Eyeworld

N NOVEMBER 2019 | EYEWORLD | 25 Contact information Sen: senh@nei.nih.gov by Liz Hillman EyeWorld Editorial Co-Director Serological evidence of Borrel- ia burgdorferi (the bacteria that causes Lyme) was positive in 7.4% of patients (two out of 27). This, according to the researchers, means 323 people would need to be screened to detect a true case of Lyme- associated uveitis. Given the low prevalence of Lyme in the study cohort, as well as a lack of history that would suggest Lyme and the cost of screening (screening in this study ranged from $30,000– $65,000), the study authors do not suggest such routine screening for B. burgdorferi infection that could be causing the uveitis. According to the University of Illinois College of Medicine, conjunctivitis, uveitis, inflammation of the optic nerve, and sensitiv- ity to light and floaters are ocular symptoms that can be associated with Lyme disease. 2 This association, however, is rare and often occurs at later-stage disease. The two cases in the Caplash et al. study that had Lyme presented with intermediate uveitis and improved on antibiotics followed by immunomodulatory treatment. A s the weather cools, concern over tick season and the possibility of tick-borne disease transmis- sion, such as Lyme disease, drops. It's rare for Lyme disease to affect the eye, but despite this rarity, Hatice Nida Sen, MD, said screening for Lyme disease is routinely done for patients with ocular inflammatory disease who are in Lyme endemic areas. Dr. Sen and her colleagues wanted to find out if such screening was gratuitous. They con- ducted a review of 648 patients who were seen at the uveitis clinic at the National Eye Institute, 572 of whom lived in areas where Lyme was endemic. An eye exam was performed as well as a panel of laboratory testing for various condi- tions, including Lyme, regardless of other signs that could suggest these conditions. According to the paper, 27 patients from the group of 572 tested positive in a first-ti- er test for Lyme. 1 Two patients were positive on immunoblot analysis and diagnosed with Lyme-associated uveitis. This represented 0.31% of the study group. False positives were registered on the immunoblot tests for the remaining 25 individuals. Should you be screening for Lyme in uveitis patients? About the doctor Hatice Nida Sen, MD Director, Uveitis and Ocular Immunology Fellowship Program National Eye Institute Bethesda, Maryland Relevant financial interests Sen: None References 1. Caplash S, et al. Usefulness of routine Lyme screening in pa- tients with uveitis. Ophthalmology. 2019. Epub ahead of print. 2. Lyme disease and the eye. University of Illinois College of Medicine. chicago.medicine.uic. edu/departments/academic-de- partments/ophthalmology-vi- sual-sciences/our-department/ media-center/eye-facts/lyme-dis- ease/. Accessed July 9, 2019. state standards. For those AMD patients whose vision is lower but who obtain permission to continue to drive, it can be even more problem- atic. "Driving with vision worse than 20/40 can be challenging," she said. "Driving at night pres- ents the greatest difficulty among patients who did not meet the state requirements, but we found that daytime driving was also difficult." Overall, Dr. Patnaik views the issue as continuing to grow in scope, with macular degeneration becoming more common. "The prevalence is increasing, as is older patients wanting to maintain their independence at some level and continue driving," she said. "I think that it will become a bigger issue overall as we go forward." continued from page 24

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