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American Journal of Opthalmology

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Minimum Imaging Sets for Diagnosis, Activity Assessment, and Complications in Noninfectious Posterior Uveitis - Multimodal Imaging in Uveitis (MUV) Task Force Report 9 - 18/11/25

Doi : 10.1016/j.ajo.2025.07.029 
Alessandro Invernizzi 1, 2, ⁎ , Aniruddha Agarwal 3, 4, Sapna Gangaputra 5, Matteo Airaldi 6, 7, 8, Ester Carreno 9, Marion R. Munk 10, 11, 12, Francesco Pichi 3, 4, Jessica Shantha 13, Rupesh Agrawal 14, 15, 16, 17, SriniVas Sadda 18, Lee M. Jampol 12, Justine R. Smith 19, Douglas A. Jabs 20, 21, Soon Phaik Chee 22, David Sarraf 23, Vishali Gupta 24, ⁎
on behalf of the

Multimodal Imaging in Uveitis (MUV) Task Force #

  Complete list of Multimodal Imaging in Uveitis (MUV) Task Force members in Appendix A.
Alejandra de-la-Torre 25, Alejandro Fonollosa 26, Alessandro Invernizzi 27, 28, Amani Fawzi 29, Andrew Dick 30, 31, 32, 33, Aniruddha Agarwal 34, 35, Anita Agarwal 36, 37, Antoine Brezin 38, Ariel Schlaen 39, Bahram Bodaghi 40, Claudia Fabiani 41, David Sarraf 42, Debra A. Goldstein 43, Dilraj Grewal 44, Douglas A. Jabs 45, 46, Edmund Tsui 47, Elisabetta Miserocchi 48, 49, Ester Carreño 50, Francesco Pichi 51, Ilknur Tugal-Tutkun 52, Inês Leal 53, 54, Janet L. Davis 55, Jeannette Ossewaarde-van Norel 56, Jennifer E. Thorne 57, Jessica G. Shantha 58, Jose S. Pulido 59, Justine R. Smith 60, Jyotirmay Biswas 61, K. Bailey Freund 62, 63, Kathryn Pepple 64, Lee M. Jampol 65, Luca Cimino 66, 67, Marc De Smet 68, Maria Vittoria Cicinelli 69, Marion R. Munk 70, Massimo Accorinti 71, Maura Di Nicola 72, Meghan Berkenstock 73, Michael Altaweel 74, 75, Phoebe Lin 76, Quan Dong Nguyen 77, Richard Spaide 78, Rupesh Agrawal 79, 80, 81, Sapna S. Gangaputra 82, Soon Phaik Chee 83, Srinivas Sadda 84, Sumit Sharma 85, Timothy M. Janetos 86, Vishali Gupta 87, Zohar Habot-Wilner 88
25 Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia 
26 Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain 
27 Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy 
28 Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia 
29 Northwestern University Feinberg School of Medicine, Chicago, USA 
30 University of Bristol, UK 
31 Bristol Eye Hospital, UK 
32 Institute of Ophthalmology, University College London, London, UK 
33 National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK 
34 Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates 
35 Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA 
36 California Pacific Medical Center (CPMC), San Francisco, CA, USA 
37 West Coast Retina, San Francisco, CA, USA 
38 Department of Ophthalmology, Ophtalmopôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université Paris Cité, 75014, Paris, France 
39 Hospital Universitario Austral, Derqui-Pilar, Argentina 
40 Department of Ophthalmology, IHU FOReSIGHT, Pitié-Salpêtrière Universtiy Hospital, Paris, France 
41 Ophthalmology Unit, Department of Medicine, 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 
42 Stein Eye Institute, University of California, Los Angeles, California, USA 
43 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA 
44 Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA 
45 Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 
46 Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA 
47 Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA 
48 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy 
49 Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy 
50 Hospital Universitario La Paz, Madrid, Spain 
51 Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates 
52 Department of Ophthalmology, Istanbul University, Istanbul, Turkey 
53 Department of Ophthalmology, Hospital de Santa Maria, Unidade Local de Saúde (ULS) Santa Maria, Lisbon, PRT 
54 Rheumatology Research Unit and Centro de Estudos Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal 
55 Department of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL, USA 
56 University Medical Center Utrecht, Utrecht, the Netherlands 
57 Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 
58 Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, USA 
59 Wills Eye Hospital, Thomas Jefferson University Philadelphia, PA 
60 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia 
61 Uveitis & Ocular Pathology Department, Sankara Nethralaya, Chennai, India 
62 Vitreous Retina Macula Consultants of New York, New York, USA 
63 Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA 
64 Department of Ophthalmology, University of Washington, Seattle, USA 
65 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA 
66 Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy 
67 Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy 
68 Micro Invasive Ocular Surgery Clinic, Lausanne, Switzerland 
69 Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy 
70 Augenarzt Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland 
71 IRCCS Fondazione Bietti, Rome, Italy 
72 Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA 
73 Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 
74 Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA 
75 McPherson Eye Research Institute, University of Wisconsin - Madison, WI, USA 
76 Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, USA 
77 Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA 
78 Vitreous Retina Macula Consultants of New York, New York, USA 
79 National Healthcare Group Eye institute, Tan Tock Seng Hospital, Singapore 
80 LKC School of Medicine, Nanyang Technological University, Singapore 
81 Duke NUS Medical School, Singapore 
82 Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA 
83 Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore 
84 Doheny Eye Institute, University of California – Los Angeles, California, USA 
85 Cleveland  Clinic Foundation, Cole Eye Institute, Cleveland, USA 
86 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA 
87 Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India 
88 Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel 

1 From the Department of Biomedical and Clinical Science (A.I.), Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy 
2 Department of Ophthalmology (A.I.), Save Sight Institute, University of Sydney, Sydney, Australia 
3 Eye Institute (A.A. and F.P.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, UAE 
4 Cleveland Clinic Lerner College of Medicine (A.A. and F.P.), Cleveland, Ohio, USA 
5 Vanderbilt Eye Institute (S.G.), Vanderbilt University Medical Center, Nashville, Tennessee, USA 
6 St Paul’s Eye Unit (M.A.), Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK 
7 Department of Eye and Vision Science (M.A.), University of Liverpool, Liverpool, UK 
8 Department of Molecular and Translational Medicine (M.A.), University of Brescia, Brescia, Italy 
9 Hospital Universitario La Paz (E.C.), Madrid, Spain 
10 Augenarzt Praxisgemeinschaft Gutblick (M.R.M.), Pfäffikon, Switzerland 
11 Department of Ophthalmology (M.R.M.), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 
12 Department of Ophthalmology (M.R.M. and L.M.J.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA 
13 Department of Ophthalmology (J.S.), University of California, San Francisco, California, USA 
14 National Healthcare Group Eye Institute (R.A.), Tan Tock Seng Hospital, Singapore, Singapore 
15 LKC School of Medicine (R.A.), Nanyang Technological University, Singapore, Singapore 
16 Duke NUS Medical School (R.A.), Singapore, Singapore 
17 Ocular Infections and Antimicrobials (R.A.), Singapore Eye Research Institute, Singapore, Singapore 
18 Doheny Eye Institute (S.S.), University of California – Los Angeles, Los Angeles, California, USA 
19 Flinders Health and Medical Research Institute and College of Medicine and Public Health (J.R.S.), Flinders University, Adelaide, South Australia, Australia 
20 Department of Ophthalmology (D.A.J.), Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Baltimore, USA 
21 Department of Epidemiology (D.A.J.), Center for Clinical Trials and Evidence Synthesis, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 
22 Singapore National Eye Center (S.P.C.), Singapore, Singapore 
23 Stein Eye Institute (D.S.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA 
24 Advanced Eye Centre (V.G.), Postgraduate Institute of Medical Education and Research, Chandigarh, India 

⁎ Inquiries to Alessandro Invernizzi, Department of Biomedical and Clinical Science, Eye Clinic, University of Milan, Via G.B. Grassi 74, Milan, 20157, Italy. Department of Biomedical and Clinical Science Eye Clinic University of Milan Via G.B. Grassi 74 Milan 20157 Italy ⁎⁎ Vishali Gupta, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. Department of Biomedical and Clinical Science Eye Clinic University of Milan Via G.B. Grassi 74 Milan 20157 Italy

Résumé

Purpose

To evaluate a minimum imaging set (MIS) to support ophthalmologists in diagnosing, monitoring disease activity, and identifying disease-specific complications for six types of noninfectious posterior uveitides (NIPU).

Design

Visual questionnaire answered live by a group of ophthalmologists.

Participants

International group of ophthalmologists, including uveitis experts, medical retina experts, general ophthalmologists, and ophthalmologists-in-training.

Methods

Five groups of uveitis experts were selected by the Multimodal Imaging in Uveitis (MUV) taskforce and asked to create an MIS for each of the following entities: multiple evanescent white dots syndrome (MEWDS), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multifocal choroiditis and panuveitis, punctate inner choroidopathy (PIC), serpiginous choroiditis and birdshot chorioretinopathy. The MIS were designed to improve an ophthalmologists’ ability to diagnose and manage these NIPU without the need for a complete multimodal imaging approach. Five visual questionnaires, including the color fundus photography (CFP), used as a proxy for funduscopic examination, and the MIS of a series of cases, were constructed and proposed to the group of ophthalmologists. The number of correct answers achieved by participants reviewing the MIS was compared to those obtained by examining the CFP alone.

Main Outcome Measures

Sensitivity, specificity, and accuracy of MIS as compared to CFP alone in diagnosing, assessing activity, and identifying complications in NIPU.

Results

A total of 156 ophthalmologists participated in the visual questionnaire. For diagnostic purposes, the MIS outperformed CFP in MEWDS, APMPPE and birdshot chorioretinopathy. For assessing activity, MIS allowed participants to achieve significantly better results in all NIPU but APMPPE. Identification of complications (choroidal neovascularization) was tested in serpiginous choroiditis, and multifocal choroiditis, and panuveitis/punctate inner choroidopathy only, and in both cases, MIS outperformed CFP alone. The MIS performance was not significantly influenced by ophthalmologists’ level of training or geographical region of practice. The MIS outperformed CFP both in classic and challenging cases, but it exceeded 75% accuracy only in classic cases.

Conclusions

The validation exercise confirmed the utility of most of the proposed MIS. These MIS increased the ability of ophthalmologists to diagnose and manage most cases of NIPU regardless of physicians’ background and clinical setting. A complete multimodal imaging approach is still needed for more challenging phenotypes.

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Plan


 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 Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 280

P. 106-119 - décembre 2025 Retour au numéro
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