“It is a misconception that ophthalmology only involves the eye and vision. Many systemic diseases can be first diagnosed in the eye, and many systemic diseases can affect the eye.”

Shannath Merbs, MD, PhD, professor of ophthalmology & visual sciences at the University of Maryland, specializes in cosmetic and reconstructive procedures of the eyelids, orbit, and tear drainage system. Here, Dr. Merbs discusses complexity of the human eye and treatments for thyroid eye disease (TED).

What inspired you to become an ophthalmologist?
During medical school, I earned a PhD studying the chemical reactions in the eye that are responsible for color vision. Through that research, I was exposed to the beauty of the eye. Growing up, I was always good at making things and fixing things, and I realized as an ophthalmologist, I could combine my fix-it mentality and skills with my love of the eye.

What types of eye conditions do you treat?
I treat diseases involving the tissues of the eye, eyelid, and orbit in both adult and pediatric patients, including eyelid cancers, drooping eyelids, traumatic injuries, eyelash misdirection, and tearing conditions.

How does Thyroid Eye Disease affect the eyes?
TED mainly affects patients with hyperthyroidism and is an autoimmune condition where the eye muscles, eyelids, tear glands, and fat behind the eye become inflamed. The eyes can become teary and red, the eyelids can become swollen, and the eyes can bulge forward. Individuals with TED can also experience blurred or double vision.

Who is at risk of developing the condition?
Women are affected five times more often than men. Notably, smoking is linked to the development and worsening of TED, so anyone diagnosed with the condition should stop smoking. Radioactive iodine treatment for hyperthyroidism can also worsen TED.

When should patients be evaluated, and by whom?
Patients with eye symptoms and a history of thyroid disease should be evaluated by a specialist who can perform a complete eye exam, including orbital imaging if indicated. Ophthalmologists who specialize in oculoplastic surgery or neuro-ophthalmology most often manage patients with TED.

What are the current treatment options for those with the condition?
TED is typically divided into two phases. First is the active phase that usually lasts between six to 24 months and is characterized by inflammation. Treatment is focused on controlling the inflammation with steroids or low dose radiation to the orbits, if needed, to relieve the eye symptoms. An exciting new medication given intravenously has been shown to improve symptoms in more than half of TED patients in the acute phase.

In the second or stable phase, once the eye and eyelid positions have stabilized, treatment is typically surgical and is aimed at making the eyes less prominent and relieving double vision.

What can happen if a patient does not receive treatment?
Patients with bulging eyes that don’t close all the way are at risk of cornea infection and scarring. Rarely, the swelling of the orbital tissues can be so severe that the patient can lose vision because of pressure on the optic nerve.

Tell us about current vision research underway.
The current vision research at the University of Maryland is groundbreaking and has far reaching potential to improve vision. Our multiple, NIH-funded projects involve advanced imaging technologies, as well as new treatments for blinding diseases like glaucoma, ischemic optic neuropathy, retinopathy of prematurity, and trachoma.

When it comes to the eyes, what are common mistakes people make?
One of the biggest mistakes people make is sleeping with their contact lenses in. This significantly increases their risk of a corneal infection, which can lead to vision loss. Another is using a drop advertised to reduce redness. Continued use of these drops can lead to rebound redness and make the eyes even more red. Basic artificial tear drops do not have that risk.

What is the biggest misconception about the field of ophthalmology?
That it only involves the eye and vision. Many systemic diseases can be first diagnosed in the eye, and many systemic diseases can affect the eye, such as thyroid disease, diabetes and high blood pressure.

What continues to fascinate you about the human eye?
I continue to be amazed by the beauty and complexity of the eye and the process of vision. Although only about one inch in diameter, the eye is amazingly complex. The tissues are highly specialized, and the eye has to successfully communicate with the central nervous system in order for us to be able to see.

MEET THE EXPERT:

Shannath Merbs, MD, PhD, FACS
Board Certified Oculoplastic Surgeon

To schedule an appointment, call 667-214-1111.

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1. Steelers head coach Mike Tomlin tried to trip Jacoby Jones on a kickoff return: This was almost too bizarre to believe watching it live last November, but Steelers head coach Mike Tomlin actually stepped onto the field, trying to trip up Jacoby Jones. At the least very least, Tomlin was trying to force Jones back toward the middle of the field where another Steeler besides the head coach could make a tackle. The Steelers, of course, were losing at the time and you likely won’t see a shadier move by an NFL head coach on the sideline for the rest of your life. 

2. Steelers fans have the ugliest accents in the country, which is saying something if you’ve ever been to New Jersey: Don’t take our word for it, Pittsburgh actually won an “ugliest accent” tournament this month, knocking off Scranton, another Pennsylvania town, by the way, in the finals. This is why we can’t listen to the NFL Today—Pittsburgh-native, talking-head yinzers Dan Marino and Bill Cowher.

3. Bumblebee uniforms: It’s hard to put into words exactly how out of place the Steelers’s throwback, striped black-and-yellow uniforms look on a football field. Some have described Ben Roethlisberger as the world’s biggest bumblebee. Others compare them to old striped prison outfits. All we know is, we’ve seen enough of Roethlisberger and his buddies in those flesh colored pants.

4. Head ref admitted he handed the 2006 Super Bowl to the Steelers: Why this wasn’t reported more at the time, we don’t know. But in 2010, Super Bowl XL head official Bill Leavy admitted to blowing two key fourth quarter calls (not to mention a few others earlier in the game, like Roethlisberger’s TD sneak), saying he’ll go to his “grave wishing he’d done better.”

5. Steely McBeam: As one blogger put it, the mascot looks like the deranged offspring of Bill Cowher and Marge Simpson. A few years ago, one of the men who hired to play the mascot was arrestedon charges of D.U.I. He had a blood alcohol level of .166 after running a red light. Then McBeam, according to a report in the Pittsburgh Tribune-Review, complained the ground wasn’t level after failing the walk-and-turn test three times. Just like a Steeler to make excuses.

Oh, and McBeam was apparently unable to verify his correct address. Heinz Field, right McBeam?

6. Steroids:All those Super Bowl rings in the 1970s? Remember those Steeler linemen with the tight, short sleeves and huge guns. Hmmm. Among others, Steeler center Mike Webster, tackle Steve Furness, and guard Steve Courson admitted using steroids.

Jim Haslett, currently the defensive coordinator of the pro football team in Washington, admitted to experimenting with steroids as a Buffalo linebacker, and has said the use of those drugs among NFL players started with the Steelers.

7. Dirty players: Former Steelers’s wide receiver Hines Ward was voted the dirtiest player in the NFL in a 2009 poll of 296 players, receiving nearly double the vote of his closest peers, including former Steeler Joey Porter, who tied for second. Current Steeler Troy Polamalu (Reason No. 8 to hate the Pittsburgh Steelers) came in at No. 9. Several years ago, the NFL even adopted the “Hines Ward” rule, which made blindside blows to the head illegal after Ward broke the jaw of a Bengals linebacker with just such a tactic.

8. Troy Polamalu: Insures his hair with Lloyd’s of London.

9. Terry Bradshaw: Career passer rating: 70.9. Career completion percentage: 51.9 percent. Threw two more career touchdown passes than interceptions. Embarrassing singing and acting career, not to mention broadcast work, overshadow anything accomplished on the gridiron. Turnover-prone quarterback lucky enough to play on great defensive teams and buoyed by a strong running game.

10. Immaculate Reception: The whole of Steeler lore dates back to a single botched call in the 1972 AFC playoffs. The play is an infamous Bradshaw pass intended for Frenchy Fuqua—that deflected backwards as Fuqua was hit— and was scooped up by Franco Harris, who ran it in for a game-winning TD. Whether Franco actually scooped up the ball before it hit the ground remains unclear to this day. What isn’t in doubt, is that Fuqua admitted afterward in the locker room that the ball had hit him in the chest—which should’ve made Franco’s catch illegal—a violation of the former “double-touch” rule (two offensive teammates can’t touch a pass in succession) in place at the time.

So, basically, all the Steelers’s success and the Steeler Nation stuff is founded on a lie. And then performance-enhancing drugs, more gifts from the refs, dirty players, and a cheating head coach.

Go Ravens.

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