Peter Andreas Netland, MD, PhD: How to Detect Uveitis

Peter Andreas Netland, MD, PhD, professor and chair of ophthalmology, University of Virginia:

It really is a clinical diagnosis, and so you know you just have to recognize there is some inflammatory component to the disease. Sometimes it can be very subtle, the classic one that we learn about in ophthalmology residency is Posner Schlossman. That can have very mild, mild, mild, inflammation and they can present with really high pressures initially so recognizing that's something that can respond to steroids and can clear up quite quickly, a patient presents the pressure of 50 or 60, but it's a relatively benign condition that can be treated easily with mild, mild steroid treatment.

So recognizing that's important, even though it's very, very subtle to pick up you know initially. So you really have to look carefully for those subtle signs of inflammation, try to recognize that and then once you know you have that patient, then recognizing the recurrences, trying to eliminate those recurrences, and so far that's important too. And that involves the diagnostic skill as well, in the sense that when they do come in, you have to be looking out for the levels of cell and flare and if they do have a little bit there but they're not symptomatic yet, you know do make every effort to try to suppress that so the chronic long-term care is almost as important for those kind of you know assessment and diagnostic skills as the initial evaluation.

So it's something that you know you have to really look, and the key thing there is look under high power for the cell and flare, and the other aspect about it is look for the other things that may give you some clues as to the underlying etiology. It always helps to know the underlying etiology for the inflammation, if you know that somebody has fuchs heterochromic iridocyclitis that can provide you great insight into what's going to happen to that person over time, and what they're going to respond to, and what they're not. And also with certain diseases, obviously if it's an infectious disease let's say syphilis, if you diagnose syphilis then you can then you can treat that with antibiotics, and once you treat the underlying etiology the uveitis goes away.

So I think you know, we'll have new things you know Ebola and Zika and other things that are causing inflammatory diseases so we'll have to deal with, so recognizing those underlying ideologies is really important too. So you're also looking for things that may give you some clues about that, but you know specifically to try to recognize things that are treatable, herpetic care to uveitis, another very important one to look for the signs that might go along with that because we want to pick that up, because again antiviral therapy you know can be very, very essential and helpful for those patients.

So yeah I think the diagnostic part of it is really important for not only the initial evaluation, help you figure out the etiology of the uveitis, hopefully, and also help you to manage the patient's long-term — both are important.