Toddler's Arthritis Almost Leads to Blindness

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At just 10 years old, Julia Fong of Los Angeles has already had to deal with serious medical problems more often associated with adults.

When she was 2, her parents, Milton and Eileen Fong, learned she suffered from juvenile idiopathic arthritis, which is also known as juvenile rheumatoid arthritis.

Just a year later, her parents got more disturbing news about Julia: Doctors diagnosed a condition called uveitis, which causes an inflammation of the middle layer of the eye. It can ultimately cause blindness.

In a story that aired on ABC affiliate KABC, Milton Fong called the possibility of his daughter's blindness "a parent's greatest nightmare."

The couple had no idea their daughter's eyesight was in jeopardy.

"Because you don't see any outward symptoms, you assume everything is OK, and that may not be the case," said Eileen Fong.

Autoimmune diseases such as rheumatoid arthritis are the most common causes of uveitis in children. Like Julia, children with uveitis often exhibit no symptoms of any eye disease. Adults with certain types of uveitis may experience a range of symptoms, including pain, redness and vision problems.

Even if the inflammation isn't too severe, the consequences can be.

"Children who have the mildest uveitis in some cases have the worst time of it," said Dr. C. Stephen Foster, president and CEO of the Massachusetts Eye Research and Surgery Institution in Cambridge. Foster had no involvement with Julia's case.

Uveitis Sometimes Difficult to Treat

According to the Ocular Immunology and Uveitis Foundation, uveitis is the third leading cause of blindness in the U.S., and 5 to 10 percent of cases occur in children younger than 16. At any given time, there are approximately 115,000 cases of pediatric uveitis nationwide, and about 2,250 new cases diagnosed every year.

"Worldwide, the leading cause of uveitis is infection," said Foster, who is a clinical professor of ophthalmology at Harvard Medical School in Cambridge.

There are different types of uveitis that vary depending on where the inflammation is in the eye, the cause and whether it's an acute or chronic condition. The type that Julia has tends to be chronic.

The condition can be treated, but it's vital to catch it early to limit the damage caused by the inflammation.

Experts say while treatments are available, they aren't always optimal.

"We aren't in love with our treatments," said Dr. Ralph Levinson, professor of clinical ophthalmology at the Jules Stein Eye Institute at UCLA in Los Angeles. Levinson was not involved in Julia's treatment.

"There are potential side effects and toxicities and they aren't always effective," Levinson said.

Depending on the type of uveitis a person has and how severe it is, medication options can vary. They include steroids that can be applied topically, injected or taken orally. Steroids, however, have a lot of side effects and can increase the risk of developing cataracts and eye infections.

Non-steroidal anti-inflammatory drugs (NSAIDs) used for arthritis and medicines that work on the immune system to keep inflammation down are other options.

"We estimate that any given drug is going to work in about 2/3 of the patients," said Levinson. "Most kids don't go blind, but unfortunately, some do."

Julia is taking antibody drugs that stimulate the immune system. Her parents hope the treatment will spare their daughter's vision.

Doctors urge parents of children with juvenile idiopathic arthritis to get their children's vision checked regularly.

"The reason we insist on kids being screened is that they don't have symptoms until they lose vision," said Levinson.