Retina and uveitis specialists Jessica Shantha, MD, and Steven Yeh, MD, worked from 2015 to 2017 in West Africa, studying uveitis and ocular inflammation in survivors of Ebola virus disease (EVD).¹ Here, they discuss their work with Sruthi Arepalli, MD, editor of Retinal Physician’s Uveitis Corner column.

Q. What got you started in work specifically with Ebola?

A. At Emory in 2014 we became involved in the care of an EVD survivor who developed ocular symptoms. This patient developed an acute hypertensive anterior uveitis in his left eye that advanced to a panuveitis with hypotony and count-fingers vision. Our team discovered actively replicating Ebola virus as the cause of his uveitis. Through multiple interventions and cataract surgery, years later he has maintained 20/20 vision. It was this patient that piqued our interest in the patients in Africa. Given the thousands of EVD survivors in West Africa and Democratic Republic of the Congo, we continued to work to understand the ocular complications among EVD survivors across populations and across international borders.

Q. What have you found thus far in terms of ophthalmic complications in EVD survivors?

A. We found during the West African EVD outbreak that up to 20% of EVD survivors showed ocular complications, including uveitis. Nearly 40% of patients with uveitis had lost significant vision approaching World Health Organization criteria for blindness. Long-term sequelae of EVD survivorship include ophthalmic findings, as well as impact to mental health and the complex relationships between vision health and quality of life. These issues are particularly prominent in resource-limited settings such as West Africa.

Q. What are the next steps in care and capacity building?

A. The care for patients with complex disease extends beyond uveitis care. Basic eye-care and subspecialty-care needs require thoughtful and considered training, infrastructure, and systems. We’ve employed these approaches to conduct uveitis symposia in Sierra Leone, Liberia, and the Democratic Republic of the Congo. Through supply-chain management, equipment, and fundraising initiatives, we’ve been able to build the first vitreoretinal surgery program in Sierra Leone with our Ministry of Health and Sanitation partnering ophthalmologists. This vitreoretinal capacity building will open the door for access to surgical retina care for 8 million people in Sierra Leone and the surrounding region.

Q. What motivates you to continue the current work?

A. For myself [Dr. Shantha], it is advocacy and providing care for patients with uveitis — educating the ophthalmic health care workers in West Africa to better provide for patients with uveitis. Uveitis is a blinding disease, and it is very difficult to diagnosis and manage for a multitude of reasons that include inability to send laboratory investigations and limited treatment options. This motivates me to continue to work toward better solutions for the diagnosis and management of uveitis not only in the United States but abroad.

From my perspective [Dr. Yeh], one of our mentors, Dr. Paul Farmer, once said, “A moment of moral clarity is this: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.” I’ve learned from Paul and many partners that in a time when we have increasing innovation and the ability to treat vision-threatening and blinding disease, we still have access issues. Dr. Shantha also has commented previously that “being in Liberia and Sierra Leone makes you want to do more.” These principles and observations have led us to continue the current work for about 8 years since the West African Ebola outbreak.

Q. Can these lessons be applied to other outbreaks and future pandemic threats? What can we expect in the future?

A. Absolutely. Through Ebola, COVID-19, and the recent Monkeypox outbreak, we’ve learned that the eye not only offers a window to the soul but offers a unique perspective on emerging infectious disease and their consequences. There are a multitude of lessons learned both related to ophthalmic consequences of infectious diseases of outbreak significance, as well as the systems of care that we’ve all adapted to through the COVID-19 pandemic. Pandemic response and awareness will definitely be needed in the future.

Q. What guidance can you give to someone interested in pursuing or balancing international research?

A. [Dr. Shantha] There are many ways to do global work through education, teaching, research, and advocacy. For example, the American Academy of Ophthalmology (AAO) has multiple resources and supports the Global Ophthalmology Summit taking place September 8 to 10 in Atlanta, Georgia. Also, Over the last 8 years, our team has grown tremendously both in the United States and in West Africa. It is these strong partnerships and the emphasis on building local capacity that has sustained the work. Funding is also key; one has to be comfortable with applying for grants from multiple organizations to sustain the program.

[Dr. Yeh] I completely agree with all of Dr. Shantha’s comments. I would add that Dr. R.V. Paul Chan, professor and Panton Chair of Ophthalmology at the University of Illinois Chicago, has recently spearheaded an AAO Task Force for Global Ophthalmology to discuss the parameters and guidance related to research and education for global ophthalmic health. Dr. Shantha and Dr. Joshua Ehrlich from the University of Michigan recently coauthored a publication discussing the major principles related to responsible, ethical, and rigorous global ophthalmology research to answer contextually relevant research questions in partnership with local ministries of health.² Anyone interested in this career path should read their work in international ophthalmology clinics and consider how principles related to global ophthalmic research will guide and inform care for patients across the world. I believe these goals led by AAO underscore why many of us entered medicine initially. In addition, there are many initiatives that warrant vitreoretinal and uveitis subspecialty training. It’s an exciting time to be part of these efforts! RP

REFERENCES

1. Shantha JG, Crozier I, Yeh S. An update on ocular complications of Ebola virus disease. Curr Opin Ophthalmol. 2017;28(6):600-606. doi:10.1097/ICU.0000000000000426
2. Ehrlich JR, Shantha JG, Mathenge C, et al. Research partnerships and guidance in academic global ophthalmology. Int Ophthalmol Clin. 2023;63(1):15-24. doi:10.1097/IIO.0000000000000447