HIV/AIDS, severe acute respiratory syndrome (SARS), H5N1 (avian flu), MRSA, Ebola virus, Zika virus, diabetes. What do these diseases and infections have in common? At one time or another, they have been called an outbreak (Ebola virus), an epidemic (SARS), or a pandemic (HIV/AIDS).

Now, upon hearing these words, perhaps your thoughts turn to scenes from 28 Days Later or Contagion. That is understandable. But let us temper that panic because most of these diseases and infections are, for the most part, out of the headlines now. That being said, let us check in on those with which we, as retina specialists, are most familiar (HIV/AIDS, Ebola virus, Zika virus, and diabetes) because of the ocular complications they can cause in our patients.

AIDS-related eye problems include HIV retinopathy and cytomegalovirus retinitis. According to the Centers for Disease Control and Prevention, since the epidemic began in the early 1980s, an estimated 1,210,835 people have been diagnosed with AIDS, and in 2014 alone roughly 20,896 people were diagnosed with the disease.1 Therefore, retina specialists still occasionally see patients with ocular complications of HIV/AIDS.

Before Zika virus, Ebola virus was in the news. The most recent and largest reported outbreak occurred in March 2014 and is still under investigation, having affected more than 28,652 individuals in multiple countries in West Africa.2 Eye-related concerns are rare, but they exist. To read about the individual, public, and global health implications of Ebola virus as it relates to the eye, check out the article “Ebola and the Eye” in our October 2015 issue by Jessica G. Shantha, MD, and colleagues (bit.ly/shantha2015).

Right now, a significant concern for all is the Zika virus.3 The current Zika virus epidemic began in Brazil, and the virus has now made its way to the United States, with several cases of locally transmitted disease reported in Florida. Ocular findings in newborns infected with the virus include chorioretinal scar and retinal pigmentary changes in the macular region. A timely and informative article in this issue by Camila V. Ventura, MD, and colleagues describes their observations at a clinic in Brazil and provides insights on the management of babies with ocular manifestations of Zika virus (page 54).

Diabetes is not an infectious disease, but in some areas of the developed world it has reached epidemic proportions, and it can have serious visual consequences. In fact, diabetic eye disease is now the fifth most common cause of blindness.4

Patients with these diseases and infections are generally not managed by only one type of physician. Enter the cover focus of this issue: integrated care. Two articles in this month’s cover focus involve the care of patients with diabetes. Philip Storey, MD, MPH, and Julia A. Haller, MD, explain how communication between ophthalmologists and primary care physicians can lead to better patient adherence to diabetic eye examination schedules, consequently leading to improved care (page 68). Rishi P. Singh, MD, and Ingrid U. Scott, MD, MPH, describe how electronic health records can help optimize outcomes in these patients (page 71).

News coverage of outbreaks, epidemics, and pandemics can be sensationalist, and we may sometimes feel like we are in a Billy Joel song. “AIDS, crack, Bernie Goetz, hypodermics on the shores, China’s under martial law, rock and roller Cola wars, I can’t take it anymore… .” But creating awareness is important, and it is the duty of health care professionals to face these entities and to do our part to help identify, prevent, and treat them. The sooner we can establish an effective plan to accomplish these goals for the outbreaks du jour, the better off we will all be. n

Allen C. Ho, MD,
Chief Medical Editor

Robert L. Avery, MD,
Associate Medical Editor

 

1. Centers for Disease Control and Prevention. HIV/AIDS. www.cdc.gov/hiv/statistics/overview/ataglance.html. June 2016. Accessed August 31, 2016.

2. Centers for Disease Control and Prevention. Ebola (Ebola Virus Disease). www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html. April 14, 2016. Accessed August 31, 2016.

3. Centers for Disease Control and Prevention. Zika Virus. www.cdc.gov/zika/about/overview.html. August 3, 2016. Accessed August 31, 2016.

4. Leasher JL, Bourne RR, Flaxman, SR, et al; on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study. Diabetes Care. 2016;39(9):1643-1649.