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Comment & Response
October 2013

When You Can Have the Bird Without Shooting It!: Extramacular Enhanced Depth Optical Coherence Tomography in Birdshot Chorioretinopathy—Reply

Author Affiliations
  • 1Moorfields Eye Hospital, National Health Service Foundation Trust, London, England
  • 2Birmingham Midland Eye Centre, Birmingham, England
  • 3Doheny Eye Institute, University of Southern California, Los Angeles
  • 4Queen Elizabeth Hospital Birmingham, Birmingham, England
JAMA Ophthalmol. 2013;131(10):1369-1370. doi:10.1001/jamaophthalmol.2013.5367

In Reply We thank Sherif for his observations regarding our article.1 As he notes, we believe that extramacular enhanced depth OCT (EMEDOCT) will provide important new insights not only into BSCR but, by extension, into many other chorioretinal diseases, whether inflammatory or not. Our limited access to histology, notwithstanding the excellent report by Gaudio et al,2 has so far been a major limitation to our understanding of the pathogenesis of this disease. We believe that our report provides an opportunity to start to correlate the available histological data with the in vivo high-resolution imaging provided by enhanced depth spectral-domain OCT. We agree, based on the available data, that it is most likely that the hyperreflective foci in the choroid represent lymphocytic aggregates, whereas the hyperreflective foci in the retina represent the disruption of photoreceptors.2,3 Additionally, an important clinical implication is that these OCT-quantifiable choroidal hyperreflective foci may provide us with an objective measure of disease activity. Most of the parameters we use to measure severity in BSCR (such as visual acuity, color vision, visual fields, electrodiagnostic tests, and arguably fundus fluorescein angiography and indocyanine green angiography) reflect either damage or a combination of activity and damage; vitreous haze is an exception here in that it probably is a true activity marker. We hope that our ongoing work to develop EMEDOCT as a noninvasive objective measure of asymptomatic extramacular disease activity in BSCR will significantly improve our ability to detect active disease and to treat in a more responsive manner.