Meet Dr. Derzko-Dzulynsky, Canadian Uveitis Specialist

I recently had the opportunity to chat with Dr. Larissa Derzko-Dzulynsky, MD, FRCSC, a leading Uveitis Specialist in Canada. In her dual roles as Clinical Physician and Associate Professor in the University of Toronto Department of Ophthalmology and Vision Sciences (DOVS) she has earned the respect of physicians and patients across the country.

Josette Abruzzini: Dr. Derzko-Dzulynsky, thank you for joining us on our BUSNA blog! I'd like to start by asking how you became involved in diseases of the eye.

Dr. Derzko-Dzulynsky: During my medical studies I had the opportunity to do a number of electives, and was introduced to ophthalmology and later, diseases of the retina. The first mentor was Dr. Michael Howcroft, who was a retina and vitreous surgeon at the University of Toronto. Dr. Stephen Foster at Harvard University introduced me to uveitis and ocular inflammatory disease.

I never expected to become an ophthalmologist but once I started studying the eye I found it very interesting. I completed my fellowship training in uveitis with Dr. Jean Deschenes at McGill University.

Josette: What’s your best estimation of the number of Canadians who have birdshot uveitis?

Dr. Derzko-Dzulynsky: It’s hard to say. I’ve seen 20-30 birdshot patients over the years. We established a data base in the Toronto area which has grown to include the Province of Ontario. I’d say there are 40-50 in Ontario. We hope to expand the data base to include the whole country, but I’d guess there are a couple of hundred people in Canada with birdshot uveitis.

Josette: Thank you for serving as president of the Canadian Uveitis Society. Can you tell us about the recent Canadian Uveitis Survey?

Dr. Derzko-Dzulynsky: Information we gained from the survey helped us evaluate the different types of uveitis. We had seen a variety of approaches to the investigation of uveitis and this study enabled us to narrow our focus. After studying the data we were able to make recommendations for how to approach specific kinds of uveitis, such as birdshot. We established protocols for diagnosis and treatment which made our clinical practices more relevant.

Josette: How would this affect, for example, an ophthalmologist’s response to floaters? Many people have floaters but how does an ophthalmologist know to suspect birdshot?

Dr. Derzko-Dzulynsky: There are several factors they must consider, such as the number of floaters and the degree to which they affect vision and cause vitreous haze. Ophthalmologists must look at how diffuse they are, where they are located and how much they obstruct view to the retina and optic nerve.

In birdshot, it is also important for the ophthalmologist to do a thorough exam of the retina and choroid, looking for white/cream (birdshot) spots as well as inflammation of the retinal vessels and macular edema. The demographics of the patients are factors, as are additional symptoms such as difficulties with night driving and peripheral vision.

Josette: I understand that you’re also involved in research on spondylarthropathy. Since this is a disease in which bones in the vertebrae fuse together and cause pain, can you share a little about how this disease might be related to the eye?

Dr. Derzko-Dzulynsky: Spondylarthritis can be related to gut health and patients with this form of arthritis sometimes develop secondary or reactive diseases, such as uveitis. We don’t yet know everything about the gut-health connection but are paying close attention to this area. Researchers at the Oregon Health and Science University (Dr. Phoebe Lin) and at the N.I.H. (Dr. Rachel Caspi) have recently published very interesting studies on the gut-health connection.

Josette: Which areas of research do you think hold the most promise for controlling or curing birdshot?

Dr. Derzko-Dzulynsky:I’d have to say the gut-health connection shows promise. It seems likely that there’s a link. For example, we are trying to determine specifically which probiotics might help which uveitis diseases. In general, we are looking at which specific medications are most appropriate for each type of uveitis, so that we can use a more targeted approach for treating uveitis. This may include medical treatments for uveitis and potentially probiotics in the future.

Some universities, such as the University of Toronto, are developing academic practice models which will encourage more clinician scientists in ophthalmology . This is will certainly benefit uveitis research in Canada.

Josette: Do you think there’s interest in developing a bio bank in Canada like they have in the UK?

Dr. Derzko-Dzulynsky: The University of Toronto is setting up a cytokine lab. Once this is more established it’s hoped that something like a bio bank can help immunologists and geneticists better understand the common cytokine patterns or differences in various types of uveitis. This may also help to target potential therapies for uveitis in the future.

Josette: You’ve collaborated with other physicians and researchers and written white papers on immunosuppressives and uveitis. Could you give us a general sense of the types of findings you were able to make?

Dr. Derzko-Dzulynsky: We reviewed the success rates of various medications, such as Cellcept and a few biologics (mainly anti-TNF), on specific uveitis diseases. We then presented the information to the Canadian Government in order to secure funding for the most effective medications for uveitis patients. We have seen an increase in support, and as a result of our efforts, we’ve sped up the approval process for them getting the best treatments for our patients. In Canada, physicians must apply for medications on behalf of each patient. We helped to standardize that process.

Josette: Thank you for sharing with me today. One last question. Is there any particular person who inspired you to become a doctor?

Dr. Derzko-Dzulynsky: I’d have to say my mother. She was as OB-GYN, so I saw what it was like to live in the family of a physician. In a way I wanted to follow her lead, although I had no interest in becoming an OB-GYN. Thanks to my various mentors, I eventually found my own path.

Josette: And we are glad you did! Thank you for chatting with me today, and for all that you do to help uveitis patients across Canada!

Birdshot Uveitis Society of North America (BUSNA) is a volunteer organization comprised of persons diagnosed with Birdshot Uveitis. It provides information and support for North American patients and it raises funds for Birdshot Uveitis research. For more information, please visit our website.