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Purpose The purpose of this study was to describe fundus autofluorescence (FAF) findings in eyes with birdshot chorioretinitis (BSCR) and to compare findings to demographic, medical, and clinical characteristics. Methods In this multicenter, prospective, cross-sectional study, 172 eyes (86 patients) with BSCR were investigated. Participants underwent a standardized evaluation including collection of demographic data, ophthalmic and treatment history, and ophthalmologic examination. Using a standardized protocol, hypo- and hyperautofluorescence in macular and extramacular regions and specific patterns of abnormal FAF could be scored for 167 eyes. Images were scored by two independent, masked graders. Measures of visual function included best-corrected visual acuity (BCVA), contrast sensitivity (CS), color vision, and Humphrey visual field mean deviation (HVF-MD). Results Any abnormal FAF finding was observed in 132 eyes (79.0%); macular abnormalities were observed in 84 eyes (49.1%). The most common findings were peripapillary confluent hypoautofluorescence (122 eyes [73.1%]); extramacular granular hypoautofluorescence (100 eyes [59.9%]); and macular granular hypoautofluorescence (67 eyes [40.1%]). Confluent hypoautofluorescence was related to longer median disease duration (8.7 years) than granular hypoautofluorescence (7.9 years) or hyperautofluorescence (5.6 years). Macular confluent hypoautofluorescence was associated with BCVA ≤20/25 (odds ratio [OR] = 7.83, P = 0.007), BCVA ≤20/50 (OR = 4.94, P = 0.002), and abnormal CS (OR = 4.56, P = 0.009). Presence of macular or extramacular hypoautofluorescence was related to HVF-MD ≤-3 dB (OR = 2.43, P = 0.01 and OR = 2.89, P = 0.003, respectively). Conclusions In this large cohort, various FAF abnormalities were found, indicating that disorders of the retinal pigment epithelium are features of BSCR. Abnormal FAF is a marker of visual dysfunction in the disease.

The Multicenter Uveitis Steroid Treatment (MUST) Trial has compared fluocinolone acetonide implant versus systemic corticosteroids, supplemented with immunosuppressive drugs, as alternative treatments for intermediate uveitis, posterior uveitis, and panuveitis and shown that both treatments, on average, are effective in preserving vision for these patients.1,2 A corticosteroid implant is placed into a patient's eye to deliver corticosteroid locally for the management of uveitis.3 It is designed to reduce the need for systemic use of corticosteroids, which may increase the risk for high blood pressure, diabetes mellitus, and infections.4 However, several studies have indicated that use of the implants leads to a higher risk of developing cataracts and glaucoma,2,3,5 both well-known ocular adverse effects of corticosteroid therapy. While the MUST Trial has demonstrated that risks of systemic adverse effects do not differ greatly between groups and has found that benefits are similar,2 in clinical practice, the problem of trading off local versus systemic adverse effects and benefits of alternative routes to deliver corticosteroids in eye disease remains of interest in specific cases. The scenario of comparing qualitatively different outcomes of treatments is challenging in the clinical setting. Understanding how patients may interpret the trade-offs between the adverse outcomes would help to inform benefit–harm assessments and treatment decisions of this nature.6,7 The aim of a quantitative benefit–harm assessment is to compare treatments through a comprehensive assessment of their effects on multiple benefits and harms,7 which requires learning about patient preferences (i.e., the importance or weights that patients place on outcomes8) to estimate the benefit–harm balance.7,9,10 Besides benefit–harm assessment, preference data also play a key role in other health care research such as economic evaluation and decision analysis.11,12 They often are incorporated into such studies to properly reflect patients' needs and to generate findings that support patient-centered care.13,14 The aim of our study was to learn how patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis value adverse treatment outcomes of corticosteroid implant and systemic corticosteroids by conducting a preference-elicitation survey. In addition, we explored whether patients' characteristics and their experiences with treatment outcomes were associated with their preferences.

Metrics evaluating quality of life (QoL) have gained importance with the introduction of cost-effectiveness analysis (CEA). CEA attempts to evaluate whether an improvement in health due to a new form of treatment is worth the cost of the treatment.1 In practice, these analyses require data on general health-related QoL, specifically measures of health utility, to be generalizable across different treatments and diseases. In patients with uveitis specifically and eye disease in general, there is a paucity of research on the relationship of general health-related QoL and health utility metrics with visual acuity, an often used and clinically important outcome for evaluating the effectiveness of treatments for ocular diseases, or vision-related functioning. Vision-related functioning is a broader measure than visual acuity, because it evaluates patients' ability to conduct activities of daily living (e.g., reading, driving, and face recognition) for which peripheral vision, and contrast and color vision, as well as visual acuity, are important.2 Previously, visual acuity and vision-related functioning have been shown to be strongly related in patients with other eye diseases,3 and QoL scores are lower in uveitis patients than in healthy controls, especially among patients with significant vision loss.4 However, the degree to which standard health utility measures change with clinically meaningful differences in visual acuity or vision-related functioning is uncertain for patients with uveitis and limited visual acuity impairment. Studying the relationships in the path from visual acuity to visual function to generic health-related QoL (particularly health utility) for patients with uveitis specifically is worthwhile because uveitis differs from other conditions affecting visual acuity. Uveitis is a collection of approximately 30 diseases characterized by intraocular inflammation that are collectively an important cause of visual loss in the developed world.5,6 Because noninfectious uveitis often strikes at a younger age than many common eye disorders, such as cataract, macular degeneration, and glaucoma, it has a disproportionately high impact on years of potential vision lost and workplace or home-based productivity effects.7 In addition, pain is sometimes associated with uveitis that is not associated with other conditions, and visual acuity often fluctuates rather than being stable. The Multicenter Uveitis Steroid Treatment (MUST) Trial was designed to evaluate the comparative effectiveness of a systemic treatment strategy, primarily oral corticosteroids that may be supplemented with immunosuppressive drugs, to the fluocinolone intraocular implant.8 The primary outcome of the MUST Trial is the change in best corrected visual acuity after 2 years of follow-up. The study also collected data on several QoL metrics, including self-reported vision-related functioning assessed with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), health-related QoL assessed with the Medical Outcomes Study 36-Item Short Form (SF-36), and health utility assessed with the EuroQoL EQ-5D questionnaire. We present the associations between measures of vision (visual acuity and vision-related function) and the more general measures of QoL and heath utility that were obtained at enrollment in the MUST trial. Our objective, for patients with uveitis, was to test relationships between (1) visual acuity and specific elements of visual function; (2) visual acuity and summary measures of visual function and generic health related QoL; (3) visual function and the QoL measures, to allow for possible mediation; and (4) specific elements of visual function and health-related QoL, to further explore relationships from the third test.