The various multifocal choroidopathies differ in course, prognosis, and treatment. Here is an overview of various case examples.
The various multifocal choroidopathies differ in course, prognosis, and treatment. While the prognoses do differ, they are hopeful with early treatment in most cases.
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and multiple evanescent white dot syndrome (MEWDS) are self-limited, spontaneously remitting diseases for which treatment typically is not needed.
For both, the prognoses are reasonably good and excellent, according to Douglas Jabs, MD, MBA.
Roughly 75% of patients with APMPPE have a final visual acuity (VA) of 20/40; about 5% have a final VA of 20/200 or worse. Regarding treatment of APMPPE, administration of corticosteroids does not make a sizable difference in the visual outcomes compared with no treatment.
“There is little evidence regarding the benefit of corticosteroids for these patients,” noted Dr. Jabs, a professor of epidemiology, The Johns Hopkins University Bloomberg School of Public Health, and professor of ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore.
Likewise with MEWDS, the average VA outcome is very good, 20/21, and 95% of patients achieve 20/25 or better without treatment.
Patients with central nervous system or systemic vasculitis can have a scenario similar to APMPPE in the eye. The vasculitis should be treated with corticosteroids and immunosuppression.
Patients with birdshot chorioretinopathy (BSCR) lose vision as the result of macular edema and progressive visual field loss. Corticosteroids can effectively treat the macular edema but treatment with doses of 15 mg daily or less results in recurrence of the macular edema, and that dose is too high for safe use over the long term. A safe long-term dose is half of that dose (i.e. 7.5 mg/day or less).
Douglas Jabs, MD, MBA
This article is based on Dr. Jabs’ presentation at the American Academy of Ophthalmology 2019 annual meeting. Dr. Jabs has no financial interest in any aspect of this report. Most treatments referred to are administered on an off-label basis.