Published: July 17, 2008
Updated: Feb. 15, 2011
A drug-delivery device implanted in Lucy Thompson's eye gives her relief.
For Lucy Thompson, the uveitis came out of nowhere and quickly took over her life. For 10 years, despite all sorts of treatment, it refused to let up -- until a revolutionary steroid implant surgically inserted in her eye by doctors at the Duke Eye Center finally gave Thompson relief -- and a new lease on life.
Thompson’s battle with uveitis began in January 1994. Living in Cambridge, England, she was sitting at dinner one night when her left eye suddenly became very sensitive to light and painful to keep open. She looked in the mirror and noticed the pupil in that eye was dilated.
Thompson immediately went to the emergency room where she was diagnosed with uveitis, an inflammatory disease (actually a group of diseases) that can cause severe pain, light sensitivity, decreased vision, and sometimes blindness. An estimated 175,000 people in the United States are afflicted with uveitis; worldwide, that number could be as high as 800,000.
“I’d never heard of uveitis before,” she recalls, “but that was the beginning of a long haul.” Over the next decade, Thompson moved around a great deal, living in England, New York, Chapel Hill, N.C., Charleston, S.C., and finally Charlotte, N.C., where she now resides. In each place, she sought treatment, from eye drops and oral medications to steroid injections around the eye. Some treatments worked for a little while, but ultimately nothing stopped the frequent flare-ups, which played havoc with Thompson’s daily life.
“I was working in public relations and marketing at the time, and my eyes were so light-sensitive, I’d be working in front of my computer with my sunglasses on! When you have a flare-up, it’s painful, your vision decreases, everything’s blurry. It was a challenge just trying to get through the day. At one point, I considered taking a leave of absence from my job because even just having uveitis in one eye was a major quality of life issue.”
Finally, nearly six years ago, a physician in Boston suggested that Thompson try the Duke Eye Center where Glenn Jaffe, MD, professor of ophthalmology and director of the Duke Uveitis Clinic, was engaged in some innovative treatments for uveitis. By the time she came to her first appointment at Duke in October 2002, Thompson was at a low point, tired of what had been a long and frustrating battle.
Slowly but surely, things started to change for the better. For the first few years, she received several different medications in an effort to achieve long-lasting control of the inflammation. Jaffe and Duke rheumatologist Rex McCallum, MD, professor of medicine in the Division of Rheumatology and Immunology, who works in partnership with Jaffe in the multidisciplinary Duke Uveitis Clinic, started their new patient on an oral immunosuppressant medication called Methotrexate, then switched her to another immunosuppressant, Imuran, when the first didn’t quiet her flare-ups. But Thompson had a severe allergic reaction to the Imuran and ended up in the hospital for several days -- and the inflammation still didn’t subside.
“Lucy’s case was challenging because most of the usual things we try with other patients didn’t work for her, so we had to do things that were off the beaten path,” says McCallum, who managed the immunosuppressant regimen. “It was frustrating for all of us, her included, because we were trying hard to get things better controlled, and nothing worked very well for long.”
Jaffe and McCallum suggested trying one more immunosuppressant, Cellcept. As with the other medications, the doctors started Thompson on a standard dose, and then gradually increased it to try to keep the flare-ups in check. As with the other medications, Cellcept worked for a while then the flare-ups would return. When they neared the maximum dose of Cellcept, Jaffe added steroid injections around Thompson’s left eye -- and then eventually an injection in the eye.
To receive these treatments, Thompson drove from Charlotte to Durham one Friday every three to four months, accompanied by a rotating roster of close friends and family members who helped make the trek through snow, sleet -- anything not to miss an appointment. And if a severe flare-up struck, she’d have to make an extra, urgent trip.
Finally after more than a decade of treatment, including nearly two years at the Duke Eye Center, an injection in the eye quieted down the uveitis enough for Jaffe to insert an innovative implant into Thompson’s left eye that would gradually release anti-inflammatory steroid medication into the back of the eye for about three years
Because the new steroid implant delivers medication locally and for a prolonged period of time, there are no side effects in other parts of the body. Potentially, this device will relieve patients from oral or injected medications that may suppress the immune system or have other toxic effects. The implant also eliminates the need for repeated injections in or around the eye.
Jaffe was very familiar with the implant, which releases a steroid called fluocinolone acetonide, because he was involved in the preclinical development of the implant and was the lead investigator of the clinical trials to test the effectiveness and safety of this drug-delivery implant.
The results he had seen from multicenter studies were very promising, and he felt confident that the device could benefit Thompson. When he recommended it for Thompson, the U.S. Food and Drug Administration had not yet approved the implant (that happened in April 2005), which was developed by Control Delivery Systems and is licensed by Bausch & Lomb. Jaffe secured the FDA’s approval for this individual case, and in June 2004, he performed the 30-minute outpatient surgery on Thompson.
A few months after inserting the implant, Thompson experienced one common side effect of the implant: elevated pressure inside the eye. Duke glaucoma surgeon Leon Herndon, MD, associate professor of ophthalmology and medical director at the Duke Eye Center, installed a valve to reduce the pressure and, like most patients who have this follow-up surgery, Thompson’s left eye has been fine since the procedure.
“I love that implant!” Thompson cheers. “It changed everything around for me. Within a few weeks I was off the immunosuppressant drugs, and I haven’t had a flare-up in that eye since. My vision is back to normal, and I can wear contact lenses again. It’s been unbelievable.”
Jaffe and McCallum, too, were thrilled with her results. “I was very excited,” says Jaffe, “because this was the first time Lucy was free of those flare-ups, which had disrupted her life for so many years. As in most patients who’ve had the implant, we saw a dramatic resolution of the inflammation, and we were able to get her eye quiet for the first time.”
“The results were spectacular,” McCallum agrees. “The implant worked like a dream.”
Jaffe is currently participating in a clinical trial that compares treatment of uveitis with immunosuppressants and steroid injections to treatment with the implant, as well as testing the implant device to deliver medications for other eye conditions, such as swelling from diabetic macular edema and retinal vein occlusions in patients who have not been fully responsive to other types of treatment.
Thompson says her life has changed completely since she received the implant. “I was one of the unhappiest people you ever met when I walked into Duke Eye Center the first time. There are plenty of problems bigger than this in the world, but for me personally, the uveitis was affecting my family, my job, my independence, and my ability to get through the day as a normal person. And then we put the implant in, and I actually went back to school and changed careers. My life today is completely different.”
After earning a degree in nutrition, Thompson now works with two health care systems in Charlotte. She spends half the week working with cancer patients and the other half working on prevention and wellness.
“Having uveitis, I had a lot of time to think,” says Thompson. “When you have a flare-up, you can’t read or watch TV or go to movies because of the light and the vision problems, so you spend a lot of time thinking about what you’re doing with your life. And with this new career, I feel like I’m doing a little more to make a difference in the world, even if it’s one patient at a time.”
Thompson says she feels blessed that she’s now able to enjoy more of her favorite activities, from spending time with friends and family, to going on a mission trip to Russia and Lithuania with her church, to being “one of the world’s greatest aunts” to her nieces and nephews. Now she can enjoy outdoor activities that she had to avoid -- from biking to playing with her Springer Spaniel Bella on frequent trips to Wrightsville Beach, North Carolina.
In January 2007, Thompson got another scare when, for the first time, uveitis developed in her right eye. Fortunately, the flare-up was not as severe as that in the other eye, and Cellcept has kept it under control so far. At some point soon, the implant in her left eye will need to be replaced since the medicine typically runs out after three to five years.
A decision about the device’s replacement will be made by Jaffe, McCallum, and Thompson as a team, as have all previous decisions regarding her care at Duke. Should she need other treatment, the Duke Uveitis Clinic’s multidisciplinary approach extends to other Eye Center services, as evidenced by Thompson’s coordinated care and Herndon’s involvement in the follow-up glaucoma surgery.
Duke Eye Center’s approach was precisely what Thompson needed after years of struggling with uveitis. “I’m sure I’m not the easiest patient they have. I was very skeptical going in because I’d been through the wringer, and I asked lots of questions to try to follow what was going on. But I couldn’t be happier with the Duke doctors and the Eye Center staff -- they’re amazing. I feel so lucky that I’m able to do what I’m doing now, and I couldn’t be more pleased.”