Black dots in vision lead to uveitis diagnosis

September 17th, 2018
A picture of Jamie Simnitt, who saw black spots in her vision and was diagnosed with uveitis.
Seeing black dots in her vision, Jamie Simnitt was diagnosed with uveitis and treated at UCHealth Sue Anschutz-Rodgers Eye Center.

Jamie Simnitt was a 20-year-old college student when the black dots appeared. She was waiting tables over the summer in Denver at the time. It was as if someone had taken a pepper shaker off a table and sprinkled it inside her eyes. She called her mom and told her: “I’m either losing my mind or something’s really wrong.”

Simnitt wasn’t losing her mind that day in 2012. What followed was a six-year odyssey to tame a disease she hadn’t known existed and fend off the blindness it threatened. Now, with help from a team of specialists at the UCHealth Sue Anschutz-Rodgers Eye Center on the Anschutz Medical Campus, Simnitt, now 26, can look forward to seeing the rest of her life unfold.

The disease is called uveitis. It affects an estimated 300,000 adults and 22,000 children in the United States alone. It can manifest in a few ways, the common theme being an attack by the body’s immune system on various parts of the eye. Sometimes uveitis is associated with diseases such as tuberculosis or AIDS; sometimes it’s tied to more common autoimmune disorders as ulcerative colitis or rheumatoid arthritis; and sometimes, as it was with Simnitt, the cause remains a mystery.

The effects of uveitis are not mysterious at all. The inflammation can detach a retina (which was causing those phantom pepper flakes); cloud the eye’s vitreous gel and cause cataracts; trigger glaucoma; and, left untreated, lead to blindness from these and other causes.

Enter the Eye Center

From that moment she wasn’t losing her mind until 2017, Simnitt lived in Idaho, where she went to college. Doctors in Boise and Salt Lake City treated increasingly alarming symptoms with procedures ranging from a vitrectomy in the left eye to tube shunt procedures on both eyes to release the pressure from glaucoma that sometimes had gotten so bad that it blotted out her vision.

By 2017, Simnitt recognized that it was time to return to Colorado, where she had grown up in Conifer. Given the precarious nature of her vision and the need for an array of specialists to care for her eyes, University of Utah ophthalmologists referred her to the UCHealth Eye Center. Dr. Alan Palestine, one of the few ophthalmologists who specializes in uveitis in the Rocky Mountain region, took the lead in her care.

Simnitt’s uveitis was continuing to damage her eyes: in addition to the glaucoma, her lenses were quickly clouding with cataracts, and there was retinal damage. These would require eye surgery. The top priority, though, was to address the underlying inflammation.

Jamie Simnitt in her hospital bed after surgery for uveitis.
After surgery at UCHealth’s University of Colorado Hospital, Jamie Simnitt regained much of her lost eyesight.

“You can’t operate on an eye that’s inflamed,” Palestine said.

He teamed up with with two UCHealth Eye Center colleagues: retina specialist Dr. Paula Pecen, who like Palestine is a uveitis expert, and cataract and glaucoma specialist Dr. Leo Seibold. Working with Simnitt, whose five years of experience with uveitis had made her an expert patient, they came up with a plan.

High five

First, they would use medications including a systemic immunosuppressant (mycophenolate) to get the inflammation under control. Then they would operate on one eye, then the other, to improve her vision.

For Simnitt, the surgeries couldn’t happen soon enough. By late 2017, her eyesight had declined to the point she couldn’t drive. Concern about exacerbating the glaucoma meant that an otherwise active woman who had managed a physical therapy clinic in Boise wasn’t allowed to lift anything remotely heavy or do more than short walks.

The first surgery, on her right eye, happened in June. It was a team effort, with Pecen cleaning up retina damage and doing a vitrectomy, followed by Seibold performing cataract surgery (in which the eye’s cloudy lens is replaced with an acrylic one). In August, it was the left eye’s turn. Seibold handled that one, revising an earlier glaucoma surgery and replacing the cloudy lens.

Simnitt drove herself to the Anschutz Medical Campus for her follow-up appointment with Seibold. Her left eye’s vision checked out normal. Seibold entered the exam room with a big smile and a hand raised for a high-five. Smack went their hands.

“There’s no better feeling as an eye surgeon than to be able to restore someone’s vision from the level she had – she’d told me she hadn’t driven a car since December – to the point that she drove herself to the appointment,” Seibold said later.

Long-term effort

The right eye still lags behind, but should be correctable once the earlier fixes settle in, Simnitt says. Combined, her vision is already at a point that she finds herself marveling at the sharpness and vividness of the world around her, one that her cataracts had blurred and dimmed. As she put it on her Instagram page, “I’m hoping to never forget how beautiful it all is and to not take for granted this gorgeous, vivid life.”

“For the first week or so, I’d put toothpaste on my toothbrush and I’d go, ‘Wow, it’s so bright!’ The stupidest little things were amazing to me,” she said.

Now the focus is on keeping Simnitt’s uveitis from meddling with her eyesight in the future. Palestine and Pecen follow about 750 patients with uveitis. It’s a long-term effort, Palestine said, and very patient-specific.

“This is a very complicated disease to manage,” he said. “She has three ophthalmologists for two eyes, she had multiple procedures done at the same time, and then there’s the need for ongoing treatment for inflammation to minimize the damage.”

With respect to inflammation caused by autoimmune disease, the UCHealth Eye Center team collaborates closely with UCHealth’s highly regarded rheumatology program. It’s led by a University of Colorado School of Medicine faculty team which, like that of Ophthalmology, has a long history of pioneering care and research. One example: in addition to his work with rheumatoid arthritis, scleroderma and lupus patients in his rheumatology clinic, Dr. Jason Kolfenbach sees uveitis patients at the Eye Center in a joint clinic with Palestine to help provide coordinated care for complex patients.

Bringing to bear expertise in the broader trends in autoimmune therapies pays off for patients, Palestine said. New drugs to treat inflammatory autoimmune disorders emerge every couple of years, adding to the complexity of the arsenal of possible approaches to tailor for a given uveitis case. That should work in Simnitt’s favor over time, he added.

Simnitt said she appreciates the skills and experience brought to bear to save her vision, the kindness of UCHealth staff, and, not least, that Palestine and colleagues saw beyond her set of uveitis-damaged eyes to consider her as “a whole person.”

“I’m incredibly blessed. A lot of people in the world don’t have access to the treatments I’ve had and they’ve gone blind,” she said. “I kind of feel like I have a new lease on life.”