• Ebola Survivors Facing a “Second Death"


    On Sunday, exactly 1 year after he was first examined by Emory Eye Center clinicians, Ebola virus survivor Ian Crozier, MD, called on ophthalmologists to see his case as much more than a dramatic tale of recovery from severe panuveitis and temporary blindness. “Survivors emerging from Ebola treatment units are now facing a whole set of unexpected sequelae, and the eye is perhaps the most urgent of these,” Dr. Crozier said.

    “Many survivors are developing uveitis that can be sight threatening. This, in a sense for some of them, will be a ‘second death’ of sorts. There’s an urgency to carefully evaluate these survivors, to provide care as we can, and to understand this disease.”

    Dr. Crozier spoke as part of a panel that included a physician who served alongside him treating Ebola patients in Africa, John Fankhauser, MD; the 2 Emory ophthalmologists who treated him, uveitis expert Steven Yeh, MD, and resident Jessica G. Shantha, MD; and Lowell A. Gess, MD, namesake for a Freetown, Sierra Leone, eye hospital that he worked to expand in response to the 2014-2015 Ebola outbreak in West Africa.

    Dr. Crozier’s experience with Ebola. Dr. Crozier was infected in Sierra Leone while caring for Ebola patients during the outbreak, which, according to the World Health Association (WHO), sickened more than 28,635 people and killed 11,314.

    He was airlifted to Atlanta in September 2014 and spent 10 weeks recovering from multiorgan system failure. Four weeks after he was discharged, however, his left eye developed acute, aggressive panuveitis; eventually, his visual acuity fell to 20/800, intraocular pressure plunged to 1 mm Hg, and aqueous sampling revealed that the eye was harboring live Ebola virus.

    Treatment was empirical—topical, oral, and periocular corticosteroids plus an experimental antiviral, favipiravir—and Dr. Crozier’s eye and vision gradually recovered over several weeks.

    But research to document ocular sequelae in Ebola survivors and determine how best to treat them is essential, Dr. Crozier said. “I can’t say whether any of those therapies did me good. I can’t say whether any of those therapies did me harm,” he said.

    A large-scale, imminent threat to vision in Africa. Dr. Yeh, who since has traveled to Africa to help train health care workers, said in an interview that Dr. Crozier’s case has led African health officials, agencies (such as WHO), and visiting ophthalmologists to work together to expand eye care, despite the lack of ophthalmic physicians in the region.

    There currently are only 2 ophthalmologists for 6 million people in Sierra Leone, he said. “So there are a number of midlevel providers who are also providing eye care to survivors. We’ve worked with them and written some treatment protocols that are currently being used in Sierra Leone, and also have been distributed throughout other countries in West Africa,” he said. “They’re having encouraging results from a therapeutic standpoint with the corticosteroid-based therapies we’ve recommended.”

    Dr. Crozier, who continues to practice in Africa, said such efforts could help prevent another humanitarian crisis from this Ebola outbreak. “It would be a tragedy for these survivors, having been through everything they’ve been through, to suddenly face going blind. There’s an immense need to try to prevent this ‘second death’ for them.”—Linda Roach

    Financial disclosures. Dr. Frazier has no financial disclosures.

    Dr. Yeh—Clearside: C; Santen: C.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.