Eyeworld

EW NEWS & OPINION 25 June 2017 by Liz Hillman EyeWorld Staff Writer Narrated by Sir Elton John, educational film and its companion materials increase public awareness "S ight is arguably our most import- ant sense," Sir Elton John nar- rated in a recently produced documentary film. While this might be an obvious statement for ophthalmologists and other eyecare professionals whose daily business involves providing patients with the best opportunity to see as well as their circumstances might allow, to much of the popula- tion, sight is often taken for granted. And yet, as Sir Elton John continued, "no one is exempt" from ocular issues, "just growing old is a risk to our sight." SIGHT: The Story of Vision, a 1-hour long documentary with companion materials that include second-screen features, a detailed e-book, and planetarium program, was released on select PBS stations on World Sight Day, Oct. 13, 2016, and has had more than 1,300 broadcasts in the PBS system since. Award-winning documentary film draws attention to SIGHT The documentary has already been recognized with several awards. Filmmaker Kris Koenig, Koenig Films, Chico, California, said the idea for creating a comprehensive overview about the human eye was first conceived from his late wife, Anita Ingrao, who initially wanted to make a film about the history of spectacles, the blending of fashion and clinical eyecare. Mr. Koenig felt there was more to the story beyond glasses that had to be told. "I think there is a total lack of awareness. … the reality is no one has ever done a film like this; no one has ever done a broad overview of human vision," Mr. Koenig said. Mr. Koenig and Ms. Ingrao, who produced the Emmy Award-winning 10-hour PBS telecourse Astronomy: Observations and Theories and the award-winning 400 Years of the Telescope, began jotting down ideas for SIGHT on their drive home to northern California after the 2013 Los Angeles premier of Assaulted, their documentary that discussed civil rights and the Second Amend- ment. The pair had already been in contact with David Fleishman, MD, for his knowledge of histori- cal spectacles and website Antique Spectacles and Other Vision Aids, and by February 2014, a meeting of 20 advisory board members, who included ophthalmologists, optom- etrists, industry representatives, and others, took place. "Out of that meeting, we ham- mered out the four main threads [of the film], and that's the history, technology, medicine, and human- ity of human vision," Mr. Koenig said. The filmmakers traveled to South Africa, Australia, China, Vietnam, and other countries to document individuals' stories about their ocular conditions, to visit some of the world's leading eye hospi- tals, and to learn about some of the pioneering efforts for eye health in science, medicine, and technology. All the while, Ms. Ingrao was fight- ing stage 4 breast cancer, which she succumbed to in November 2014. Mr. Koenig put the film on hold for Other recent studies have shown that lower levels of vitamin D were associated with increased noninfec- tious anterior uveitis (though not a confirmed causal effect, the study authors acknowledged), and bacteria in the gut may be impacting ocular inflammation as well. 11,12 For the latter study, researchers found that gut bacteria appeared to activate T cells in a mouse model, which led to autoimmune uveitis. In contrast, mice without these gut bacteria saw reduced T cell activation and de- layed onset of uveitis. The research- ers hypothesize that bacteria in the gut produce a molecule that looks similar to a retinal protein that acti- vates these T cells, which can cross the blood-retinal barrier, and lead to this inflammation. Dr. Foster said more should be done in terms of furthering education on uveitis and proper treatment. "I think it all revolves around education and the comprehensive ophthalmologist and retina special- ist taking an interest in this subject matter, in particular about the med- ications that can not only induce steroid-free remission, but eventual- ly can reset the immune system so that patients can be in remission off any drug whatsoever for the rest of their lives," Dr. Foster said. EW References 1. The Ocular Immunology and Uveitis Foun- dation. Glossary of Terms, Incidence and Prev- alence of Uveitis. www.uveitis.org/patients/ education/glossary. Accessed April 10, 2017. 2. NIH study shows two treatments for uveitis equally effective. National Eye Institute. nei.nih.gov/news/statements/uveitis. Accessed April 10, 2017. 3. Thorne JE, et al. Prevalence of noninfectious uveitis in the United States: a claims-based analysis. JAMA Ophthalmol. 2016;134:1237– 45. 4. Nussenblatt RB. The natural history of uveitis. Int Ophthalmol. 1990;14:303–8. 5. Suttorp-Schulten MS, et al. The possible im- pact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80:844–48. 6. Uveitis—Ocular Inflammatory Disease. Massachusetts Eye Research and Surgery Institution. www.mersi.com/services/what- we-treat/uveitis-ocular-inflammatory-disease. Accessed April 10, 2017. 7. Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011;118:1916–26. 8. Becker MD, et al. Management of sight-threatening uveitis: new therapeutic options. Drugs. 2005;65:497–519. 9. Jabs DA, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommen- dations of an expert panel. Am J Ophthalmol. 2000;130:492–513. 10. Jaffe GJ, et al. Adalimumab in patients with active noninfectious uveitis. N Engl J Med. 2016;375:932–42. 11. Grotting LA, et al. Association of low vitamin D levels with noninfectious anterior uveitis. JAMA Ophthalmol. 2016 Dec 22. Epub ahead of print 12. Horai R, et al. Microbiota-dependent activation of an autoreactive T cell receptor provokes autoimmunity in an immunologically privileged site. Immunity. 2015;43:343–53. Editors' note: Dr. Foster has no finan- cial interests related to his comments. Contact information Foster: sfoster@mersi.com continued on page 26 Calling continued from page 24

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