0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Clinical Sciences

Correlation Between Clinical Signs and Optical Coherence Tomography With Enhanced Depth Imaging Findings in Patients With Birdshot Chorioretinopathy

Andrea D. Birnbaum, MD, PhD1; Amani A. Fawzi, MD1; Alfred Rademaker, PhD2; Debra A. Goldstein, MD1
[+] Author Affiliations
1Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Ophthalmol. 2014;132(8):929-935. doi:10.1001/jamaophthalmol.2014.877.
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Vasculitis Grading Scale

Vasculitis is graded on a scale of 0 (none) to 2. Grade 1 indicates subtle skip areas of perivenous sheathing (arrowheads); grade 2, more pronounced sheathing (arrowheads). No patient had extensive vasculitis.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Grading Scale for Optical Coherence Tomography With Enhanced Depth Imaging (OCT-EDI)

For suprachoroidal fluid, the presence a hyporeflective region between the choroid and sclera was sought and graded based on its thickness. Arrowheads represent areas where suprachoroidal fluid is visualized on OCT-EDI. Grade 0 denoted absence; 1, a sliver of fluid whose vertical extent was less than that of the overlying retinal pigment epithelium (RPE); and 2, a hyporeflective band thicker than the RPE in the same scan (regardless of the lateral extent). Disruption of RPE was graded based on its lateral extent in an individual B-scan. Arrowheads mark regions with RPE disruption as illustrated by increased illumination of the choroid. Grade 1 was assigned to scans with RPE disruption affecting <50% of the scan; 2, 50% to 90% RPE disruption; and 3, 91% or more RPE disruption. The retinal thickness grading scale was based on the lateral extent of cystoid macular edema (CME). Arrowheads represent areas of RPE thickening and CME. Grade 1 was assigned to scans with any CME in the fovea or perifoveal CME involving more than 50% of the scan (for extrafoveal cuts); 2, scans with foveal and perifoveal CME or perifoveal CME in 50% or more of the scan (for extrafoveal cuts). Grade 3 represented loss of retinal architecture. Grading of the ellipsoid zone was similar to that for RPE disruption. Arrowheads represent regions where the ellipsoid layer is not identified on OCT-EDI. Grade 1 was assigned for disruption of the ellipsoid layer in less than 50% of the scan; 2, 50% to 99% of the scan; and 3, complete absence of the ellipsoid zone.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();