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May 17, 2019
Media Contact: Leigh DeLozier, 404-778-3711

Steven Yeh, MD, mohindo baby ebola eye exam
Retina specialist, Steven Yeh, MD, examines the eyes of Muhindo, a young Ebola survivor CREDIT: WHO/J. D. Kannah

Emory Eye Center, University of North Carolina and World Health Organization partner in work with Ebola survivors

(Atlanta) The ongoing Ebola virus disease (EVD) outbreak in eastern Democratic Republic of Congo (DRC) is the second largest outbreak in history, with the World Health Organization (WHO) reporting more than 1,600 cases and 1,060 deaths since August 2018.

Emory Eye Center physicians first became involved with EVD survivor care when uveitis specialists Steven Yeh, MD, and Jessica Shantha, MD, along with Emory Infectious Disease and CDC specialists, discovered live Ebola virus in the ocular fluid of a survivor weeks after blood tests showed no virus. This took place during the West African outbreak from 2014 to 2016.

Since that time, it has been shown that EVD survivors are at risk for systemic and ophthalmic sequelae including uveitis and retinal scarring. More than 20 percent of EVD survivors in West Africa developed uveitis and nearly 40 percent developed severe vision impairment or blindness.

Drs. Steven Yeh, Ian Crozier, Jessica Shantha and Jean-Claude Mwanza

 

Based on this work, the WHO Global Outbreak Alert and Response Network (GOARN) and the DRC Ministry of Health have partnered with ophthalmologists from the Emory Eye Center and University of North Carolina ophthalmologist Jean-Claude Mwanza, MD, MPH, PhD, to develop and implement an eye care program for EVD survivors in eastern DRC. The team from Emory, UNC, and WHO GOARN traveled to Beni, DRC, in March 2019 to share advanced diagnostic training and treatment protocols with DRC ophthalmologists, screen and treat EVD survivors for eye disease, and develop systems for vision care during the outbreak.

It was the first WHO GOARN deployment for eye care in an acute outbreak setting and is the earliest that EVD survivors have received eye exams during an outbreak.

Over 250 ebola survivors where seen.  Pictured here, Centrine, takes an eye test to check for any complications. CREDIT: WHO/J. D. Kannah

 

“Until now, any studies or treatments have been reactive,” says Dr. Shantha. “Having this opportunity to be proactive by seeing people earlier in the outbreak enabled us to enact some of the guidelines we had recommended for screening and care. This was very important because of the lack of equipment and personnel to screen patients thoroughly.”

The team screened more than 250 EVD survivors during their visit (over 80 percent of the EVD survivors to date; nearly one-third were infants and children). Thirty-four percent of those screened reported ocular symptoms during or after their EVD illness ranging from itchy eyes and tearing to light sensitivity and eye pain. Ebola-related uveitis has shown to be a complication that develops in survivors, with the risk increasing over time.

“Having the system in place allowed us to see 80 to 100 individuals per day,” Dr. Yeh says. “Each patient received a thorough, full dilation eye exam and education about symptoms that could be warning signs for uveitis. We’re now able to offer a different level of care because of what we and others have learned by working with EVD survivors in West Africa.”

The team also learned that the DRC survivors are willing to help others however they can.

“It was amazing to see survivors working to help others,” says Dr. Mwanza. “They are going into communities to educate people and are serving at the bedside of those who are sick. The stigma of being an Ebola survivor is still there, yet survivors feel a sense of duty to look after the others. They are a very tight community.”

Representatives from WHO/GOARN, the Emory Eye Center, and the University of North Carolina are committed to improving the ophthalmic health of EVD survivors and strengthening vision health systems within DRC and beyond. Next steps will include continued support through equipment, medications and supplies for an eye clinic for ongoing EVD screenings and survivor care in eastern DRC. In addition, there is an ongoing need for follow-up evaluations for pediatric survivors and others with complications.

Lessons learned through these initiatives will impact guidelines for future EVD survivor care and education for patients and caregivers, with the potential to be a model for treating other emerging infections that lead to eye disease that may lead to vision loss.

 


Emory Eye Center Research

From its inception in 1964, Emory Eye Center’s scientific research laboratory has been home to award-winning scientists who dedicate their lives to understanding catastrophic eye diseases that affect people worldwide. Their scientific discoveries have significantly contributed to treatments for patients with conditions such as eye cancer, hereditary cataracts, diabetic retinopathy, age-related macular degeneration, idiopathic intracranial hypertension, and more.  

 

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