Every year The Arthritis Foundation® organizes numerous
events to raise awareness about arthritis and fund research to uncover a cure for the disease. What many people
don’t know is that some forms of arthritis can steal their eyesight,
especially when the disease isn’t managed through the collaborative
care of a rheumatologist and ophthalmologist.
According to Key-Whitman Eye Center’s
ophthalmologist Faisal Haq, M.D., “While most people eventually end up with osteoarthritis, which
results from normal wear and tear on the joints, rheumatoid arthritis
(RA) is a completely different disease. RA is an autoimmune disease where
the body’s own immune system produces antibodies that can work against
the body itself.
Dr. Haq explains the link between rheumatoid arthritis and vision loss.
Any autoimmune disease can affect the eyes, including psoriatic arthritis
and lupus, but Dr. Haq says rheumatoid arthritis,
which affects an estimated 1.5 million adults, is at the top of the list. With RA, antibodies are commonly known to
activate against and cause inflammation of the joints and skin, but antibodies
can also attack different parts of the eye.
Autoimmune diseases can cause dry eye, irritation and blindness
“When these antibodies are produced, they can attack the eye as well,
because the eye has a lot of collagen, in both the cornea and sclera.
So diseases like RA, which are collagen vascular diseases, can affect
the eyes for that reason,” says Dr. Haq.
While RA can cause a range of eye health issues, by far the most common
eye issue for sufferers of the disease is dry eye syndrome. Dr. Haq finds “Most people with RA have dry eye, we see that every day. If you have foreign body sensation in the eye,
fluctuating vision, blurred vision or grittiness, dry eye is likely to
In some cases, RA can lead to even more serious issues with the eyes. “Some
patients experience thinning of the cornea or corneal ulcers and in rare
cases even get a corneal perforation, which can be very serious. RA can
also cause scleritis, (inflammation of the white part of the eye), which
may result in serious sight threatening issues,” explains Dr. Haq.
Eye pain is a hallmark symptom of RA-related vision problems
People experiencing inflammation in the eye can experience light sensitivity
and blurred vision, but pain is an important symptom not to ignore. Says
Dr. Haq, “Often the pain associated with iritis (inflammation inside
of the eye) can be severe, and if you’re suffering from scleritis
(inflammation of the sclera) you can experience very severe pain. Eye
pain is the hallmark symptom for RA patients, along with light sensitivity
Inflammation inside of the eye (a condition called iritis) can result in
eye pressure going up, which
can lead to glaucoma, and iritis
may also cause cataracts to develop. “The steroid drops we use to treat iritis can also cause cataracts
and glaucoma. But that doesn’t mean we don’t treat them, it’s
better to treat the inflammation than not to treat it. We just take a
different approach to care when RA and other autoimmune diseases are involved,”
Dr. Haq says.
Managing the root cause of RA can help deter vision problems
Due to the direct connection between RA and vision issues, it’s not
uncommon for rheumatologists and eye doctors to work closely to diagnose,
monitor and manage patient care. In fact, Dr. Haq finds he collaborates
frequently with rheumatologists to help manage patients with autoimmune diseases.
Dr. Haq explains why the close collaboration between rheumatologist and
ophthalmologist is vital for the RA patient’s care.
According to Dr. Haq, “Treating the root cause of RA is extremely
important, and hydroxychloroquine (also known as Plaquenil) is a very
effective drug for managing RA. At the same time, since it can cause toxicity
in the macula, rheumatologists work closely with ophthalmologists to monitor
eye health in RA patients.
When a rheumatologist refers an RA patient who is taking Plaquenil to us,
we can perform sophisticated tests such as a macular OCT and visual field
tests that the rheumatologist isn’t equipped to perform. Since we
specialize in the treatment of eye diseases and conditions, the rheumatologist
relies on us to diagnose, monitor and treat vision issues and determine
whether they are related to RA or have occurred due to allergies or some
Coordinate care with BOTH your rheumatologist and ophthalmologist
If you suffer from RA or another autoimmune disease, Dr. Haq strongly recommends
you follow up with both your rheumatologist and ophthalmologist. “The
key takeaway here is to work closely with your rheumatologist to keep
your autoimmune disease controlled systemically. Then along with
annual eye health exams, you should contact both your rheumatologist and eye doctor immediately
if symptoms like pain, light sensitivity and redness occur,” says Dr. Haq.
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