Austin R Fox1, Lynn K Gordon2, John R Heckenlively3, Janet L Davis4, Debra A Goldstein5, Careen Y Lowder6, Robert B Nussenblatt1, Nicholas J Butler7, Monica Dalal8, Thiran Jayasundera3, Wendy M Smith9, Richard W Lee10, Grazyna Adamus11, Chi-Chao Chan1, John J Hooks1, Catherine W Morgans12, Barbara Detrick13, H Nida Sen14. 1. Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland. 2. Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California. 3. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan. 4. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. 5. Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 6. Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. 7. Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts. 8. Department of Ophthalmology, George Washington University, Washington, DC. 9. Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. 10. Bristol Eye Hospital, University of Bristol, Bristol, United Kingdom. 11. Ocular Immunology Laboratory, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. 12. Department of Physiology & Pharmacology, Oregon Health & Science University, Portland, Oregon. 13. Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland. 14. Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: senh@nei.nih.gov.
Abstract
PURPOSE: To develop diagnostic criteria for nonparaneoplastic autoimmune retinopathy (AIR) through expert panel consensus and to examine treatment patterns among clinical experts. DESIGN: Modified Delphi process. METHODS: A survey of uveitis specialists in the American Uveitis Society, a face-to-face meeting (AIR Workshop) held at the National Eye Institute, and 2 iterations of expert panel surveys were used in a modified Delphi process. The expert panel consisted of 17 experts, including uveitis specialists and researchers with expertise in antiretinal antibody detection. Supermajority consensus was used and defined as 75% of experts in agreement. RESULTS: There was unanimous agreement among experts regarding the categorization of autoimmune retinopathies as nonparaneoplastic and paraneoplastic, including cancer-associated retinopathy and melanoma-associated retinopathy. Diagnostic criteria and tests essential to the diagnosis of nonparaneoplastic AIR and multiple supportive criteria reached consensus. For treatment, experts agreed that corticosteroids and conventional immunosuppressives should be used (prescribed) as first- or second-line treatments, though a consensus agreed that biologics and intravenous immunoglobulin were considered appropriate in the treatment of nonparaneoplastic AIR patients regardless of the stage of disease. Experts agreed that more evidence is needed to treat nonparaneoplastic AIR patients with long-term immunomodulatory therapy and that there is enough equipoise to justify randomized, placebo-controlled trials to determine if nonparaneoplastic AIR patients should be treated with long-term immunomodulatory therapy. Regarding antiretinal antibody detection, consensus agreed that a standardized assay system is needed to detect serum antiretinal antibodies. Consensus agreed that an ideal assay should have a 2-tier design and that Western blot and immunohistochemistry should be the methods used to identify antiretinal antibodies. CONCLUSIONS: Consensus was achieved using a modified Delphi process to develop diagnostic criteria for nonparaneoplastic AIR. There is enough equipoise to justify randomized, placebo-controlled trials to determine whether patients with nonparaneoplastic AIR should be treated with long-term immunomodulatory therapy. Efforts to develop a standardized 2-tier assay system for the detection of antiretinal antibodies have been initiated as a result of this study. Published by Elsevier Inc.
PURPOSE: To develop diagnostic criteria for nonparaneoplastic autoimmune retinopathy (AIR) through expert panel consensus and to examine treatment patterns among clinical experts. DESIGN: Modified Delphi process. METHODS: A survey of uveitis specialists in the American Uveitis Society, a face-to-face meeting (AIR Workshop) held at the National Eye Institute, and 2 iterations of expert panel surveys were used in a modified Delphi process. The expert panel consisted of 17 experts, including uveitis specialists and researchers with expertise in antiretinal antibody detection. Supermajority consensus was used and defined as 75% of experts in agreement. RESULTS: There was unanimous agreement among experts regarding the categorization of autoimmune retinopathies as nonparaneoplastic and paraneoplastic, including cancer-associated retinopathy and melanoma-associated retinopathy. Diagnostic criteria and tests essential to the diagnosis of nonparaneoplastic AIR and multiple supportive criteria reached consensus. For treatment, experts agreed that corticosteroids and conventional immunosuppressives should be used (prescribed) as first- or second-line treatments, though a consensus agreed that biologics and intravenous immunoglobulin were considered appropriate in the treatment of nonparaneoplastic AIR patients regardless of the stage of disease. Experts agreed that more evidence is needed to treat nonparaneoplastic AIR patients with long-term immunomodulatory therapy and that there is enough equipoise to justify randomized, placebo-controlled trials to determine if nonparaneoplastic AIR patients should be treated with long-term immunomodulatory therapy. Regarding antiretinal antibody detection, consensus agreed that a standardized assay system is needed to detect serum antiretinal antibodies. Consensus agreed that an ideal assay should have a 2-tier design and that Western blot and immunohistochemistry should be the methods used to identify antiretinal antibodies. CONCLUSIONS: Consensus was achieved using a modified Delphi process to develop diagnostic criteria for nonparaneoplastic AIR. There is enough equipoise to justify randomized, placebo-controlled trials to determine whether patients with nonparaneoplastic AIR should be treated with long-term immunomodulatory therapy. Efforts to develop a standardized 2-tier assay system for the detection of antiretinal antibodies have been initiated as a result of this study. Published by Elsevier Inc.
Authors: Farzin Forooghian; Ian M Macdonald; John R Heckenlively; Elise Héon; Lynn K Gordon; John J Hooks; Barbara Detrick; Robert B Nussenblatt Journal: Am J Ophthalmol Date: 2008-07-30 Impact factor: 5.258
Authors: Ashley Behrens; John J Doyle; Lee Stern; Roy S Chuck; Peter J McDonnell; Dimitri T Azar; Harminder S Dua; Milton Hom; Paul M Karpecki; Peter R Laibson; Michael A Lemp; David M Meisler; Juan Murube Del Castillo; Terrence P O'Brien; Stephen C Pflugfelder; Maurizio Rolando; Oliver D Schein; Berthold Seitz; Scheffer C Tseng; Gysbert van Setten; Steven E Wilson; Samuel C Yiu Journal: Cornea Date: 2006-09 Impact factor: 2.651
Authors: B Trusko; J Thorne; D Jabs; R Belfort; A Dick; S Gangaputra; R Nussenblatt; A Okada; J Rosenbaum Journal: Methods Inf Med Date: 2013-02-08 Impact factor: 2.176
Authors: Júlia T Takiuti; Vitor K L Takahashi; Christine L Xu; Ruben Jauregui; Stephen H Tsang Journal: Ophthalmic Genet Date: 2019-08-08 Impact factor: 1.803
Authors: Avni P Finn; Akshay S Thomas; Sandra S Stinnett; Robert T Keenan; Dilraj S Grewal; Glenn J Jaffe Journal: Graefes Arch Clin Exp Ophthalmol Date: 2018-08-20 Impact factor: 3.117