Abstract
Purpose
To identify full-field electroretinographic (ffERG) biomarkers that differentiate active versus inactive birdshot chorioretinopathy (BSCR) and long-term efficacy of intravitreal versus systemic immunosuppression.
Methods
Patients with BSCR at Casey Eye Institute with ffERG between 1999–2019 were included (n = 29). A group of healthy patients was used as controls (n = 47). Patients with BSCR were categorized as active or inactive based on the uveitis specialist’s clinical assessment. Cross-sectional comparison of ffERG markers between active, inactive, and control patients was performed, in addition to rate analysis of ffERG metrics in BSCR eyes treated with either intravitreal fluocinolone acetonide 0.59 mg (IVFAI) or systemic immunomodulation (SI).
Results
Both active and inactive BSCR tended to have lower amplitude and slower timing than controls, but only 30 Hz flicker time (p < 0.001, p < 0.01) and dim scotopic b-wave amplitude (p < 0.001, p < 0.05) were significant. Timing for inactive BSCR was faster than active for bright scotopic a-wave (p < 0.01), photopic b-wave (p < 0.01), and 30 Hz flicker (p < 0.01). Eyes treated with SI showed improvement in dim scotopic b-wave amplitude compared to a decline for IVFAI (p < 0.05), whereas eyes treated with SI showed slower degradation of bright scotopic b-wave amplitude (p < 0.01). Conversely, eyes treated with IVFAI showed greater improvement in bright scotopic (p < 0.05) and photopic a-wave timing (p < 0.01).
Conclusions
Timing of 30 Hz flicker, bright scotopic a-wave, and photopic b-wave may be useful biomarkers for disease activity in BSCR. Moreover, both SI and IVFAI were effective in preserving retinal function to varying degrees.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Change history
23 April 2025
The headings in tab. 2 and 5 have been updated due to inconsistency.
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Funding
This work was supported by the National Institutes of Health (Bethesda, MD) P30 EY010572 core grant, the Malcolm M. Marquis, MD Endowed Fund for Innovation, and an unrestricted grant from Research to Prevent Blindness (New York, NY) to Casey Eye Institute, Oregon Health & Science University.
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CRR: study conceptualization, methodology, data collection, original draft; EW: statistical analysis; AA: data collection; SS: data collection; WT: methodology, data collection & curation, review and editing; DC: statistical analysis; RYC: study conceptualization, review and editing; RGW: data collection; JTR: data collection, review and editing; PL: data collection, review and editing; MEP: data collection, review and editing; EBS: data collection, review and editing; PY: study conceptualization, methodology, data collection and curation, review and editing, funding acquisition, supervision.
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Rosenberg, C.R., White, E., Alsamarraie, A. et al. Electroretinography of disease activity and treatment response in birdshot chorioretinopathy. Eye 39, 1853–1859 (2025). https://doi.org/10.1038/s41433-025-03769-3
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DOI: https://doi.org/10.1038/s41433-025-03769-3
