Update on imaging biomarkers in uveitis

To evaluate which imaging biomarkers in uveitis have approached clinical utility, which remain incompletely validated, and how consensus frameworks and artificial intelligence are reshaping the path toward standardized, decision-useful assessment.

Quantitative optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) metrics have gained disease-specific precision. Anterior segment OCT particle-size analysis differentiates inflammatory cells from pigment with high discriminative performance. OCTA vessel density tracks chronic microvascular loss in birdshot chorioretinopathy more reliably than it captures real-time inflammatory activity. Choroidal vascularity index shows promise as a subclinical choroidal marker, though cross-platform standardization remains unresolved. The multimodal uveitis (MUV) international taskforce has established consensus minimal imaging sets for five white dot syndromes, providing the first systematic effort to define which modality is essential for diagnosis, activity monitoring, and complication detection in specific entities. Artificial intelligence applications have demonstrated proof-of-concept performance, but translation is constrained by small datasets and absent prospective validation.

Most proposed imaging biomarkers remain disease-specific and incompletely validated. Recent quantitative approaches and international consensus frameworks may narrow the gap between descriptive imaging and actionable, trial-ready biomarkers. The bottleneck has shifted from image acquisition to validation, harmonization, and integration with clinical outcomes.