancer, cluster headaches, but am also actually facing homelessness. I have no family and not even one friend to look to for support. I readily admit that I am severely depressed and have anxiety to the point of staying in bed for hours on end. I only get up to assist my mother, who will be needing more and more care in the very near furture, which I am afraid I will not be able to provide due to my own illness. I realize you do not have the answer to the complex issues I am facing. However, I am wondering if you have any suggestions as to how I might get information regarding life expectancy, type and intensity of pain and related issues to help me defnitively decide whether to even put myself through chemotherapy, given the other issues in my life. Thank you for your time and I do apologive for the length of this reply. I simply do not know anywhere else to turn.

Expert:  Dr. Dan B. replied 6 years ago.
Wow. I cannot imagine what pain you and your mother must be enduring. Unfortunately, I do not have those statistics, nor do I exactly know where to go to get them. My suggestion would be to start with breast cancer advocacy/patient support groups. The Internet might be the best way to find one or more of those groups. In them you are very likely to find either patients or medical professionals who might be able to zero you in on the information you seek in an expeditious manner. I wish I could give you better information than that but being an ophthalmologist I just don't have that kind of information to give you that would be what you are looking for.
I will, however, keep both you and your mother in my prayers for your headaches, your depression, your eye conditions, the cancers and for your ability to find some peace through all of this. I will also try and pass this request on to one of the other medical experts on JustAnswer who may better be able to direct you.