Anterior uveitis can be an early indicator of Axial SpA, a systemic rheumatic disease. Timely diagnosis is key to managing Axial SpA and preventing long-term complications.The key acronym is SPINE:Symptoms starting slowlyPain in the lower backImproves with movementNight time wakingEarly onset (under 40)This video accompanied the fantastic audit by @livuni medical student Timothy Boey. We were incredibly proud to see Timothy present his findings at the prestigious Royal College of Ophthalmologists Annual Congress in Liverpool!Myself and other Ophthalmology colleagues in the country are working to raise awareness and enhance patient care pathways. Early detection can make a world of difference #shorts #ophthalmology #rheumatology

🔎Eye Spy: Unveiling Systemic Secrets

The eyes aren't just windows to the soul, they're a window to our overall health! Thanks to #Optometry Today for inviting me as a Medical Ophthalmologist to talk about #Oculomics - the revolutionary field using eye exams to detect systemic diseases decades early.

Optometrists are key to this, with their unique skills and patient access.

Learn how eye tests can reveal signs of conditions like cardiovascular disease, and how AI is accelerating research in this exciting new era of healthcare:

https://www.aop.org.uk/ot/videos/2024/12/10/oculomics-a-window-to-overall-health

Up, up and away – clearing the clouds…

Bringing clarity to Uveitis Diagnosis with AI:

It’s a pleasure to share this joint Nature EYE editorial with Peter Thomas in which we survey how artificial neural networks (ANNs) might be used to enhance the diagnosis of uveitis, a significant cause of vision loss worldwide:

https://www.nature.com/articles/s41433-024-03588-y

The Challenge: Uveitis, an intraocular inflammatory condition, presents a complex diagnostic puzzle due to its myriad causes and varied clinical presentations. Traditional diagnostic methods, often reliant on subjective clinical judgment, can lead to delays and inaccuracies.

Collaboration: The partnership of data scientists and clinicians holds the key to unlocking the full potential of AI and machine learning in ophthalmology. We review the state of play to accompany this paper from Jacquot et al (https://www.nature.com/articles/s41433-024-03530-2) who have used a multilayer perceptron (MLP) model, to predict the underlying causes of uveitis. Their model, trained on a dataset of 375 patients, demonstrated impressive accuracy, matching expert opinion in 77.8% of cases and achieving 93% accuracy within the top two probable diagnoses.

We’re striving towards a more objective and standardised approach to uveitis diagnosis, and these models can help – particularly with diagnostic decision support systems (DDSS) which can complement (but not replace) clinicians – hopefully streamlining the clinical workflow and reducing diagnostic errors. The DDSS in the paper we feature focuses on diagnostically challenging cases (ideally providing valuable support where it's most needed…)

While challenges remain in terms of geographic transferability, under-representation of rare aetiologies, and integration into electronic medical records, the potential of this technology is undeniable. Future research will focus on validating these tools across diverse populations and refining them for seamless integration into clinical practice.

Repost of the NASS Rheum for Improvement Podcast from last year - hosted by Lucy Davies and featuring Rheumatology Professor Karl Gaffney and myself as we discussed acute anterior uveitis 👁️(inflammation in the front of the eye) in the context of Axial SpA (aka AS or Ankylosing Spondylitis) - a type of inflammatory arthritis primarily affecting the spine & sacroiliac joints and linked to HLAB27 ‣

40% of these patients could have spondyloarthritis, including AS, and in this pod we discuss these links, discover how ophthalmologists can identify AS in their patients and the vital role of collaboration between ophthalmology and rheumatology.

There is still an 8.5 year diagnostic delay in AS, and collaboration amongst healthcare professionals is critical to streamline the diagnostic process and to improve the overall quality of life for those living with this condition.

Useful Resources:

➤ Act on Axial SpA: campaign https://actonaxialspa.com

➤ Recognising axial SpA in Ophth: https://actonaxialspa.com/recognising-axial-spa-in-ophthalmology/

➤ Papers of interest: https://actonaxialspa.com/ophthalmology/

➤ Toolkit for HCPs: https://actonaxialspa.com/hcp-toolkit/

➤ Helpful vids: https://cloud.info.ucb.com/NASS_all_content & https://cloud.info.ucb.com/NASS_all_content/full_video_January

➤ For patients: Guide to #uveitis in AS covering diagnosis & managementhttps://nass.co.uk/resource/nass-guide-to-uveitis/

➤ Patient Information Leaflet: https://nass.co.uk/wp-content/uploads/resources/Uveitis-Guide.pdf

NotebookLM can be a game-changing tool for learning... It's like having a virtual research assistant that can analyze documents, summarize key facts, explain complex ideas, and brainstorm new connections – all based on your uploaded sources. I think the potential is for turning a dense research paper or a collection of lecture notes into a digestible podcast. NotebookLM's "Audio Overview" feature does that, generating engaging discussions with AI hosts who summarize the material and highlight important connections. I've applied this to my History of Uveitis editorial here: https://www.nature.com/articles/s41433-024-03519-x Have you used this tool yet - what do you think? I think there's a lot of possibilities for certain learning styles and especially learning on the go, making even the most challenging subjects more accessible and engaging.

Full Behçet's Uveitis Video here: https://youtu.be/KHlZ7aElCJU

Medicine, while grounded in evidence, has historically been shaped by traditions and assumptions that sometimes do not withstand scrutiny in light of new data, technologies, or even insights"You can't have XYZ in this disease".

Questioning entrenched beliefs encourages critical thinking and a willingness to adapt practices based on emerging evidence, and we need to keep fostering a culture that values curiosity and respectful debate to ensure that patient care remains dynamic, equitable, and responsive to the ever-evolving landscape of healthcare knowledge.

Behcet's Uveitis tends to affect either the front of the eye (anterior uveitis) or the back (posterior uveitis). It tends not to cause intermediate uveitis - wherein inflammatory cells can be seen suspended within the vitreous.

These cells are appreciated similar to that of anterior chamber cells but with the slit lamp focused behind the lens. Larger inflammatory collections known as "snowballs" may also be identified within the vitreous. They aren't classically seen in Behçet's Disease but "never say never"... Isolated intermediate uveitis, albeit rare, can occur - (and more common in early rather than late disease)

https://behcetsuk.org/conference/2024conf/

A talk delivered at the Behçet's UK 2024 conference entitled "Behçet's and the Eye" https://behcetsuk.org/conference/2024conf/ Dr Ghadiri explores thecomplex relationship between Behçet's disease and ocular health. The presentation highlighted the systemic nature of Behçet's disease, with a focus on how it manifests in the eyes, particularly in the form of uveitis and retinal vasculitis. Dr. Ghadiri discussed the challenges of early diagnosis, the importance of multidisciplinary care, and the latest advancements in treatment strategies to prevent vision loss and preserve quality of life. The talk emphasized the critical role of ongoing research and patient-centered approaches in managing this rare but impactful condition.

Article here: https://www.nature.com/articles/s41433-024-03519-x

This editorial in EYE outlines the captivating history of Uveitis (inflammation in the eye), the understanding and management of which having evolved alongside advancements in medicine.

From early descriptions in ancient Egyptian papyri, to the primogenitors of modern medicine laying the foundation of the link between eye inflammation to systemic disease, to innovations of the 19th and 20th century – the eras have seen a narrative of progress, collaboration and innovation as we strive to understand and treat this complex disease.

Pivotal breakthroughs in immunology, imaging, and biologic therapies that transformed uveitis treatment, and who knows what the future holds for precision medicine int the management of ocular inflammation.

Here’s to the journey ahead…