February 16, 2018
2 min read

Identify autoimmune disease as early as possible

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The world-renowned British academician and rheumatologist, Verna Wright, MD, once quipped, “Clinicians may all too easily spend years writing ‘doing well’ in the notes of a patient who has become progressively crippled before their eyes.” This is sad but, unfortunately, true to a certain extent.

In an era in which insurance reimbursement necessitates volume, electronic health record vendors have conditioned us to become Pavlovian mouse clickers, and the federal government seems more interested in regulatory mandates than patient well-being, it is easy to lose sight of what’s really important – our patient. As optometrists, we are adept at diagnosing and treating all things ocular, but we need to look beyond the eye.

Michael D. DePaolis

As a publication, our editorial mission has always been about the eye and beyond. In fact, Primary Care Optometry News’ inaugural issue, published 22 years ago this month, featured an article on the optometrist’s role in identifying cytomegalovirus retinitis as a surrogate marker in HIV-AIDS. Through the years we’ve attempted to address ocular manifestations of systemic disease, primarily hypertension and diabetes, huge public health issues with identifiable ocular findings and well-defined treatment protocols, unlike autoimmune disease.

The U.S. National Library of Medicine reminds us there are over 80 different forms of autoimmune disease. With many sharing an ambiguous array of symptoms and similar lab findings, it’s understandable why they can be so stressful and frustrating, for both patient and doctor. In fact, the American Autoimmune Related Disease Association (aarda.org) estimates that an individual with autoimmune disease will likely see five doctors over a 4.6-year period before arriving at a working diagnosis. It is for precisely this reason we play such a critical role.

Given the eye’s vulnerability across the spectrum of autoimmune disease, we are oftentimes the first doctor to see these individuals. Granted, ocular findings associated with autoimmune disease – be it dry eye, anterior uveitis, vasculitis, etc – are, in and of themselves, ambiguous. However, more important than making a specific systemic diagnosis is identifying the link between ocular findings and underlying autoimmune disease. For instance, is it just contact lens-related dry eye or dry eye accompanied by dry mouth? Is it idiopathic anterior uveitis or related to the chronic lower back pain?

As I see it, the heroism is in bringing potential underlying autoimmune disease to light. Treat the ocular manifestations, order appropriate labs, communicate with the primary care physician and, where appropriate, bring in specialty services. Most importantly, do so as early in the game as we can.

In this month’s issue, our feature article, “Comanagement a priority in patients with autoimmune disease,” provides a compelling argument for optometry’s role. Those with a more insatiable appetite should visit our parent portal, healio.com. Here you can link with our allergy/immunology, endocrinology and rheumatology publications. It’s a great way to sign up for weekly newswires and remain current on all things autoimmune.

We all share a common goal of being patient focused. Occasionally this means more than just helping them see better ... it means helping them feel better.