Inside The Emory Eye Center’s Fight Against Ebola-Related Eye Disease
Ruby Katz | Aug. 2026
We sat down with Emory professors Jessica Shantha, MD and Steven Yeh, MD to discuss the spread of Ebola, how it may live on as an acute inflammation in your eyes (otherwise known as Uveitis) and their journey to providing treatment with long-lasting impact.
The 2013-2016 Ebola epidemic in West Africa was the most widespread outbreak in the disease’s history, causing disruption to the region in multiple countries including Guinea, Liberia and Sierra Leone. At the time of the outbreak, Emory physicians and researchers Dr. Steven Yeh and Dr. Jessica Shantha discovered a concerning link between Ebola survivorship and vision loss. Their journey down the road to caring for Ebola survivors with uveitis led to multiple projects bringing healthcare systems, health education and ultimately local capability to the region.
And it all started with one patient seeking care at the Emory Eye Center, Dr. Ian Crozier, the index patient.
After developing Ebola during his work caring for patients in West Africa in 2014, Dr. Ian Crozier developed severe, life-threatening illness from Ebola. Crozier was repatriated to the US, was treated at Emory University and very thankfully recovered from the viral disease. Unfortunately, three months after his recovery, Dr. Crozier began to experience increasing vision loss and developed a severe sight-threatening inflammatory process, or uveitis.
Doctors Shantha and Yeh observed acute eye redness, light sensitivity and eye pain – coming to diagnose Crozier with acute hypertensive anterior uveitis. The inflammation worsened, and his vision declined, so the decision was made to sample fluid from the eye to assess it for Ebola virus.
Ebola Outbreak Map, Centers for Disease Control and Prevention (CDC)
Ebola Outbreak Map, Centers for Disease Control and Prevention (CDC)
“Whenever somebody comes in with uveitis, especially when there's high eye pressure, there's always a risk that it's due to virus, and we know that from other viruses such as herpes virus, rubella virus, varicella zoster virus. So, it was a consideration at the time that Ebola virus could be in the eye, and that's why we sent the specimen to the laboratory with the appropriate biosafety level for precautions.” – Steven Yeh, MD.
In collaboration with the Emory University Serious Communicable Diseases Program and the CDC, polymerase chain reaction testing was performed. The test was positive and additional viral culture was also positive for Ebola.
“This was a very unique observation, a new discovery. He had survived Ebola, and while the virus was negative in his blood, it was positive in his eye.” – Jessica Shantha, MD. “After seeing how severe his inflammation was and watching him temporarily lose vision, we became very curious. Dr. Yeh, myself, and the patient, we started asking: if this is happening here, what’s happening to patients in West Africa?”
It really changed the paradigm around Ebola, as eye disease can be severe and acute after severe systemic illness. Patients develop Ebola and after survival, they hope to move on with their lives. But eye complications are really one of many systemic sequelae.
These observations led to trips in West Africa to understand the disease further, multiple grant applications, and projects stemming from those observations. Ultimately, these efforts translated into a sustained service of care in each location, taking research insights and using them to create a protocol for testing, diagnosis, and treatment in Sierra Leone and abroad. The results have been an increase in ophthalmologic care in these regions, a decrease in stigma, and an increase in clinic access and training.
Would you consider Dr. Ian Crozier’s case to be the catalyst in terms of realizing Ebola could live in the eye?
Yeh: Yes, he was the index patient. Dr. Crozier’s efforts, along with other health care workers involved in the fight against Ebola, were heroic. As one of the United States healthcare workers who developed severe, life-threatening illness from Ebola, Crozier was repatriated, and ultimately during his Ebola survivorship developed a severe sight-threatening inflammatory process, or uveitis.
It really changed the paradigm of how we think about Ebola, as eye disease can be severe and acute after severe systemic illness. Patients develop Ebola and after survival, they hope to move on with their lives. But eye complications are really one of many systemic sequelae. It’s very relevant, especially since there's currently an ongoing Ebola outbreak right now in the Eastern Democratic Republic of Congo, which is very concerning.
Can you walk me through that initial test that revealed Ebola in the eye? I’m sure that came as a kind of shock.
Yeh: Much of the concern from the patient's perspective was ‘how do we clear the virus?’ But also, is there the potential that virus can be persistent in other patients? Especially given the magnitude of the West African outbreak. In subsequent studies of patients at about a year and a half to three years out after surviving Ebola virus, when we looked at aqueous humor, Ebola virus testing was negative from the aqueous humor. These tests were performed given the increasing number of Ebola survivors who needed cataract surgery and the potential risk to ophthalmologists and eye care providers.
Dr. Shantha and Dr. Yeh worked closely with multiple teams at ELWA Hospital to assess aqueous humor for Ebola virus persistence prior to vision-restorative surgery for cataract, a complication of untreated uveitis in many Ebola virus disease survivors.
Dr. Shantha and Dr. Yeh worked closely with multiple teams at ELWA Hospital to assess aqueous humor for Ebola virus persistence prior to vision-restorative surgery for cataract, a complication of untreated uveitis in many Ebola virus disease survivors.
Does the Ebola Vaccine have a direct connection to Uveitis?
Shantha: The vaccine is intended to prevent Ebola infection during outbreaks. We don’t know its direct effect on uveitis. Questions remain about whether vaccinated individuals who are exposed to Ebola develop uveitis, but no study has addressed that. The more significant aspect of this story is that a vaccine was developed because of the scale of the outbreaks. There are still outbreaks occurring, and the development of an Ebola vaccine has been monumental for both patients and healthcare providers in affected regions.
Dr. Yeh assesses an Ebola virus disease survivor for potential ocular complications in an office in the city of Makeni, Sierra Leone.
Dr. Yeh assesses an Ebola virus disease survivor for potential ocular complications in an office in the city of Makeni, Sierra Leone.
When someone has Ebola now, do physicians typically check the eye after they survive it?
Yeh: Right now, in terms of the programs that have been carried out in both Sierra Leone and Liberia, we are looking at patients specifically identified as needing eye surgery. There were over 70 Ebola survivors that we assessed to ensure that their aqueous humor was clear of virus before the local cataract surgeons proceeded with cataract surgery.
And it was reassuring to know that at least in the just over 70 patients that we assessed that the cataract surgery could proceed with appropriate surgical precautions with some measure of reassurance to the health care providers.
From your studies, have you found a commonality in the type of Uveitis that presents in Ebola survivors?
Yeh: Yes, there's a very high prevalence of disease both in Liberia and in Sierra Leone. 25 and even up to 33% of Ebola survivors in West Africa seem to develop uveitis.
This may seem obvious, but why West Africa? Is that because Ebola is most prevalent there?
Shantha: West Africa experienced the largest Ebola outbreak in history during 2014–2015. Previous outbreaks had been more isolated, but advances in transportation and communication allowed this outbreak to spread much more widely. Physicians caring for patients were also transported internationally for treatment, making it a global concern.
That was where the greatest number of patients were located and where we established collaborations and partnerships, particularly in Sierra Leone. Being on the ground there allowed us to directly evaluate patients and conduct the research.
Dr. Shantha and a group of Sierra Leone ophthalmologists and eye care nurses evaluate patients who have survived Lassa fever, a hemorrhagic fever endemic to West Africa.
Dr. Shantha and a group of Sierra Leone ophthalmologists and eye care nurses evaluate patients who have survived Lassa fever, a hemorrhagic fever endemic to West Africa.
You have been treating survivors in this area for years now, do you believe the barriers to their treatment remain the same even now?
Yeh: Yes, I would say there is still a mix of stigma and issues that survivors still face. Because many of the patients who we saw in the wake of the West African Ebola outbreak had very limited access to eye care, I think that was one of the considerations that brings us back to just thinking about Emory University and the University of Nebraska Medicine Medical Center's collaborative efforts. We acknowledge that there are healthcare disparities that we've been able to raise funds and awareness for.
We have been able to develop vision healthcare infrastructure to not only care for Ebola survivors and understand the disease but also provide advanced ophthalmic care for other diseases like retinal disease, uveitis, corneal disease, glaucoma - a range of different sight-threatening ophthalmic conditions.
The West African outbreak was challenging because it was the first time that the outbreak had occurred in West Africa - the largest outbreak in history, 28,600 cases, 11,300 deaths. But in the Democratic Republic of Congo in 2018 to 2020, it's an area that's been challenged by militia conflict and security. That’s definitely a deterrent for patients seeking care, it's not only a dangerous virus, it can also be a dangerous setting.
On one of our engagements, Dr. Shantha, Dr. Crozier, Dr. Jean-Claude Mwanza, and I traveled to Eastern DRC with the World Health Organization with United Nations security coverage to develop an eye clinic and build health care capacity. It also required that we have additional security measures. When we were establishing the clinic, it was necessary to not only manage the eye care portion of it but also ensure that we were mindful of security considerations.
What would you say the biggest developments have been looking back on the last five or six years?
Yeh: Ultimately, one of the biggest developments is that eye disease can be a vital part of outbreak response given its impact to Ebola survivorship. Vision health is extremely important as patients move forward with their lives. Being able to work with partners on the ground, develop healthcare capacity, develop training, partner with them in how they'll evaluate patients as the outbreak moves forward, is an area that that we've been very active in from a training perspective.
We're continuing to work with the partners in DR Congo and other countries where this is an issue. This is the aspect of being proactive, that we want to continue to equip the local providers to have what they need and with a comprehensive understanding of disease and personal protective equipment so that they can continue to provide care.
Would you say there has been a support system within the survivor communities in these areas?
Yeh: Yes, and it’s very important. There's a potential for stigma associated with having had a disease and especially during the West African outbreak, there was always the question of when patients could go home. There's a lot of psychosocial stressors. In Sierra Leone they established what's called the Sierra Leone Association of Ebola Survivors, and that allowed them to have community with regards to thinking about which services were needed. We've worked with their group very closely. It helps not only ophthalmology services, but also things like mental health.
Dr. Yeh and Dr. Shantha, along with team members from the University of Nebraska Medical Center, University of California San Francisco Proctor Foundation, Emory University and the Lowell and Ruth Gess Eye Hospital (Photograph at Connaught Government Hospital, Freetown, Sierra Leone).
Dr. Yeh and Dr. Shantha, along with team members from the University of Nebraska Medical Center, University of California San Francisco Proctor Foundation, Emory University and the Lowell and Ruth Gess Eye Hospital (Photograph at Connaught Government Hospital, Freetown, Sierra Leone).
With the decrease in NIH funding, has your research been affected in recent years?
Yeh: With the decrease in federal funding, we have looked more closely at the array of potential supports that include federal, industry, and philanthropic funding. We are grateful to our generous donors, industry supports, and federal grants through NIH and USAID in the past, and we look forward to other opportunities. Our programs now include Ebola, Lassa, mpox, metagenomics, childhood vision loss, and vision health systems strengthening, and mental health related to vision loss.
One individual who helped us immensely from an advisory and a guidance perspective was Rahm Sitaraman. He's supported our program in many ways, but he's also provided just invaluable guidance and advice to me - thinking about how to define our objectives, develop a strong operational plan that is governed by the strategy so that we can move through a very complex environment.
From the Nebraska side, the Truhlsen Foundation and the Truhlsen Eye Institute have been incredibly supportive. I think in that spirit of collaboration, the philanthropic efforts have been critical in continuing our efforts with some recent uncertainties in the funding environment.
We spoke about the last five years. What are the hopes for the next five years?
Shantha: I would say that our efforts have moved from Ebola care and understanding Ebola virus' disease, to thinking about how we can strengthen vision health systems.
Yeh: At least within West Africa, we've been able to establish retina surgical programs and subspecialty care and develop training models and other research opportunities. We’ve been able to utilize the infrastructure for Ebola survivors to carry out the metagenomics work so that we can understand not only Ebola, but other infectious pathogens.
Interestingly, some of the learnings that we've been able to achieve overseas, whether it's telemedicine, training, upscaling of labor, are also translatable to things that are happening in the United States in our rural communities
.
Creating A Lasting Impact
It would be remiss not to mention the lasting impact this ongoing effort has had on these geographic regions. Made possible through Emory’s collaborative role in supporting and sustaining these efforts, doctors Shantha and Yeh have worked together to transform local ophthalmic healthcare infrastructure in Sierra Leone, helping build systems capable of caring for more than 100 patients per day, collecting critical clinical data, and training local teams to perform cataract surgeries.
Their commitment extends beyond visits, as they traveled to Sierra Leone approximately every four months to provide hands-on training and support, which would not have been possible without donors supporting their efforts on these trips. These donations allowed for travel, security, spacing, human infrastructure, and the supply of much needed medical equipment to these regions. Emory’s doctors and donors have supported advanced diagnostic capabilities by funding the supply of an OCT (Optical Coherence Tomography) machine and are helping to bring a second machine into service.
Emory’s role in training local providers, including physicians’ assistants who are performing the cataract surgeries on Uveitis patients, solidifies the sustainability and impact of this investment. Through its leadership, clinical expertise, research innovation, and philanthropic investment, Emory helped build enduring healthcare capacity in the region to collectively overcome the effects of Ebola.
These efforts generated important insights into the long-term effects of Ebola and contributed to innovations that continue to inform and educate patient care, demonstrating how strategic partnerships, education, research, and philanthropy can transform healthcare systems and improve lives around the world.
About Our Emory Researchers and Physicians
Dr. Jessica Shantha is an Associate Professor and uveitis specialist in the Department of Ophthalmology at Emory University. She has completed both a medical retina (Retina Consultants of Hawaii) and uveitis (UCSF/Proctor Foundation) fellowships after completion of ophthalmology residency at Emory University.
Dr. Steven Yeh is currently Professor of Ophthalmology and Director of Retina and Uveitis at the Truhlsen Eye Institute, University of Nebraska Medical Center – as well as Adjunct Professor at Emory University School of Medicine. After undergraduate training at the Massachusetts Institute of Technology, Dr. Yeh attended Baylor College of Medicine for medical training, where he then completed Ophthalmology Residency and Chief Residency. He then pursued fellowship training in Uveitis, Ocular Immunology, and Medical Retina at the National Institutes of Health, followed by a Fellowship in Retinal Surgery at Oregon Health and Science University.
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