Tuesday, March 27, 2007

Uveitis and Eye Drops . . . Duration (Nov. 11, 2006)

So how long was Anna taking eye drops before the next treatment (Vioxx?)? What were or are her main trouble spots? Have her eyes been involved for awhile? It is uveitis that she gets in them? If so, how long before it would clear up and/or come back again?

Well, the treatment for the uveitis has changed with her pediatric ophthalmologists! We started out with one ophthalmologist (and we stayed with him for well over a year, but our inner nudgings finally got the better of us, and we gathered up our courage and got a second opinion and changed doctors---I really hate to do that, but after we did, both Anna and I said many times, "I'm SO glad we changed eye doctors!"). The first ophthalmologist (Dr. #1), would put Anna on mild steroid drops, called Fluerometholone (I can't guarantee that my spelling of some of these medications is right!!!), or FML drops. He would put her on drops and then make an appointment for two weeks to check on her eyes. One time, even with the drops, her eyes flared even more, so he had us giving her Pred Forte drops (steroid drops again, but more potent than FML drops). We would give these drops to her four times a day--around the clock--every six hours. As Anna's eyes were improving, he would have us taper down the drops. Her one eye was clear for a good amount of time.

When we switched eye doctors, (to Dr. #2), the new doctor had a different philosophy. Now he would try to talk me into putting Anna on Methotrexate (but the PRh has to prescribe that and monitor that, and at the time, the PRh told me that he felt that putting Anna on Methotrexate for mild uveitis and arthritis was like trying to shoot a tiny target with a canon. The PRh just wasn't ready to do that, and frankly, neither was I. Anna had a needle phobia for a very long time (and the majority of kids I knew of who were on Methotrexate ended up having to have it by injection because of stomach issues). Her eyes usually just had a trace of inflammation, but Dr. #2 would say that he just wanted to get Anna's eyes totally clear, even though a trace of inflammation wasn't anything for me to get really worried about. He prescribed FML drops, but only once or twice a day (depending on how much mild inflammation he saw), and we would see him about every 2-3 months. I think we saw him for about three or four years--last year, he moved to Cincinnati . . . I was SO sorry to see him go. I really grew to like him immensely, and Anna and I both missed him for a very long time after he left . . . it took a little while to get used to the new ophthalmologist, Dr. #3.

Anyway . . . . before Dr. #2 left the area, the PRh decided to put Anna on the Methotrexate, because Vioxx had been pulled, Anna was starting to experience some stiffness if she sat for 20 minutes or more, her toe was really puffy, and the PRh was concerned that the longer Anna was on eye drops, albeit mild ones, the greater the chance that she would develop cataracts. It was just time to take the next step, and because of all the issues, the PRh was at a point where he didn't hesitate. He just said, "It's time to put her on Methotrexate." Dr. #2 was very happy that we finally took this step, and he was able to taper the eye drops to the point where we didn't have to give any at all! I think Anna had been on eye drops of some sort for about four years at that point. So we went for several months on oral Methotrexate and no eye drops at all. Anna's joints and eyes were quiet for several months, so the PRh said, "Let's see if we can lower the dose of Methotrexate. If all goes well, maybe we can get her totally off medication before school starts!" (This was in the spring of 2005.) Well, lowering the dose of Methotrexate (just 2.5 milligrams) caused Anna's eyes to flare---at the very next appointment. Dr. #2 was a bit frustrated. Anna's joints mildly flared, also. I think that summer, we were in Hershey, PA (where both of Anna's doctors practice) at least every two weeks!

Dr. #2 recommended a colleague of his, who is in private practice, and we transferred to him (Dr. #3). Dr.#3, too, has a different treatment philosophy than Dr. #2. He doesn't fool around with the mild FML drops, but put Anna on the Pred Forte drops (twice a day, I believe). Anna's eyes were improving, but then her pressures began to rise to a worrisome level (Pred Forte drops can cause that). So in the 18 months that we've been seeing Dr. #3 (usually every six weeks, but we're now at every 8 weeks), we've increased the Methotrexate a few times, (when her pressures began to rise, he took her totally off the Pred Forte drops). Since the last increase (we're now up to 17.5 mg weekly), Anna's eyes have been steadily improving. They're not totally clear yet, but two weeks ago, Dr. #2 just saw an occasional cell, which is even less than a "trace." (With the uveitis, you start to learn this terminology!) He's greatly encouraged, but said we can't lower the Methotrexate dose yet. (Frankly, I'm very apprehensive about even trying to lower the dose in the very near future!).

I'm not sure if that story answers your specific questions about uveitis, but if you have other questions, feel free to ask!


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