Deconstructing White Dot Syndromes-Multimodal Imaging in Uveitis (MUV) Taskforce: Report 11

Area of Science:

• Ophthalmology
• Immunology
• Medical Imaging

Background:

• The term "white dot syndromes" (WDS) historically groups diverse non-infectious posterior uveitis (NIPU) entities based on funduscopic appearance.
• The clinical relevance of the umbrella WDS terminology has been questioned due to potential heterogeneity among these conditions.

Purpose of the Study:

• To critically examine the validity of the WDS construct in light of advanced retinal and choroidal imaging.
• To evaluate whether current imaging technologies support a unified classification for these NIPU entities.

Main Methods:

• Perspective review of literature on imaging and pathophysiology of NIPU.
• Analysis of high-resolution OCT, OCT angiography (OCTA), and indocyanine green angiography (ICGA) findings.
• Focus on six classically defined WDS entities: MEWDS, MFCPU, PIC, APMPPE, SC, and BSCR.

Main Results:

• Multimodal imaging demonstrates distinct anatomic features and patterns of tissue involvement for each NIPU.
• OCT/OCTA reveal specific damage patterns: photoreceptor/RPE injury (MEWDS), Bruch's membrane disruption (MFCPU/PIC), choriocapillaris ischemia (APMPPE/SC), and choroidal infiltration (BSCR).
• ICGA differentiates choroidal perfusion, distinguishing vascular non-perfusion from other inflammatory damage.

Conclusions:

• The WDS classification overlooks significant biological and prognostic differences among NIPU.
• Imaging-based immunopathogenesis hypotheses suggest distinct pathways for each condition.
• A paradigm shift towards disease-specific terminology is necessary for diagnostic precision and tailored management.