Birdshot Chorioretinopathy : Prospective Follow-up and Immunogenetic Studies(CO-BIRD)
NCT ID: NCT05153057
Last Updated: 2022-10-31
Study Results
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Basic Information
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RECRUITING
600 participants
OBSERVATIONAL
2004-11-02
2030-12-31
Brief Summary
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1. To analyze the clinical features of a cohort of patients with birdshot chorioretinopathy (BCR), an inflammatory bilateral ocular disease, affecting the choroid and the retina.
Various imaging techniques will be used to assess the effect of the disease on the retina and the choroid.
A standardized assessment of the visual function will be performed with visual acuity, visual field and color vision testing. The quality of life of the patients will be evaluated with the VFQ-25 questionnaire.
These analyses will help delineating different forms of the disease among its heterogeneous presentations.
2. To identify predisposing factors for the disease. The condition is unique from the immunogenetic standpoint by its association with the HLA-A29 allele, which is the strongest link between an HLA class I antigen and a disease. To date, however, the mechanisms leading to birdshot chorioretinopathy remain unknown. GWAS (Genome Wide association Study) based on DNA of the cohort patients will be performed with the aim to identify other susceptibility genes associated with BCR.
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Detailed Description
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One of the main difficulties of the diagnosis lies in the spectrum of presentations of the disease. The typical birdshot lesions are ovoid with their main axis oriented toward the optic disc. However, some are round and the can be clearly seen on fundus examination while others can be limited to subtle depigmentations. Typical lesions are one-quarter to one-half disc diameters, but confluent lesions may yield larger areas of depigmentation that are difficult to recognize. Although the typical lesions are depigmented, their presentation may change over time and pigment or atrophy may replace the initial cream-colored spots. The typical location, or the most easily seen location of the spots, is nasal to the optic disc. However, involvement of the posterior pole inside the temporal arcade is also possible. The spots usually predominate in the mid-periphery, but may also extend to the equator. A standardized classification of the birdshot lesions according to their size, their number, their pigmentation and their localization has been suggested to help in the categorization of the various disease presentations and for the longitudinal follow-up of affected patients. Spots clearly visible at the time of the diagnosis may disappear later. Hence, if the diagnosis of the birdshot chorioretinopathy is not made when spots are clearly visible, later presentations may not meet the definition commonly used for the disease. The disappearance of birdshot spots after treatment has been documented, but the effect of treatment on spots has not yet been assessed in large cohorts of patients. Indocyanine green angiography has been suggested as a reliable method to detect spots. However, it remains to be validated by a randomized assessment comparing indocyanine green angiography to color photographs for the detection of birdshot lesions.
Fluorescein angiography is useful in patients with birdshot chorioretinopathy to assess disease activity. In active disease, angiographic findings include leakage of the retinal veins, macular edema and optic disk hyperfluorescence. These findings are not disease specific, but they require a careful examination of the fundus seeking subtle spots when birdshot lesions are not obvious.
Given the above, the first goal of our prospective cohort study is to assess the heterogeneity of the disease, its spectrum of presentation and its evolution over time.
One of the characteristics of birdshot chorioretinopathy is its association with the HLA-A29 allele, which constitutes the strongest link between a disease and class I HLA allele. The mechanism by which HLA-A29 confers a risk for birdshot chorioretinopathy is a key question that remains unanswered. As with other associations between HLA class I antigens and diseases (HLA-B27 with spondylarthropathies and HLA B51 with Behçet's disease), the physiopathogeny of these links have not been elucidated.
Other factors playing a role in the physiopathogeny of the disease and not linked to the major histocompatibility complex are researched. A few families of patients with birdshot chorioretinopathy have been reported, which could point to additional genetic factors for disease susceptibility but does not rule out an environmental effect.
Hence, the complex physiopathology of birdshot chorioretinopathy could involve the HLA-A29 allele, other unknown genetic factors, as well as environmental factors.
Given the above, we are planning a GWAS (Genome Wide association Study) based on DNA of the cohort patients, which will be performed with the aim to identify other susceptibility genes associated with BCR.
Conditions
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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Birdshot chorioretinopathy
Patients with a diagnosis of birdshot chorioretinopathy, with confirmed HLA-A29 positivity.
Observational study
The goal of the study is purely observational. Treatment decisions will be made by physicians according to the grading of the intraocular inflammation related to birdshot chorioretinopathy and to their consequences on visual function. These treatment decisions will be independent from the observational study.
Interventions
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Observational study
The goal of the study is purely observational. Treatment decisions will be made by physicians according to the grading of the intraocular inflammation related to birdshot chorioretinopathy and to their consequences on visual function. These treatment decisions will be independent from the observational study.
Eligibility Criteria
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Inclusion Criteria
2. Presence of at least three peripapillary "birdshot lesions" inferior or nasal to the optic disk in one eye
3. Low-grade anterior segment intraocular inflammation (defined as ≤ 1+cells in the anterior chamber)
4. Low grade vitreous inflammatory reaction (defined as ≤ 2+ vitreous haze‡) Supportive findings
1\. HLA-A29 positivity 2. Retinal vasculitis 3. Cystoid macular edema
Exclusion Criteria
2. Posterior synechiae
3. Presence of infectious, neoplastic, or other inflammatory diseases that can cause multifocal choroidal lesions
18 Years
ALL
No
Sponsors
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Assistance Publique - Hôpitaux de Paris
OTHER
Responsible Party
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Principal Investigators
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Antoine BREZIN, PhD & MD
Role: PRINCIPAL_INVESTIGATOR
Université de Paris, Ophtalmopôle, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris.
Locations
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Ophtalmopôle, Hôpital Cochin
Paris, Île-de-France Region, France
Countries
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Central Contacts
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Facility Contacts
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References
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Levinson RD, Brezin A, Rothova A, Accorinti M, Holland GN. Research criteria for the diagnosis of birdshot chorioretinopathy: results of an international consensus conference. Am J Ophthalmol. 2006 Jan;141(1):185-7. doi: 10.1016/j.ajo.2005.08.025.
Monnet D, Brezin AP, Holland GN, Yu F, Mahr A, Gordon LK, Levinson RD. Longitudinal cohort study of patients with birdshot chorioretinopathy. I. Baseline clinical characteristics. Am J Ophthalmol. 2006 Jan;141(1):135-42. doi: 10.1016/j.ajo.2005.08.067.
Monnet D, Brezin AP. Birdshot chorioretinopathy. Curr Opin Ophthalmol. 2006 Dec;17(6):545-50. doi: 10.1097/ICU.0b013e3280109479.
Holland GN, Shah KH, Monnet D, Brezin AP, Yu F, Nusinowitz S, Levinson RD. Longitudinal cohort study of patients with birdshot chorioretinopathy II: color vision at baseline. Am J Ophthalmol. 2006 Dec;142(6):1013-8. doi: 10.1016/j.ajo.2006.06.065. Epub 2006 Aug 2.
Monnet D, Levinson RD, Holland GN, Haddad L, Yu F, Brezin AP. Longitudinal cohort study of patients with birdshot chorioretinopathy. III. Macular imaging at baseline. Am J Ophthalmol. 2007 Dec;144(6):818-828. doi: 10.1016/j.ajo.2007.08.011. Epub 2007 Oct 18.
Gordon LK, Monnet D, Holland GN, Brezin AP, Yu F, Levinson RD. Longitudinal cohort study of patients with birdshot chorioretinopathy. IV. Visual field results at baseline. Am J Ophthalmol. 2007 Dec;144(6):829-837. doi: 10.1016/j.ajo.2007.08.010. Epub 2007 Oct 15.
Levinson RD, Du Z, Luo L, Monnet D, Tabary T, Brezin AP, Zhao L, Gjertson DW, Holland GN, Reed EF, Cohen JH, Rajalingam R. Combination of KIR and HLA gene variants augments the risk of developing birdshot chorioretinopathy in HLA-A*29-positive individuals. Genes Immun. 2008 Apr;9(3):249-58. doi: 10.1038/gene.2008.13. Epub 2008 Mar 13.
Kappel PJ, Monnet D, Yu F, Brezin AP, Levinson RD, Holland GN. Contrast sensitivity among patients with birdshot chorioretinopathy. Am J Ophthalmol. 2009 Feb;147(2):351-356.e2. doi: 10.1016/j.ajo.2008.08.021. Epub 2008 Oct 29.
Levinson RD, Monnet D, Yu F, Holland GN, Gutierrez P, Brezin AP. Longitudinal cohort study of patients with birdshot chorioretinopathy. V. Quality of life at baseline. Am J Ophthalmol. 2009 Feb;147(2):346-350.e2. doi: 10.1016/j.ajo.2008.08.011. Epub 2008 Oct 9.
Pagnoux C, Mahr A, Aouba A, Berezne A, Monnet D, Cohen P, Levinson RD, Brezin AP, Guillevin L. Extraocular manifestations of birdshot chorioretinopathy in 118 French patients. Presse Med. 2010 May;39(5):e97-e102. doi: 10.1016/j.lpm.2009.12.005. Epub 2010 Mar 10.
Brezin AP, Monnet D, Cohen JH, Levinson RD. HLA-A29 and birdshot chorioretinopathy. Ocul Immunol Inflamm. 2011 Dec;19(6):397-400. doi: 10.3109/09273948.2011.619295.
Dastiridou AI, Bousquet E, Kuehlewein L, Tepelus T, Monnet D, Salah S, Brezin A, Sadda SR. Choroidal Imaging with Swept-Source Optical Coherence Tomography in Patients with Birdshot Chorioretinopathy: Choroidal Reflectivity and Thickness. Ophthalmology. 2017 Aug;124(8):1186-1195. doi: 10.1016/j.ophtha.2017.03.047. Epub 2017 Apr 26.
Cunningham ET, Levinson RD, Denniston AK, Brezin AP, Zierhut M. Birdshot Chorioretinopathy. Ocul Immunol Inflamm. 2017 Oct;25(5):589-593. doi: 10.1080/09273948.2017.1400800. No abstract available.
Bousquet E, Khandelwal N, Seminel M, Mehanna C, Salah S, Eymard P, Bodin Hassani S, Monnet D, Brezin A, Agrawal R. Choroidal Structural Changes in Patients with Birdshot Chorioretinopathy. Ocul Immunol Inflamm. 2021 Feb 17;29(2):346-351. doi: 10.1080/09273948.2019.1681472. Epub 2019 Nov 12.
Ferreira de Moura T, Enjalbert A, Monnet D, Kecili S, Imikerene L, Loeliger J, Thorne JE, Brezin AP. Peripapillary atrophy in patients with birdshot chorioretinitis. Br J Ophthalmol. 2025 Jul 22;109(8):882-887. doi: 10.1136/bjo-2024-326440.
Kaisari E, Loeliger J, Thorne JE, Monnet D, Imikirene L, Kecili S, Brezin AP. Quality of Life in Patients with Birdshot Chorioretinitis Aged 80 and Older. Ocul Immunol Inflamm. 2025 Feb;33(2):280-286. doi: 10.1080/09273948.2024.2400172. Epub 2024 Sep 9.
Debillon L, Thorne JE, Bousquet E, Duraffour P, Kecili S, Monnet D, Brezin AP. Birdshot Chorioretinitis in Patients Aged 80 and Older. Ocul Immunol Inflamm. 2024 Sep;32(7):1212-1217. doi: 10.1080/09273948.2023.2215322. Epub 2023 May 19.
Other Identifiers
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NI16002
Identifier Type: -
Identifier Source: org_study_id
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