SARDs/IMR — Awareness Central

Veterinary Ophthalmologist Visit Check-List

Preparations to you must make before visiting the veterinary ophthalmologist for SARDs/IMR diagnosis.

If you are about to visit a veterinary ophthalmologist, please read this page so that you can be prepared.  We suggest that you print out this page to have as reference for your visit. 

You can download and print the PDF version of this page by using the download link below:

Download SARDSAwareness Veterinary Ophthalmologist Visit Checklist

Mental preparation

• Some veterinary ophthalmology clinics will try to prepare you to accept your dog’s blindness from the moment you walk through their doors.  From the clerk who checks you in, to the technician who takes the vitals, and ultimately the ophthalmologist who performs the examination, you will hear such comments as:
  • “Oh, blind dogs can live just as happy lives as seeing dogs.”
  • “SARDs is not painful, and you should be grateful he’s doesn’t have a tumor or cancer.”
  • “As long as he doesn’t fall off a cliff, he’ll live a healthy life.”

• Don’t settle for the above non-sense.  The mentality exhibited above is from people who are already resigned to doing nothing to help your pet maintain or regain its vision capability, all the while being eager to charge you hundreds of dollars for your veterinary visit and examinations.
   
• While it is true that there are cases when “nothing can be done”, whether it be due to lack of research, or treatment options, etc., no matter what the circumstances are, your veterinarian should treat you and your pet with respect, and have compassion for your pet’s condition.  Often, not only are we seeking treatment for our pets, but for our conscience as well.
   
• With SARDs/IMR, there is at experimental treatment as an option.  So, if you are willing to take a chance, your veterinarian should be helpful and provide as much service and guidance as possible. 
   
• Remember, you printed this out because you are willing to do whatever is in your power to help your dog maintain or regain its vision.  So, if possible, find a veterinary ophthalmologist who shares the same objective as you do.
   
• The problem with SARDs/IMR, however, is that quick action is crucial.  If left untreated, SARDs/IMR may cause your dog to go blind within a few days to a few weeks.  If you don’t act fast, any or all chance of recovery may be lost.
   
• You may not have the luxury of time to choose which ophthalmologist you visit.   Your regular veterinarian may just refer you to the closest specialist available.  So, if you end up with a veterinary ophthalmologist who isn’t as helpful as you would like, you must be in control of your situation to make the most of your visit.
   
• However, control first starts with education.  So educate yourself about SARDs/IMR.

Educational preparation:

• Read the SARDs/IMR Primer.
   
• Read the SARDs/IMR Diagnosis page.
   
• Download and print Dr. Grozdanic’s presentation file:  Sudden Acquired Retinal Degeneration Syndrome (SARDs) and Immune Mediated Retinitis (IMR)  — approach to diagnostic and therapeutic modalities available on the Documentation page.
   
• Take two copies of the presentation with you.
  • The first copy is for you. 
    • Make a binder, and keep it with you so that you have reference material to read and review.  Having information fresh in your mind will help you to have an intelligent discussion with your veterinary ophthalmologist while your dog is undergoing tests.
  • The second copy is for the veterinary ophthalmologist. 
    • Don’t be surprised if your specialist isn’t aware of any experimental treatment options for SARDs/IMR.  Veterinary ophthalmologists are human, too, and can’t always keep on top of the latest and greatest research and technological advancements.  Even specialists don’t know everything.  However, the good ones want to continue learning, even if it means getting information from their patient clients. 

• Memorize the following:
  • All SARDs patients will have a flat-line ERG.
  • Some IMR patients will also have a flat-line ERG.
  • So, how can you tell apart the SARDs patients with a flat-line ERG from the IMR patients with the same flat-line ERG?
    • This is where the Blue & Red Light Tests (Colorimetric Pupil Light Reflex) helps:
      •  SARDs patients will have….
        • Good pupil constriction response to the blue light.
        • No pupil constriction response to the red light.
      • IMR patients will have….
        • Good pupil constriction response to the blue light (same as SARDs patients).
        • Some / slow pupil constriction response to the red light.

Appointment pre-arrival preparation:

• Call ahead and confirm that….
  • The specialist has a working ERG machine. 
  • The specialist has a working Melan-100 Light Source for performing the Colorimetric Pupil Light Reflex (PLR) analysis — Blue / Red Light Test to observe pupil constriction behavior.
  • The specialist you’ve been scheduled to see will actually be present.

Pre-diagnosis considerations:

• Observe — How will the veterinary ophthalmologist determine if the condition is SARDs/IMR?
  • Will the vet just look into your dog’s eyes and guess?
  • Will the vet perform an electroretinogram (ERG)?
  • Will the vet perform a colorimetric pupil light reflex test (blue & red light test)
    • If so, observe if the vet first observes the eyes with white light.
      • If a white light is used prior to the use of blue and red lights, the pupils may not react in a manner consistent with SARDs/IMR diagnosis.
      • Just to be safe, ask that the veterinary ophthalmologist perform the blue and red light test before using any white lights for examination of the eye. 
      • The order of the examination will insure a more reliable result with the blue and red light test.
  • Will the vet perform a dim and bright light maze test to obtain objective evidence of loss of day and night time vision capability?
    • If no base-line is taken now, how will treatment results be measured later?
       

Post-diagnosis considerations:

• Your emotional state may be unpredictable. 
   
• Be prepared to tell the veterinary ophthalmologist to give you some time to compose yourself before he or she starts to bombard you with technical and medical jargon. 
   
• Now that you’ve composed yourself:
  • Is the diagnosis SARDs?
  • Is the diagnosis IMR)?
  • Is intravenous human immunoglobulin (IVIg) an option?
  • What are the health conditions that would preclude IVIg as a treatment option?
  • Is there a local IVIg treatment provider available?
    • What is the IVIg treatment provider’s name?
    • Where is the IVIg treatment provider located?
    • How many IVIg treatments has the provider performed?
    • Has the provider ever performed an intra-ocular treatment as well?
    • What are the survival rates?
    • Have their been any deaths due to anaphylactic shock?
    • What are the success rates?
  • If local IVIg treatment is not an option, what is the immediate course of treatment?
    • Steroids (Prednisone) and Antibiotics (Doxycycline)?
    • Will liver supporting medications be prescribed during the steroid treatment?
  • If steroid treatment begins to damage the organs, what are the options with IVIg treatment?

Experimental Treatment (IVIg) considerations:

There are many factors that should be considered before you decide to seek IVIg treatment.  These are some:

• How much will it cost?
• What are the chances of success?
• What are the risks and long term effects?

For us, we knew that IVIg only gave our dog a chance to maintain his vision.  We had no guarantees of success.  In fact, the odds were against us.  However, we were still hopeful and optimistic, and despite having no guarantees to the success of IVIg treatment, we knew that we were guaranteed the following:

We were guaranteed to be able to answer “Yes” to these questions:

• • “Did we do absolutely everything possible that we could to save his vision?”
  • “Did we feel that we took our dog to the person who we thought was best qualified to treat this condition?”

Peace of mind is always obtained by knowing that we’ve done our best.  Period.

We know that you will do what you believe is best for you and your pet.

We hope that our information has helped you in making that decision.

We wish you good luck and best wishes to a speedy recovery for your dog.