Birdshot Retinochoroidopathy: Ocular Complications and Visual Impairment

Thorne, Jennifer E.; Jabs, Douglas A.; Peters, George B.; Hair, David; Dunn, James P.; Kempen, John H.

doi:10.1016/j.ajo.2005.01.035

« Previous Next »American Journal of Ophthalmology
Volume 140, Issue 1 , Pages 45.e1-45.e8, July 2005

Birdshot Retinochoroidopathy: Ocular Complications and Visual Impairment

Jennifer E. Thorne, MD
- Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Inquiries to Jennifer E. Thorne, MD, Wilmer Eye Institute, 550 North Broadway, Suite 700, Baltimore, MD 21205; fax: 410-955-0629
Douglas A. Jabs, MD, MBA
- Dr. Jabs is a recipient of a Research to Prevent Blindness Senior Scientific Investigator Award.
- Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
George B. Peters, MD, MBA
- Department of Ophthalmology, Lion’s Eye Institute, Albany Medical College, Albany, New York
David Hair, MD
- Department of Ophthalmology, Georgetown University, Washington, D.C.
James P. Dunn, MD
- Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
John H. Kempen, MD, PhD
- Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

Accepted 25 January 2005. published online 19 May 2005.

Purpose

To describe the incidence of vision loss and of ocular complications attributable to birdshot retinochoroidopathy and to describe the association between therapy and the incidence thereof.

Design

Retrospective cohort study.

Methods

setting: Single-center, academic practice. study population: Forty patients with birdshot retinochoroidopathy were evaluated from January 1984 through March 2004. observation procedure: Demographic and clinical information on patients diagnosed with birdshot retinochoroidopathy was collected. main outcome measures: Visual acuity and visual field loss; ocular complications including cystoid macular edema (CME).

Results

In affected eyes, the frequencies of vision loss to 20/50 or worse and to 20/200 or worse and of CME at presentation were 33%, 13%, and 20%, respectively. Patients who presented with a duration of disease of ≥ 30 months had higher frequencies of visual impairment to 20/50 or worse (68% vs 32%; P = .004) and to 20/200 or worse (32% vs 9%; P = .01), and had a higher frequency of CME (38% vs 14%; P = .02) than patients who presented with a duration of disease <30 months. The incidence rates on follow-up for vision loss to 20/50 or worse and to 20/200 or worse were 13% and 4% per eye-year (EY), respectively. The incidence of CME was 10%/EY. Use of immunosuppressive drug therapy was associated with a reduced risk of developing CME (relative risk = 0.17; 95% confidence interval: 0.05, 0.64; P = .009).

Conclusions

Birdshot retinochoroidopathy is a progressive disease with the potential for visual impairment. Patients who present at a later date after the onset of disease were more likely to have vision impairment and CME. Use of long-term immunosuppressive therapy may reduce the risk of CME.