Andrea D Birnbaum1, Amani A Fawzi1, Alfred Rademaker2, Debra A Goldstein1. 1. Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
IMPORTANCE: Birdshot chorioretinopathy (BCR) is a bilateral posterior uveitis that typically requires aggressive therapy to prevent loss of vision. Clinical signs of disease activity may be subtle and visual acuity is often preserved despite significant loss of visual function. Optical coherence tomography with enhanced depth imaging (OCT-EDI), a new technology that allows visualization of structures posterior to the retinal pigment epithelium, may be a useful tool to monitor disease activity in these patients. OBJECTIVE: To determine the correlation between symptoms and signs of disease activity in BCR and specific findings on OCT-EDI. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 14 patients treated for BCR in the uveitis clinic at Northwestern University. All patients underwent OCT-EDI (58 scans). Clinical symptoms of photopsias/vibrating vision and signs of macular edema, vitreous haze, and retinal vasculitis were graded; a second grading scale was developed for the evaluation of OCT-EDI. Individual scans of each eye of each patient at each point were graded in a masked fashion. EXPOSURE: Optical coherence tomography with EDI in BCR. MAIN OUTCOMES AND MEASURES: Spearman rank correlation of clinical measures to OCT-EDI measures. RESULTS: The most frequent score in each clinical category was 0 (inactive). In those BCR patients with symptoms (21 eye examinations), the subjective complaint of photopsias/vibrating vision was associated with the objective finding of suprachoroidal fluid on OCT-EDI (P = .003), and the frequency and severity of photopsias correlated with the thickness of the fluid band (Pearson product moment correlation, 0.39). Two of the clinical markers of disease activity measured in this study (vasculitis and vitreous haze) also showed a significant Spearman rank correlation with the presence and amount of suprachoroidal fluid on OCT-EDI (vasculitis, 0.45 [P < .001]; vitreous haze, 0.59 [P < .001]). CONCLUSIONS AND RELEVANCE: The presence of suprachoroidal fluid on OCT-EDI appears to correlate with the subjective complaints of photopsias in patients with BCR and other more easily assessed clinical features such as vasculitis and vitreous haze. Optical coherence tomography with EDI may be a useful tool for objective monitoring of BCR.
IMPORTANCE: Birdshot chorioretinopathy (BCR) is a bilateral posterior uveitis that typically requires aggressive therapy to prevent loss of vision. Clinical signs of disease activity may be subtle and visual acuity is often preserved despite significant loss of visual function. Optical coherence tomography with enhanced depth imaging (OCT-EDI), a new technology that allows visualization of structures posterior to the retinal pigment epithelium, may be a useful tool to monitor disease activity in these patients. OBJECTIVE: To determine the correlation between symptoms and signs of disease activity in BCR and specific findings on OCT-EDI. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review of 14 patients treated for BCR in the uveitis clinic at Northwestern University. All patients underwent OCT-EDI (58 scans). Clinical symptoms of photopsias/vibrating vision and signs of macular edema, vitreous haze, and retinal vasculitis were graded; a second grading scale was developed for the evaluation of OCT-EDI. Individual scans of each eye of each patient at each point were graded in a masked fashion. EXPOSURE: Optical coherence tomography with EDI in BCR. MAIN OUTCOMES AND MEASURES: Spearman rank correlation of clinical measures to OCT-EDI measures. RESULTS: The most frequent score in each clinical category was 0 (inactive). In those BCR patients with symptoms (21 eye examinations), the subjective complaint of photopsias/vibrating vision was associated with the objective finding of suprachoroidal fluid on OCT-EDI (P = .003), and the frequency and severity of photopsias correlated with the thickness of the fluid band (Pearson product moment correlation, 0.39). Two of the clinical markers of disease activity measured in this study (vasculitis and vitreous haze) also showed a significant Spearman rank correlation with the presence and amount of suprachoroidal fluid on OCT-EDI (vasculitis, 0.45 [P < .001]; vitreous haze, 0.59 [P < .001]). CONCLUSIONS AND RELEVANCE: The presence of suprachoroidal fluid on OCT-EDI appears to correlate with the subjective complaints of photopsias in patients with BCR and other more easily assessed clinical features such as vasculitis and vitreous haze. Optical coherence tomography with EDI may be a useful tool for objective monitoring of BCR.
Authors: Evangelos Minos; Robert J Barry; Sue Southworth; Annie Folkard; Philip I Murray; Jay S Duker; Pearse A Keane; Alastair K Denniston Journal: Orphanet J Rare Dis Date: 2016-05-12 Impact factor: 4.123
Authors: Laura J Kopplin; Marion Munk; Justin Baynham; James T Rosenbaum; Eric B Suhler; Kristin Biggee; Debra A Goldstein; Phoebe Lin Journal: J Vitreoretin Dis Date: 2019-07-01