With more Birdshotters registering on BUS, we are beginning to develop a better picture of Birdshot.  One of the interesting questions that keeps arising is whether certain geographical areas have more people with Birdshot.

At our Birdshot Day on 3 March, we were quite amazed to find two people with Birdshot from a very small town.  They were equally amazed!  We have also noticed that there are several members who live within a few miles of each other in an urban area and another ‘cluster’ in a northern city – again quite disproportionate to the probable total numbers of people with Birdshot in the UK.

We would really like to build up a more accurate picture of the geographical spread and we can only do this with your help.

We would love to have your postcode (if you have not already supplied us with it) so we can map where you live, and produce a more accurate map of the geographical location of us Birdshotters.  Your postcode will be kept totally confidential – it will only be used to help us identify your geographical location on a map.  Once we have mapped the UK, we will attempt to map other countries too, and begin to build up an international picture.

Please send your postcode to us at info@birdshot.org.uk

We thought you would be interested in seeing the google analytics map of the UK of visitors to the BUS website since September 2010. Of course, not all visits are from Birdshotters, but it certainly identifies areas where the strongest interest is.

Thank you in advance to everybody who sends us their postcode, so we can produce a realistic map of the UK to show geographical locations of people with Birdshot.  This will help to make sure research and services are targeted to meet our needs.

Sirolimus has been given orphan drug status, which suggests that the studies carried out at various institutions have shown positive results. It is still being trialled as  part of a phase 3 study (see attached link.)

This drug given as an invitreal injection, was discussed at the Birdshot Day 2012. We were told that the risk of developing glaucoma and cataracts as an adverse effect of sirolimus may be lower than the risk associated with steroid treatment.

We await more information, but it is possible sirolimus might be a useful alternative treatment for people with Birdshot, especially for those who fail to achieve remission on the Cellcept (mycophenolate mofetil)/ cyclosporin formula.

Recent research into Vitamin D  reported in Food Consumer, the Daily Mail, and the Daily Express, amongst many, shows a potentially interesting relationship between Vitamin D levels  and eye health.  The research funded by the Biotechnology and Biological Sciences Research Council (BBSRC) have found that vitamin D reduces the effects of ageing in mouse eyes and improves the vision of older mice significantly.

The research was carried out by a team from the Institute of Ophthalmology at University College London and is published in the current issue of the journal Neurobiology of Ageing.

Professor Glen Jeffery, who led the work, explains “In the back of the eyes of mammals, like mice and humans, is a layer of tissue called the retina. Cells in the retina detect light as it comes into the eyes and then send messages to the brain, which is how we see. This is a demanding job, and the retina actually requires proportionally more energy than any other tissue in the body, so it has to have a good supply of blood. However, with ageing the high energy demand produces debris and there is progressive inflammation even in normal animals. In humans this can result in a decline of up to 30% in the numbers of light receptive cells in the eye by the time we are 70 and so lead to poorer vision.”

The researchers found that when old mice were given vitamin D for just six weeks, inflammation was reduced, the debris partially removed, and tests showed that their vision was improved.

Professor Jeffery said “Researchers need to run full clinical trials in humans before we can say confidently that older people should start taking vitamin D supplements, but there is growing evidence that many of us in the Western world are deficient in vitamin D and this could be having significant health implications.”

Birdshot Uveitis Society is very interested to find out more about this piece of research, particularly as one or two of our members have told us that they believe that vitamin D may have helped their eye problems.    We are contacting the researchers to  find out more about this.

Four important points to note:

• At this stage there is only scientific evidence that the eye sight of the mouse improves.  There have yet to be trials on humans.
• Too much Vitamin D can be harmful, so it needs to be monitored.
• We would never advocate that members add in extra supplements without first discussing  with the specialists who treat them.
• Seemingly harmless supplements can put extra strain on your liver and kidneys or interact with your other medications

BUS did not think that the results of this study were really that surprising, given the fact that immuno-suppressants suppress the immune system it is likely that you may suffer from infections of various sorts, whether it is cystitis, sinusitis, colds or flu or something more serious like cytomegalovirus colitis and viremia.

The following paper entitled “Cytomegalovirus colitis and viremia from mycophenolate mofetil monotherapy in birdshot chorioretinopathy” was published in Ocul. Immunol. Inflamm. 2011 Dec; vol. 19(6) pp. 450-2.

Author: Pantanelli SM, Khalifa YM

The paper describes a case of cytomegalovirus (CMV) viremia and colitis in a patient on mycophenolate mofetil (MMF) monotherapy for birdshot chorioretinopathy. It showed that treatment with MMF 1.5 g twice daily for 5 years led to leucopenia and a CD4 count of 299, which resulted in active CMV infection.

The papers conclusion was that treatment with MMF alone may put otherwise immune-competent individuals at risk for opportunistic CMV infection. It is hope that awareness of this possible association may allow for better monitoring, earlier detection, and treatment in future cases.

PMID: 22106917

URL – http://www.ncbi.nlm.nih.gov/pubmed/22106917?dopt=Citation

The link between HLA- A29 and Birdshot Chorioretinopathy is one that interests many people and the paper published by:  Brézin AP, Monnet D, Cohen JH, Levinson RD, on this subject asks the question:

Why do people of European descent tend to get Birdshot, whilst other ethnic groups who also carry the HLA A29 antigen do not?

The paper explains that there are two different subtypes of HLA29A:- HLA29:02 is most frequent in caucasians, whilst HLA29:01 is most frequent in Asians.

It used to be thought that the disease only appeared in people with the HLA-A29:02 version of the antigen.  The paper tells us that is no longer a valid argument.   It suggests that another factor, probably not HLA linked, is either protective in Asians and in Africans or, alternatively, triggers an autoimmune reactivity that is possibly present in Caucasians of european descent and absent in Asians and in Africans.

We might start to make progress if scientists can find the answer to what this might be.

We are trying to get hold of the full research paper so that we can review it in detail.

We came across a piece of French research (published in September 2011) that is very timely in reminding professionals that ICG – Indocyanine Green Angiography (green dye is injected into blood stream and quickly reaches the blood vessels at the back of the eye, which can then be photographed) is still a very useful tool for people with Birdshot as it can identify leakages that are hard to see by other methods such as Optical Coherence Technology (OCT).

This is yet another example of an ‘old’ method that, although superseded by a range of new methods, still has a part to play in our disease and should remain as one of the several monitoring and diagnostic tools used for Birdshot.

Here is an abstract from that research:

Desmettre T, Cohen SY, Devoisselle JM, Gaudric A

“A full interpretation of indocyanine green angiography images involves not only optical issues but also pharmacokinetic and biochemical aspects. These issues may involve biochemical changes in the fluorescence yield and the affinity of the molecule for lipoproteins and phospholipids. For age-related macular degeneration (AMD), the advent of photodynamic therapy and especially anti-VEGF drugs has increased the use of OCT in assessing treatment response and guiding retreatment. The ease and advantages of OCT have become increasingly associated with a decreasing interest in ICG angiography, which is becoming less well suited for the current management of AMD. An aging population, the efficacy of anti-VEGF drugs and the relative rarity of polypoidal choroidal vasculopathy (PCV) in Europe are factors contributing to our proportional increase in AMD patients. However, aside from AMD, the indications for ICG angiography remain little changed over the last decade: it remains important in diagnosing PCV and choroidal hemangiomas, since their prognosis and treatment are specific. Similarly, for certain inflammatory conditions such as Multiple Evanescent White Dot Syndrome (MEWDS) or Birdshot chorioretinitis, the value of ICG angiography remains significant. In addition, for the treatment of chronic Central Serous Chorioretinopathy, ICG angiography helps to find sites of leakage which otherwise might have been missed. The ICG angiographic appearance in this setting may also have prognostic value. Although the indications for ICG angiography are currently decreasing for AMD, these other conditions represent a large enough number of patients to justify the continued use of this original test, which remains complementary to other chorioretinal imaging techniques.”

The full article can be found at: http://www.ncbi.nlm.nih.gov/pubmed/21907446?dopt=Citation

Some of us with Birdshot are currently using adalimumab (Humira®). Rea from BUS is one of those people. We recently came across a study looking at the safety and effectiveness of long-term use of adalimumab for people with intermediate-, pan- and posterior-uveitis. This study is currently recruiting by invitation only as you do need to have been involved in the previous related studies in order to qualify.

It is being conducted across 63 locations in the US, Europe and the UK.  In the UK there are three sites: London, Bristol and Aberdeen.

This study is a Phase 3, open-label multicentre study designed to evaluate long-term safety and efficacy of adalimumab in a group of  adult subjects with non-infectious intermediate, posterior, or pan-uveitis.

If any of our members are enrolled in this study, we would be grateful for feed-back on this.

URL: Long term safety and efficacy of adalimumab in subjects with intermediate, posterior and panuveitis