The heterogeneity of uveitis continues to confound even the most highly trained uveitis specialists. Myriad disease manifestations allow for variability in disease presentation, and, for many years the uveitis community failed to rely on a single lexicon when presenting study results from the podium. In 2005, the Standardization of Uveitis Nomenclature Working Group published the results of its first international workshop, providing physicians with a common language to describe uveitis features and clinical trial endpoints.1

The standardization of nomenclature, however, is more than a decade old. Although the disease itself has not changed, physicians’ understanding of treatment effects and disease progression has evolved as imaging technology has matured. Many of these imaging techniques were in development or nonexistent during the Uveitis Nomenclature Working Group’s inaugural meeting, meaning that quantification of disease qualities proved difficult. However, the group agreed that vitreous haze (VH) could serve as a metric to describe uveitis, and an effort to quantify VH scores was completed. Thus, for many years, uveitis specialists have relied on VH as the chief metric used to measure uveitis disease severity and progression.

Subjectivity is an inherent problem with VH scoring. In a recent article in Retina Today, Sarju Patel, MD, and Debra Anne Goldstein, MD, explained that a physician scores VH by comparing a patient’s presentation with a series of photographs provided by the National Eye Institute.2 In some cases, uveitis specialists could score a patient’s VH differently, thus lending credence to the notion that interpretive variation is a real problem for uveitis researchers.

Just as our measurements for success in clinical trials involving treatments for diseases such age-related macular degeneration, diabetic eye disease, and retinal vein occlusions rely in part on objective measurements such as central retinal thickness, so too should uveitis trials rely in part on objective measurement obtained from sophisticated imaging technologies such as enhanced-depth optical coherence tomography and widefield imaging. We recognize that the multivariate nature of uveitis will likely require a composite scoring system to reliably measure objective and subjective patient response to therapy; so too do we recognize that mastering the best recipe for such a composite scoring system will take years to perfect and require adjustment as technology advances. Still, to rely on VH as the primary metric for response to treatment—as the US Food and Drug Administration does—strikes us as antiquated in an era of ever evolving technology.

1.  Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509-516.

2.  Patel S, Goldstein DA. Assessing uveitis: beyond vitreous haze. Retina Today. 2016; 11(7):34-35.

 

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