 Hi, I'm Meredith Maher at the University of Maryland Medical Center. Today, we're discussing advances in treatment for UVitis and retinal conditions with ophthalmologist Dr. Kenneth Taubenswag from University of Maryland, IAssociate. Thanks for being here today. Thanks for that, Marie. And thanks to all of you for watching. We invite you to leave your questions for our ophthalmologists in the comment section below, or you can send us a direct message if you feel more comfortable, and be sure to like this video to let us know you're tuning in live. Dr. Taubenswag, can you explain what the importance is of the retina and how it fits in with the rest of the eye? Sure. So the retina is kind of the wallpaper inside the eye that sees light. It is a collection of all the cells that take a picture. It's the film inside the camera. And if the retina is not working, you're not going to take a good picture and you're not going to see well. And it's just like so many other parts of the eye critical to your vision. And unfortunately, it's a part of the eye that can be damaged in a number of conditions, which I treat ranging from things like macular degeneration. The macula is the center part of the retina to things like diabetes, retinal vascular occlusions, which are like blood clots in the retina, to retinal detachments and things like that. How do you know when someone is beginning to develop a retinal condition? What are some of those symptoms that may indicate that it's starting to develop? So different retinal conditions can present with different symptoms. You know, one of the most, the thing that probably many people have heard of is a retinal detachment. That's one of the common conditions that we see and one of the more urgent conditions that we treat. And retinal detachments will often, people will often have floaters in their vision. Now everyone has some floaters, but people, you know, heralding the retinal detachment right beforehand, people often have a sudden increase in floaters. They can have flashing lights in their side vision. And as the retinal detachment gets closest to the center part of the retina that gives us our straight ahead vision, people start to notice that part of their vision is missing, that they have a, sometimes they'll say a curtain or a shadow coming over their vision. Other conditions, the symptoms can be something as simple as constant blurred vision. If your vision is always blurry in one eye or both eyes, that could be a, it doesn't, sometimes it's something that's not related to the retina, but it can be, especially in something like diabetes. Macular degeneration, on the other hand, the most common symptom that people present with is distortion. Notice that if they look at something that they know should be straight like the lines on the road, or the side of the picture frame, that actually things are a little bit wavy. Simultaneously, some retinal conditions are silenced. People can actually have very severe diabetic retinopathy. And they think they're okay because they're seeing fine. And for people with underlying health conditions, like diabetes, that's why even when people are asymptomatic, it can be critical to have those screening or surveillance visits, because sometimes we can catch something and save someone from losing vision or going blind, before they even notice they're having a problem. So other than having diabetes, obviously, for diabetic retinopathy, what are some other risk factors that may contribute to somebody developing a retinal condition where others may not? A lot of it's dependent on the condition. You know, one of the conditions I mentioned that we treat frequently is retinal detachment. Retinal detachment risk factors are, you know, age is a big one. This is something that usually happens in people's 50s, 60s, 70s. Being a little more near-sighted, meaning having trouble seeing far away. And the more near-sighted someone is, the thinner their retina is, and the more likely they can have a small tear in the retina, which causes that retinal detachment. Family history. Someone has a family history of retinal detachment that can put them at risk. And other eye surgeries, you know, cataract surgery, it may not cause it per se, but sometimes it can cause fluid shifts in the eye that can precipitate it. For things like macular degeneration, age, it is age-related macular degeneration. So age is a big factor. We also know that genetics plays a role. If your mom or dad had it, you're probably more likely to develop it. But it's not to say that one would. You know, macular degeneration often is a little more common people with fair skin, with blue eyes, sun may play a role, smoking. And then for some of the, many of the other conditions I treat, retinal vein occlusion, for instance, or artery occlusions, just the rest of your overall heart health, your blood pressure, your cholesterol can certainly play a role. And uveitis, a lot of the conditions we treat are infectious. And, you know, many times there's not, there's not a clear risk factor, you know, other than exposure to an infection in some way. Or they're autoimmune. And many autoimmune conditions, we're still learning more and more about them. There's probably a genetic component, but also we, you know, there's many molecules in the immune system that we're still learning about. And oftentimes we don't have great answers for why people develop uveitis. What are some of the consequences to not seeking care if you notice these symptoms developing? I mean, is it always like complete blindness is a possibility? Or, I mean, truly what can happen to these folks? And does it always affect both eyes or can it just affect one eye? So it depends, again, it depends on the condition. I treat a wide array of conditions. For some of the things I see, you know, the vision can remain stable for many years. I also, I see people with things like epiretinal membranes, which are, when someone develops a little bit of scar tissue over the retina. And people with that condition will often notice a little bit of distortion or the vision. Images in one eye may look a little smaller or larger than they do with the other eye. And that condition can stay very stable. And, you know, we can treat it with surgery, but because it can be very stable for many years, we really, you know, I really spend a lot of time with my patients, really asking them and trying to understand how much it's impacting them. Because if it's something that's not going to cause them to go blind, and they think they're seeing and okay and living their life, I'm going to be much more hesitant to recommend surgery. And for some of the other conditions that I see, like wet, macular degeneration, it can be very rapidly progressive, no matter weeks to months. And people, if they don't go blind, they can lose a lot of their central vision very quickly. And in a way that's not, I can't always fix it. If they don't get in, if their care is delayed, if their treatments are delayed. And then something like retinal detachment, you know, time really is of the essence when we see that condition. It was a universe, if we do nothing, it is universally blinding. It was an inevitably blinding condition until the mid 20th century, when we started to find techniques that we could use to fix it surgically. And now the success rates are a little bit better than 90% with a single surgery. But if someone ignores it, which unfortunately you were meant, you know, the pandemic people would often put these things off longer than they should have. And it stays some of these conditions, if you're really noticing symptoms, new blurry vision, you should reach out to see your ophthalmologist or an optometrist or someone to figure out what's going on. Steve mentioned surgical interventions. Tell us more about some advances in the treatments that are now being offered for retinal conditions, such as injections and other methodologies. Great. So, you know, the tools I have to treat retinal conditions and uveitis really range from oral medications to local medical therapy in the form of injections to laser treatments that we often do in the office to surgery. The oral medications haven't changed a whole lot for some of the conditions I treat. You know, I see a lot of patients here at University of Maryland with uveitis and steroids haven't changed a whole lot in the last 50 years. There have been a lot more sort of steroids bearing medications that we can use for uveitis. And we work closely with our rheumatology colleagues here, if someone has an associated rheumatological or autoimmune condition to pick out the best one for them. Sometimes if they don't have an underlying autoimmune condition, I'll talk to them and select one that fits their needs. And how they want to take it and make sure that I make sure they don't have any contradictions to it. Many of the retinal conditions I treat, I treat much more local therapy. The mainstay of treatment for retinal vein occlusions, for macular degeneration, and for swelling in the retina from diabetes is injections. We inject medicines in the eye, really because the side effects of taking those medicines orally or IV is much greater than injecting the medicines in the eye. Many of the injections we use were FDA approved in the kind of mid 2000s to early 2010s. There haven't been a lot of new injections on the market that I've adopted. There was a recent new approved medication in 2019, but shortly after its approval, the ophthalmology community learned that in about 4% of patients who received it had vasculitis or inflammation of the retinal blood vessels and could lose vision. So it's really important to me and to my partner Lisa Schocken here that we are using medications that are safe. There are a couple new medications that are on the horizon that are injectables. There was a recently approved medicine called ferricimab, and whereas some of the injections I use, I really have to dose them about every two months because the medicine wears off, just like if someone, I tell my patients that they take a towel and all it's going to wear off, the same with the injections. And this new medicine seems to be durable or have a lasting effect for about four months. But insurance companies may take a little while to accept it and to cover it. In addition, I think it's really critical that we're prescribing things that are safe for people. Another thing that was recently approved is a port delivery system for the same medications we inject. A lot of people, it's really hard to come in every month to get an injection. Some of our patients, especially the ones with diabetes, they work, they have childcare. It's a lot to ask someone to come in for appointment every month, especially with diabetes when they have other appointments for their kidney, for their foot. And if you can implant a little port, just like a chemotherapy port, and just refill it once or twice a year, that's something that has approved now for macular degeneration, not yet approved for diabetes. But again, I think we will adopt it if studies and post-approval data show that it's safe. So there's a lot on the horizon, but not a lot new yet that's really shovel-ready in that regard. The laser hasn't changed in many years, and that's one of the main stages of therapy for our diabetic patients to really prevent blindness when they come in with very severe disease. And surgery, vitrectomy is really the main kind of surgery that we do. The gel inside the eye is called the vitreous, and we repair renal detachments, macular holes, epiretinal membranes with vitrectomy surgery. We remove that vitreous, flatten the retina, or remove any scar tissue that's damaging its health. We use the smallest gauge vitrectomy available, so we're really the most minimally invasive surgery we can perform. But many of the technology hasn't changed a lot in the last 10 years, but at the same time, anytime there's a new technique coming out, macular holes, for instance, the techniques continue to evolve. And if someone has a large macular hole here at University of Maryland, they need an autologous retinal transplant or a graft of amniotic membrane, that's something we would do. Is that something that makes us unique in our approach to patient care? Is the fact that we have access to these various treatment options? Or is it in our research that's currently been done? Tell us what makes the University of Maryland eye program unique in that way. I think some of the things that I think make us excellent, I don't know if we're how unique we are, but I think makes it a place I would get on my own eye care, is first of all, from the time you walk in at the front desk, to our technicians, to our photographers, many of our photographers have been here for years, to all of our specialists working here, it's really a great team. And I have the luxury here of having cornea specialists and glaucoma specialists and neurophthalmology to deliver multidisciplinary care to patients. And that's something that I think is relatively unique. In addition to that, one of the nice things about being in a major academic center is for my UVitis patients, we have rheumatology is really easy to plug them in with. And just at the same time, our rheumatologist prescribes some drugs that need retinal surveillance, and we're happy to get them in and kind of provide that multidisciplinary care that people need. And I think one of the other things about many academic centers, and we're no different is that we're always staying up to date on the latest technologies, latest literature, and maybe not adopting it immediately because we don't want to be testing something that isn't, you know, doesn't have a proven track record on anyone, but really kind of using our judge and we have to be asked by our residents and fellows every day, you know, the hard questions about our treatments to make sure we are using something that's, that has really the best data supporting it. At what point should someone begin having regular eye exams to catch conditions such as the ones we've described today, you know, it sounds like some of them can remain silent, but they're still truly doing damage. So what do you suggest for patients at what age and how often should they have a comprehensive eye exam. I mean, you know, I think if someone's otherwise, you know, the American Academy of Ophthalmology has a position paper on how often people should have regular eye exams. I think if someone has any underlying medical conditions, if they have hypertension or diabetes, or anything else, they should at least be getting an exam once a year. And for our diabetics, especially a recommendation is once a year at a minimum. Type one, if you have a child, for instance, who's type one, and they're diagnosed at age 10, they're not going to have diabetic retinopathy at age 10. So the recommendation for that in that scenario is really to start annual visits five years after the diagnosis. But for anyone who's a type two diabetic, they really need an annual visit. I don't think, you know, I think otherwise, the data is not quite as good on how often, you know, someone should have an eye exam. I think if you haven't had one in a couple years, it's not a bad idea. And after you're 40, it's probably good to check in every year or two with your ophthalmologist. And because there are things that every once in a while someone will come in and they could even have a melanoma in their eye. That's very rare, but you know, occasionally we catch something that can be life changing for someone. And too often I see people that haven't seen an ophthalmologist in 10 years. And, you know, they have something going on that would be nice to have addressed to protected their vision five years prior. Is there anything else you think people should know that we haven't already covered today. Um, you know, one thing I just wanted to mention is we are in the very final stages of getting sort of all the red tape out of the way to start participating in a diabetic retinopathy clinical research network. The DRCR as it's called has orchestrated many really critical clinical trials that help inform the way ophthalmologists treat retinal conditions nationally. And one of the ones we're interested in that we we had a very great interest in is what's called protocol AF. And that's what the one we're currently trying to we're just getting the final approvals to start recruiting for. And what that trials looking at is patients with type one or two diabetes, who have pre existing mild to moderate diabetic retinopathy who have never been treated with injections. And what we what the study wants to look at is what happens and for these patients when they receive a drug called fenifibrates fenifibrates is a cholesterol medicine. And it's sort of fallen out of favor, and as a lot of primary care physicians have transitioned to giving people more of a drug class called statins like Lipitor or Crestor, but it fenifibrates a very safe cholesterol medication. And there were two fairly old studies that looked at patients who with diabetes, regardless, some had retinopathy, some had retinal damage and some did not. And there was a signal in those studies that patients who received fenifibrates tended to have need fewer injections or laser and their diabetic retinopathy seemed to not progress. And this is the first study really looking at patients who already have retinopathy, and they're sort of in that critical window where they may, if they get worse in the next couple years, they may start needing laser or injections or surgery. And the study I think is nice because if it works, if it helps prevent progression for the patients who we're able to enroll and maybe for our patients down the road, it might head off some of the need for treatments and more invasive things like surgery. And that would be a huge benefit to our patients, especially with the exponential rise of diabetes in our country. And that's something we're excited about. Simultaneously, we were wanting to participate in another one of their studies called genes and diabetic retinopathy. And I think my partner and I are also interested in some research that we're trying to kick off to try to improve some of the diabetic screening and for folks in our city and to work more with some community healthcare workers. Because, you know, diabetic retinopathy specifically is really unfortunately the number one cause of vision loss amongst working age people and working age people have some of the most barriers to care, you know, whether it's their job requirements or childcare. I'm interested in understanding what those barriers to care are and trying to eliminate them as much as possible because vision loss, blindness from diabetes is often preventable. For those of our viewers who are interested in scheduling an appointment with you or may have additional questions. Where do you see patients where your clinic locations and how can they get in touch with you and your team. So I see patients at 419 West Redwood Street and at the outpatient eye clinic at the Midtown Hospital. Dr. Shock at my partner also sees patients up in Owings Mills. And just calling our office at 667 214 1111 to make the schedule appointment. All right, great. That's all the time we have today. Thank you, Dr. Tabin slag for talking with us about UV I just been retinal condition. If you have any questions for our doc, you can leave them in the comments section below or send us a direct message and we'll get back to you within two business days. Thank you.