Jack

When Jack, a 65-year old from Springfield, Ore., sought help for his irritated and burning eyes, he was told that his contact lenses may have become too tight. But even after he was fitted with larger lenses, his eye problems worsened. “I noticed that my eyes looked different and they were watering a lot,” said the small business owner. After more doctor visits and tests, Jack was diagnosed with thyroid eye disease (TED), an auto-immune disorder that attacks the tissues around the eyes, causing the muscles and fat to swell and become inflamed. For individuals like Jack who suffer from thyroid eye disease (TED), Casey Eye Institute’s Oculofacial Plastic and Reconstructive Surgery service offers the latest medical and surgical approaches to diagnose and treat the many problems that may emerge – from minor symptoms such as dry eye to more sight-threatening issues, such as protruding eyes, retracting eyelids and compression of the optic nerve. Jack was referred to Roger Dailey, M.D., who along with colleagues John Ng,
M.D., and Eric Steele, M.D., provides this unique care. TED most often occurs in people with Graves’ disease, a disorder caused by an overactive thyroid gland. “The source of the problem are antibodies, which target the eye tissue or the thyroid gland or both,” said Dr. Dailey, adding that it only affects a small percentage of people with thyroid disorders. Jack’s case, he said, was particularly severe.

Life Changing Care

During his two years of treatment beginning in 2012, Jack made dozens of trips to the Portland facility, where he underwent five surgical procedures to alleviate the significant discomfort and vision problems that plagued him. “My eyes looked so strange  because they bulged out,” said Jack, who was so embarrassed by his appearance he was reluctant to leave his house. He also was troubled by double vision caused by the swelling and scarring of his eye muscles. Not only did this cause him to frequently stumble and fall, but he was forced to give up driving. “My condition was interfering with every aspect of my life, including work,” he said.

To lessen the pressure and irritation around Jack’s eyes and create space in his eye socket, Dr. Dailey removed some of the bone surrounding his eyes. Five months later, Dr. Steele repaired the muscles on both eyes to correct his touble vision. This was followed by additional surgeries by Dr. Dailey to move his eyelids to a normal position. “Dr. Dailey and Dr. Steele changed my life,” said Jack. “I remember them in my prayers every night.” Although he still has occasional bouts of double vision, he is back to his normal activities, including driving.

Promising Research

While corrective surgeries for TED are the standard of care, medical science is closing in on developing less invasive and more effective ways to manage this disease. An experimental medication has shown to be very effective in diminishing the inflammation associated with TED, said Dr. Dailey, principal investigator at Casey of a phase 2 multi-center clinical trial of the study drug. Called RV001 (teprotumumab), the medication “switches off” the antibody signal that activates the damaging inflammation in the orbital tissues behind the eye. The Casey study site, which recruited the most participants in the phase 2 trial nationwide, has been invited to participate in an expanded, phase 3 study of RV001. “This is the first medical therapy to be tested in human clinical trials for thyroid eye disease, said Dr. Dailey. “We are very excited to part of this groundbreaking effort to help patients like Jack find relief from the pain and distress of what can be a debilitating condition.”