At the Uveitis Clinic at the Casey Eye Institute, we use the following guiding principles in providing advice to patients:
- Everyone is different. While your physician may advise you that a certain medication is
generally safe or well tolerated, an individual's experience might vary. Similarly,
trying to determine prognosis or outcome is extremely difficult for an
individual patient. Therapy, consequently, is individually tailored to
a patient's needs. Designing the best-tolerated and most effective therapy
may require some trial and error because of the uniqueness of each patient.
- Treating inflammation is like dousing a fire. Medications are normally used
frequently at relatively high doses initially to try to reduce inflammation. However, many types
of inflammation resist, that is, the flames aren’t out completely. The
treatment will reduce damage from the inflammation. When the treatment
appears to reduce or eliminate the inflammation completely, the medication
is usually stopped gradually to ensure that the flames are indeed out.
- The least amount of medication is the best amount of medication. All medications have
potential toxicity. The optimal dosage of the medication is the least amount that
succeeds in controlling the inflammatory process.
- The punishment should fit the crime. Various medications have different degrees of
potential risk. In general, the aggressiveness or degree of risk that is appropriate
depends upon the severity of the inflammation and how much it impairs
the patient's daily living.
- Choosing the right therapy is like selecting what to eat from a restaurant menu. The
physician's responsibility is to describe options, their advantages, and their risks.
The best choice of therapy is very much a matter of personal preference
based on an understanding of the advantages and disadvantages for each
approach.
- It is not always possible to determine how successful therapy is. When you take a
medication and visual acuity doesn’t improve, it’s possible that vision may have
worsened significantly if the medication had not been taken. Conversely
if you take a medication and vision improves, it’s conceivable that the
improvement occurred spontaneously without the use of the medication.
- Immunosuppressive medications don’t work immediately. In general medications such as methotrexate, imuran, cyclosporine, and cytoxan take several weeks before you see improvement. Corticosteroid medications tend to work much faster in reducing the inflammatory response.