Q&A with Dr. Grozdanic

June 4th, 2009

This page lists various Questions and Answers with Dr. Grozdanic, DVM, PhD, of Iowa State University’s Veterinary Clinical Sciences department.  These Q&A items were gathered through various verbal and written communications with Dr. Grozdanic.

If you have had some interesting dialog with Dr. Grozdanic that you feel others would find interesting or beneficial, please share them with us using this email link: info@sardsawareness.org

Questions & Answers

New:  When we spoke to our veterinary ophthalmologist, she mentioned that there is no central repository to report SARDs cases, so it is hard to determine just how many cases there are.   Also, we have seen, all over the Internet, that “an estimated 2000 – 4000 dogs are affected each year”, a statistic that seems to be prevalent.  Was this figure extrapolated and published by ISU?

There is no repository and I would like to create one on-line.

Three years ago I did ask the veterinary ophthalmology community to provide numbers on SARDs patients seen in their practices.

We had approximately a dozen responders which stated that 15-30 cases per year is the average number. At that time, we had been seeing in Iowa, close to 15 cases per year (that we recognized, however there were many more cases which we did not adequately diagnose at that time).

Considering that there are close to 270 veterinary ophthalmologists in the USA, we placed an estimate of 8-15 cases per year, per ophthalmologist, as an average number, which came to the total number of 2000-4000.

New: We’re under the belief that use of the Melan-100 units by regular vets and vet technicians would help screen SARDs/IMR months before the sudden loss of vision.   Having seen the matrix of test scenarios posted by Bio-med, it seems like a “no-brainer” that regular veterinarians should have these in their clinics to get an early warning alert of the onset of SARDs/IMR, or other conditions.

The use of the units seems to be pretty simple as well — almost as simple as using as thermometer.  Mind you, we’re not talking about diagnosis or treatment, but about screening.  It seems even a technician could proficiently use the unit to say, “Hey, you might want to take your dog to an ophthalmologist.”

What is your opinion on this topic?

This is absolutely correct.

We are already training our students in Iowa to use this type of testing as the fast screening tool for retina and optic nerve diseases.

The major problem is that body of literature on this technology is still very limited in human and particularly veterinary medicine. If you try to look for published articles on the topic, majority of human work came from the University of Iowa, and all veterinary work came from us.

We are in process of preparing several publications for the use of this technology in veterinary medicine, and we are also involved in an effort of human ophthalmology group with the goal of establishing red-blue testing principles for early diagnosis of auto-immune retinopathies in humans.

New: Because of the rarity, it seems that by the time pet owners are aware of SARDs/IMR, their dogs are already blind, or nearly blind.   Have you had any cases of people having screened SARDs early on, before the majority of vision is lost?  If so, have you treated those patients any differently than those already adversely affected?

We are currently the only institution (at least that I am aware), which is screening all patients with red-blue light testing.

Majority of ophthalmologists use white light only as a regular part of examination, which unfortunately, does not have diagnostic value for many early changes in the retina function.

So far we are following 5 patients, which have abnormal pupil light reflex responses with red-blue routines despite having normal vision and also developed other “typical” syndroms (weight gain, polyphagia, polyuria, excessive salivation, excessive tearing…).

Unfortunately in some dogs, these pupil abnormalities were result of the cancer (20% of IMR patients actually have cancer associated retinopathy).

In the majority of patients, we initiated treatment (steroids +/- intraocular IVIg), however, traditionally these are very difficult cases to manage, because the owner has to invest significant amount of time and resources to test and treat dogs, which by all means have normal vision.  This is the reason why we frequently make movies of pupil testing, just to show owner how normal and abnormal responses look.

How is the test for the presence of circulating anti-retinal auto-antibodies performed?  Is this a blood test, or is there a specialized test for this?

This test is done by specialized lab that we [Iowa State University] are collaborating with.   It is not commercially available and we usually have to wait for 4-6 weeks for results.  So at this time we use other parameters to predict the success of therapy, and track serum auto-antibodies.  We are in process of setting up our laboratory to do this type of testing in dogs, but it will take some time before that happens.

Considering that our dog’s current course of treatment is prednisone and doxycycline, if he shows favorable response to this treatment, should we still consider IVIg as the next form of treatment?

No.  If patients are responding to steroids and doxycycline, we do not pursue IVIg, but rather try to decrease dose of steroids to the minimal acceptable dose. I have several dogs which are receiving steroids twice weekly and still have functional vision.

We read on the ISU SARDs/IMR treatment FAQ that only one IVIg treatment can be given to a dog until canine immunoglobulins can be utilized for treatment.  How many years out do you think it is before you can start treating SARDs/IMR with canine immunoglobulins?  Or can SARDs/IMR patients receive more than one IVIg treatment now?  (This question was asked on March 19, 2009.)

If you had asked me two (2) or three (3) months ago, I would have said, “No [we cannot give more than one human IVIg treatment].”  However, over the past few months, we have successfully treated dogs two (2) and even three (3) times with IVIg treatment.

So, I would say now that it is possible [to treat SARDs/IMR dogs multiple times with IVIg]…

Our veterinarian informed us that her clinic is currently providing stem-cell treatment for canines with arthritis.  They are using stem-cells from adipose tissue to regenerate cartilage for dogs.  Can similar treatments be performed to regenerate retinal cells for SARDs/IMR dogs?

We are one of the few laboratories in the USA (and only laboratory in among veterinary schools in the world), which is actively pursuing stem cell based therapy for different forms of retinal and optic nerve degenerative diseases.

At this time, we were successful in terms of genetically modifying stem cells to produce different neuroprotective substances and this approach has promise for the treatment of glaucoma and retinal ischemic diseases so far.

There is no single line of evidence that any form of stem cell therapy can restore lost neurons in the retina, brain and spinal cord so far.

The promise of therapy is there, however we are probably decades away from these discoveries.

Now that Oscar is on a steady prednisone prescription, which is intended to suppress his auto-immune system, do we need to be concerned at all for his health regarding his ability to fight off infections?

Oscar’s condition [SARDs] is a different “beast” – it is an auto-immune disease where the continuous aggressive immune attacks on the eyes are the primary cause of retinal damage (something very similar to multiple sclerosis in the brain of human patients).

The major goal with treatment of these patients is to control the immune system, as much as possible, and prevent or slow down progression of disease.  There are huge amount of resources invested in treatment of such diseases in humans for decades now, and unfortunately we are making small steps forward (which is far better compared to no treatment option).

It is obvious, that by suppressing one arm of the immune system, we can generally suppress the parts of the immune system which combat viral and bacterial infections, but fortunately that is not happening very frequently, since these patients have hyper-reactive immune system to start with.

So I would say that possible risk of infections in Oscar, should be minimal at best.

With Oscar on the lesser dosage of prednisone [20mg of prednisone, twice a week], how frequent should his blood tests be from now on?

I do recommend that blood and urine analysis is performed 2-3 times per year in all SARDs and IMR patients, just to be sure that everything is OK and that we detect the earliest possible change related to the other organ issues.

Obviously monitoring of Oscar’s liver function will be the major thing in the future.

Behaviorally, Oscar is asking for more food, as he was doing prior to the SARDs diagnosis.  We found this puzzling, as we thought this should have subsided after the diagnosis and treatment.  Also, as the steroid dosage has been decreased, we are seeing his behaviors related to his allergies, such as rubbing his nose.

Increased appetite can be a result of systemic prednisone that he is getting, but may be a result of the SARDs itself.

If he shows signs of seasonal allergies at this time, addition of oral cyclosporine may help control that and we know that every outburst of seasonal allergies is related to problems with eyes as well.

Assuming that Oscar’s internal organs are all normal, do you think that a secondary treatment via the intravenous delivery would have any benefit at all?  Please let us know your thoughts on this.  If there a chance of some additional recovery, we would not object to visiting ISU’s clinic again.

Unfortunately, we know that his liver is not functioning normally and it would be way too much of the risk to pursue systemic IVIg administration (which can effectively shut down the liver which has pre-existing damage).

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