Quantitative Imaging for Assessing Uveitis Activity: A Comprehensive Review Publisher



Nabavi A ; Zarei M ; Shome A ; Rupenthal ID ; Caspi RR ; Davis J ; Yousefi S
Source: Survey of Ophthalmology Published:2026

Abstract

Assessment of uveitis activity is critical for guiding treatment and monitoring outcomes. Conventional measures, however, are largely subjective and heterogeneous. Advances in ocular imaging have increasingly enabled a shift from qualitative clinical grading to quantitative approaches. In the anterior chamber and vitreous, optical coherence tomography (OCT)-based signatures offer repeatable and potentially reproducible surrogates for inflammatory cell count and haze quantification. Similarly, quantitative fundus fluorescein angiography offers leakage and non-perfusion measures beyond traditional semi-quantitative scores, while OCT angiography (OCTA) provides noninvasive assessment of retinal vascular density. At the retinal tissue level, OCT signatures have been expanded beyond central subfield thickness to include perivascular mapping and ultrastructural parameters such as ellipsoid zone integrity and disorganization of the retinal inner layers. Choroidal biomarkers, including thickness, vascularity index, and OCTA-derived flow parameters, have improved understanding of choroidal involvement in specific uveitic entities and show promise as potential endpoints. Peripapillary OCT and OCTA extend activity assessment to the optic nerve, introducing additional structural and microvascular metrics. Composite indices, including clinician-derived scales, imaging-based scores, and end-to-end artificial intelligence-based grading systems, have also been recently proposed. Across these modalities, methods have evolved from manual to semi-automated and now fully automated pipelines; however, clinical translation requires rigorous validation, including assessment of construct validity, responsiveness to change, and reproducibility across devices.We summarize current strategies for quantifying uveitis activity, their applications, limitations, and future directions toward standardized, objective endpoints. © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/