Steroid Treatments Effective Against Eye Disease

Madison, Wisconsin - Two steroid treatments work equally well to save the vision of patients with uveitis, the fifth leading cause of vision loss in the United States, according to a new study from researchers at the University of Wisconsin School of Medicine and Public Health (SMPH) and their collaborators.

The University of Pennsylvania, the Mount Sinai School of Medicine, Johns Hopkins University, and 18 other centers in the United States, England and Australia all took part in the Multicenter Uveitis Steroid Treatment (MUST) Trial.

The trial was supported by the National Eye Institute (NEI) and looked at treating patients with either systemic anti-inflammatory medicine or with a time-release implant surgically placed inside the eye. They found patients' vision improved under either treatment over two years. The results are published online in the journal Ophthalmology.

"The MUST Trial results will help us deliver more individualized care to patients with uveitis," said Dr. Michael M. Altaweel, associate professor of ophthalmology and visual sciences at the UW School of Medicine and Public Health and one of the lead study organizers."

Altaweel says that although the visual acuity results were similar at two years for the two treatment strategies, the steroid implant achieved better control of inflammation which suggests that uveitis patients who are not experiencing optimal results from systemic therapy have a good chance of better outcomes with implant therapy. The implant generated more local side effects than systemic therapy. The trial demonstrated the safety and effectiveness of systemic therapy for many patients who can avoid the more invasive procedure.

Uveitis is the name for a group of inflammatory diseases that damage tissues in the eye. Severe forms of uveitis affect the middle and back parts of the eye. Often both eyes are affected. Uveitis strikes at an earlier age than many of the other leading causes of blindness, so can lead to years of disability or blindness.

The conventional treatment uses corticosteroid pills to suppress a patient's immune system, but the disease can recur when treatment is stopped, so long-term treatment often is needed. Physicians have been concerned about complications of long-term treatment such as increased blood pressure, diabetes, and osteoporosis.

In 2005, the United States Food and Drug Administration approved surgical implantation of Retisert an intraocular implant that slowly releases corticosteroid medication, as a treatment for severe forms of uveitis.

The MUST Trial compared the safety and efficacy of the Retisert implant and standard systemic treatment in patients with severe forms of uveitis. It followed the vision improvements and side effects of 255 patients at 21 medical centers in three countries. Trials of this type are sometimes called comparative effectiveness studies.

"With the knowledge that there are similar outcomes of the implant procedure and systemic therapy, we can determine the optimal treatment based on each patient's specific medical and lifestyle circumstances, as well as their potential response to, or tolerance of, a particular side effect,'' says Altaweel, who is co-director of the UW Fundus Photograph Reading Center.

The director of the National Eye Institute, Dr. Paul A. Sieving, says these trials are important to improve health care.

"These results demonstrate how large-scale comparative effectiveness studies can help doctors and patients make more informed treatment decisions and reduce blindness in the United States."