Evidence and Consensus Based Imaging Guidelines in Multiple Evanescent White Dot Syndrome Multimodal imaging in Uveitis (MUV) Taskforce Report 6 - 13/09/25
Doi : 10.1016/j.ajo.2025.06.039
Marion R. Munk 1, 2, 3, #, ⁎ 
, Richard Stillenmunkes 1, 2, #, Anne Tillmann 1, Lee M. Jampol 3, Maria Vittoria Cicinelli 4, Phoebe Lin 5, Kathryn L. Pepple 6, 7, K. Bailey Freund 8, 9, Ilknur Tugal-Tutkun 10, Zohar Habot-Wilner 11, 12, Aniruddha Agarwal 13, 14, Sapna Gangaputra 15, Rupesh Agrawal 16, 17, 18, Douglas A. Jabs 19, 20, SriniVas Sadda 21, 22, David Sarraf 23, Vishali Gupta 24, ⁎
on behalf of the
, Richard Stillenmunkes 1, 2, #, Anne Tillmann 1, Lee M. Jampol 3, Maria Vittoria Cicinelli 4, Phoebe Lin 5, Kathryn L. Pepple 6, 7, K. Bailey Freund 8, 9, Ilknur Tugal-Tutkun 10, Zohar Habot-Wilner 11, 12, Aniruddha Agarwal 13, 14, Sapna Gangaputra 15, Rupesh Agrawal 16, 17, 18, Douglas A. Jabs 19, 20, SriniVas Sadda 21, 22, David Sarraf 23, Vishali Gupta 24, ⁎ on behalf of the
Multimodal Imaging in Uveitis (MUV) Taskforce†
Alejandra de-la-Torre 25, Alejandro Fonollosa 26, Alessandro Invernizzi 17, 27, Amani Fawzi 28, Andrew Dick 29, Aniruddha Agarwal 30, Anita Agarwal 31, 32, Antoine Brezin 33, Ariel Schlaen 34, Bahram Bodaghi 35, Claudia Fabiani 36, David Sarraf 37, Debra A. Goldstein 38, Dilraj Grewal 39, Douglas A. Jabs 40, 41, Edmund Tsui 42, Elisabetta Miserocchi 43, 44, Ester Carreño 45, Francesco Pichi 46, Ilknur Tugal-Tutkun 47, Inês Leal 48, Janet L. Davis 49, Jeannette Ossewaarde- van Norel 50, Jennifer E. Thorne 51, Jessica G. Shantha 52, Jose S. Pulido 53, Justine R. Smith 54, Jyotirmay Biswas 55, K. Bailey Freund 56, 57, Kathryn Pepple 58, Lee M. Jampol 59, Luca Cimino 60, 61, Marc De Smet 62, Maria Vittoria Cicinelli 63, Marion R. Munk 64, Massimo Accorinti 65, Maura Di Nicola 66, Meghan Berkenstock 67, Michael Altaweel 68, 69, Phoebe Lin 70, Quan Dong Nguyen 71, Richard Spaide 72, Rupesh Agrawal 73, 74, Sapna S. Gangaputra 75, Soon Phaik Chee 76, Srinivas Sadda 77, Sumit Sharma 78, Timothy M. Janetos 79, Vishali Gupta 80, Zohar Habot-Wilner 81
17 Department of Ophthalmology (R.A., A.I.), Save Sight Institute, University of Sydney, Sydney, Australia
25 Neuroscience Research Group (NEUROS) (A.D.), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
26 Department of Ophthalmology (A.F.), Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
27 Eye Clinic (A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
28 Northwestern University Feinberg School of Medicine (A.F.), Chicago, USA
29 University of Bristol (A.D.), UK; Bristol Eye Hospital, UK; Institute of Ophthalmology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
30 Eye Institute (A.A.), Cleveland Clinic, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
31 California Pacific Medical Center (CPMC) (A.A.), San Francisco, California, USA
32 West Coast Retina (A.A.), San Francisco, California, USA
33 Department of Ophthalmology (A.B.), Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris Cité, Paris, France
34 Hospital Universitario Austral (A.S.), Derqui-Pilar, Argentina
35 Department of Ophthalmology (B.B.), IHU FOReSIGHT, Pitié-Salpêtrière Universtiy Hospital, Paris, France
36 Ophthalmology Unit, Department of Medicine (C.F.), Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Sienna, Italy
37 Stein Eye Institute, University of California (D.S.), Los Angeles, California, USA
38 Department of Ophthalmology (D.G.), Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
39 Department of Ophthalmology (D.G.), Duke University School of Medicine, Durham, North Carolina, USA
40 Center for Clinical Trials and Evidence Synthesis (D.J.), Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
41 Department of Ophthalmology(D.J.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
42 Stein Eye Institute (E.T.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA
43 School of Medicine (E.M.), Vita-Salute San Raffaele University, Milan, Italy
44 Department of Ophthalmology (E.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy
45 Hospital Universitario Fundación Jiménez Díaz (E.C.), Madrid, Spain
46 Eye Institute, Cleveland Clinic (F.P.), Abu Dhabi, United Arab Emirates
47 Department of Ophthalmology (I.T.), Istanbul University, Istanbul, Turkey
48 Centro Hospitalar Universitário Lisboa Norte (I.L.), Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
49 Department of Ophthalmology (J.D.), University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida, USA
50 University Medical Center Utrecht (J.V.), Utrecht, The Netherlands
51 Wilmer Eye Institute (J.T.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
52 Francis I. Proctor Foundation (J.S.), Department of Ophthalmology, University of California, San Francisco, USA
53 Wills Eye Hospital (J.P.), Thomas Jefferson University Philadelphia, Pennsylvania, USA
54 College of Medicine and Public Health (J.S.), Flinders University, Adelaide, South Australia, Australia
55 Uveitis & Ocular Pathology Department (J.B.), Sankara Nethralaya, Chennai, India
56 Vitreous Retina Macula Consultants of New York (K.F.), New York, USA
57 Department of Ophthalmology (K.F.), NYU Grossman School of Medicine, New York, New York, USA
58 Department of Ophthalmology (K.P.), University of Washington, Seattle, USA
59 Department of Ophthalmology (L.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
60 Ocular Immunology Unit (L.C.), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
61 Department of Surgery (L.C.), Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
62 Micro Invasive Ocular Surgery Clinic (M.D.), Lausanne, Switzerland
63 Department of Ophthalmology (M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
64 Augenarzt Praxisgemeinschaft Gutblick (M.M.), Pfäffikon, Switzerland
65 IRCSS Fondazione Bietti (M.A.), Rome, Italy
66 Bascom Palmer Eye Institute (M.N.), University of Miami Miller School of Medicine, Miami, Florida, USA
67 Wilmer Eye Institute (M.B.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
68 Department of Ophthalmology and Visual Sciences (M.A.), University of Wisconsin, Madison, Wisconsin, USA
69 McPherson Eye Research Institute (M.A.), University of Wisconsin, Madison, Wisconsin, USA
70 Cleveland Clinic Foundation (P.L.), Cole Eye Institute, Cleveland, USA
71 Spencer Center for Vision Research (Q.N.), Byers Eye Institute, Stanford University, Palo Alto, California, USA
72 Vitreous Retina Macula Consultants of New York (R.S.), New York, USA
73 National Healthcare Group Eye institute (R.A.), Tan Tock Seng Hospital, Singapore
74 LKC School of Medicine (R.A.), Nanyang Technological University, Singapore; Duke NUS Medical School, Singapore
75 Vanderbilt Eye Institute (S.G.), Vanderbilt University Medical Center, Nashville, Tennessee, USA
76 Department of Ocular Inflammation and Immunology (S.C.), Singapore National Eye Centre, Singapore
77 Doheny Eye Institute (S.S.), University of California – Los Angeles, Los Angeles, California, USA
78 Cleveland Clinic Foundation (S.S.), Cole Eye Institute, Cleveland, USA
79 Department of Ophthalmology (T.J.), Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
80 Advanced Eye Centre (V.G.), Postgraduate Institute of Medical Education and Research, Chandigarh, India
81 Tel Aviv Medical Center (Z.H.), Tel Aviv University, Tel Aviv, Israel
1 From the Augenarzt Praxisgemeinschaft Gutblick (M.M., R.S., A.T.), Pfäffikon, Switzerland
2 Department of Ophthalmology (M.M., R.S.), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
3 Department of Ophthalmology (M.M., L.J.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
4 Department of Ophthalmology (M.V.C), IRCCS San Raffaele Scientific Institute, Milan, Italy
5 Cole Eye Institute (P.L.), Cleveland Clinic Foundation, Cleveland, Ohio, United States
6 Department of Ophthalmology (K.P.), University of Washington, Seattle, Washington State, USA
7 Roger and Angie Karalis Johnson Retina Center (K.P.), University of Washington School of Medicine, Seattle, Washington State, USA
8 Vitreous Retina Macula Consultants of New York (K.F.), New York, New York, USA
9 Department of Ophthalmology (K.F.), NYU Grossman School of Medicine, New York, New York, USA
10 Uveitis Service (I.T.), Eye Protection Foundation Bayrampasa Eye Hospital, Istanbul, Turkey
11 Division of Ophthalmology (Z.H.), Tel Aviv Medical Center, Tel Aviv, Israel
12 School of Medicine (Z.H.), Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
13 Eye Institute (A.A.), Cleveland Clinic Abu Dhabi, United Arab Emirates (UAE)
14 Cleveland Clinic Lerner College of Medicine (A.A.), Cleveland, Ohio, USA
15 Vanderbilt Eye Institute (S.G.), Vanderbilt University Medical Center, Nashville, Tennessee, USA
16 LKC School of Medicine (R.A.), Nanyang Technological University, Singapore
17 Department of Ophthalmology (R.A., A.I.), Save Sight Institute, University of Sydney, Sydney, Australia
18 Duke NUS Medical School (R.A.), Singapore; Ocular Infections and AntiMicrobials, Singapore Eye Research Institute, Singapore
19 Center for Clinical Trials and Evidence Synthesis (D.J.), Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
20 Wilmer Eye Institute (D.J.), The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
21 Doheny Eye Institute (S.S.), Pasadena, California, USA
22 Department of Ophthalmology (S.S.), University of California, Los Angeles, Los Angeles, California, USA
23 Stein Eye Institute (D.S.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA
24 Department of Ophthalmology (V.G.), Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
⁎Inquiries to Marion Munk, Augenarzt Praxisgemeinschaft Gutblick, Pfäffikon, SwitzerlandAugenarzt Praxisgemeinschaft GutblickPfäffikonSwitzerland⁎⁎Inquiries to Vishali Gupta, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
Résumé |
Purpose |
To develop imaging and consensus-based guidelines on the application of multimodal imaging in multiple evanescent white dot syndrome (MEWDS).
Design |
Consensus agreement guided by literature, and an expert committee using a nominal group technique (NGT).
Methods |
The expert committee employed a structured NGT with multiple rounds of discussion, conflict resolution, and anonymous voting to: (1) establish imaging criteria for diagnosing and monitoring MEWDS using color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA); and (2) develop consensus-based recommendations for assessing specific characteristics in patients with MEWDS. These formal recommendations were derived from a structured NGT using illustrative cases of MEWDS and were further voted upon by the entire task force.
Results |
The diagnosis of acute MEWDS is supported by distinct multimodal features on CFP, multi-focal disruption of the ellipsoid/interdigitation zone with overlying outer retinal hyper-reflectivity with OCT, and hyper-autofluorescent spots with FAF (short-wave blue/green). In complex cases, wreath-like lesions on FFA and the absence of early hypofluorescence on ICGA help differentiate MEWDS from other chorioretinopathies. The lack of specific choroidal changes on OCT and preserved signal on OCTA on retinal and inner choroidal slabs also aid in diagnosis.
Conclusions |
Multimodal imaging is essential for diagnosing MEWDS and differentiating it from other non-infectious uveitis types, extending the Standardization of Uveitis Nomenclature (SUN) classification. These imaging criteria enable detailed assessment of disease activity and offer valuable insights into MEWDS pathogenesis.
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| This invited article was submitted as part of the Virtual Special Issue on Multimodal Imaging of Non-Infectious Posterior Uveitis by the The International Uveitis Study Group MUV Working Group. |
© 2025
The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 278
P. 191-202 - octobre 2025 Retour au numéro
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