Although ophthalmologists and rheumatologists come from the same medical-school background, our training can diverge so much that even the language we speak is incompletely shared. We know many rheumatologists who stare uncertainly at the notations that are the standard nomenclature for an eye examination. And we know ophthalmologists who are unfamiliar with the new drugs—including the biologics—that are now the mainstay of immunosuppressive therapy. Given the complexity of systemic inflammatory diseases, miscommunication about ocular problems can have serious consequences, causing delays in diagnoses and even misdirected therapy.
Explore this issueDecember 2007
Case for Collaboration
Consider, for example, the management issues raised when the the Uveitis Clinic Casey Eye Institute at Oregon Health and Science University (OHSU) in Portland recently evaluated a patient with Wegener’s granulomatosis for retinal vasculitis. The patient was a 55-year-old female with biopsy-proven Wegener’s that had been treated with prednisone and cyclophosphamide. When the patient began to develop visual loss in one eye, her Wegener’s was seemingly in remission. The dilated ophthalmologic examination, however, demonstrated widespread retinal vasculitis. This examination also revealed large patches of creamy retinal injury that are characteristic of acute retinal necrosis (ARN), a herpetic infection that is rare but much more common in an immunocompromised host (see Figure 1).