Evidence and Consensus Based Imaging Guidelines in Multiple Evanescent White Dot Syndrome Multimodal imaging in Uveitis (MUV) Taskforce Report 6
Year: 2025
Type: article
Abstract: PURPOSE: To develop imaging and consensus-based guidelines on the application of multimodal imaging in multiple evanescent white dot syndrome (MEWDS). DESIGN: Consensus agreement guided by literature, and an expert committee using a nominal group technique (NGT). METHODS: The expert committee employed a structured NGT with multiple rounds of discussion, conflict resolution, and anonymous voting to: (1) establish imaging criteria for diagnosing and monitoring MEWDS using color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA); and (2) develop consensus-based recommendations for assessing specific characteristics in patients with MEWDS. These formal recommendations were derived from a structured NGT using illustrative cases of MEWDS and were further voted upon by the entire task force. RESULTS: The diagnosis of acute MEWDS is supported by distinct multimodal features on CFP, multi-focal disruption of the ellipsoid/interdigitation zone with overlying outer retinal hyper-reflectivity with OCT, and hyper-autofluorescent spots with FAF (short-wave blue/green). In complex cases, wreath-like lesions on FFA and the absence of early hypofluorescence on ICGA help differentiate MEWDS from other chorioretinopathies. The lack of specific choroidal changes on OCT and preserved signal on OCTA on retinal and inner choroidal slabs also aid in diagnosis. CONCLUSIONS: Multimodal imaging is essential for diagnosing MEWDS and differentiating it from other non-infectious uveitis types, extending the Standardization of Uveitis Nomenclature (SUN) classification. These imaging criteria enable detailed assessment of disease activity and offer valuable insights into MEWDS pathogenesis.
Authors: Marion R. Munk, Marion R. Munk, Richard Stillenmunkes, Anne Tillmann, Lee M. Jampol, Maria Vittoria Cicinelli, Phoebe Lin, Kathryn L. Pepple, K. Bailey Freund, Ilknur Tugal-Tutkun, Zohar Habot-Wilner, Aniruddha Agarwal, Sapna Gangaputra, Rupesh Agrawal, Douglas A. Jabs, SriniVas Sadda, David Sarraf, Vishali Gupta, Vishali Gupta, Alejandra de-la-Torre, Alejandro Fonollosa, Alessandro Invernizzi, Amani Fawzi, Andrew Dick, Aniruddha Agarwal, Anita Agarwal, Antoine Brezin, Ariel Schlaen, Bahram Bodaghi, Claudia Fabiani, David Sarraf, Debra A. Goldstein, Dilraj Grewal, Douglas A. Jabs, Edmund Tsui, Elisabetta Miserocchi, Ester Carreño, Francesco Pichi, Ilknur Tugal-Tutkun, Inês Leal, Janet L. Davis, Jeannette Ossewaarde- van Norel, Jennifer E. Thorne, Jessica G. Shantha, Jose S. Pulido, Justine R. Smith, Jyotirmay Biswas, K. Bailey Freund, Kathryn Pepple, Lee M. Jampol, Luca Cimino, Marc De Smet, Maria Vittoria Cicinelli, Marion R. Munk, Marion R. Munk, Massimo Accorinti, Maura Di Nicola, Meghan Berkenstock, Michael Altaweel, Phoebe Lin, Quan Dong Nguyen, Richard Spaide, Rupesh Agrawal, Sapna S. Gangaputra, Soon Phaik Chee, Srinivas Sadda, Sumit Sharma, Timothy M. Janetos, Vishali Gupta, Vishali Gupta, Zohar Habot-Wilner
Institutions: Northwestern University, University of Bern, University Hospital of Bern, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, Cleveland Clinic, University of Washington, Vitreous Retina Macula Consultants of New York, New York University, Tel Aviv University, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Abu Dhabi, Vanderbilt University Medical Center, The University of Sydney, National University of Singapore, Nanyang Technological University, Singapore Eye Research Institute, Duke-NUS Medical School, Johns Hopkins University, University of California, Los Angeles, Doheny Eye Institute, Post Graduate Institute of Medical Education and Research, Universidad del Rosario, University of the Basque Country, BioCruces Health research Institute, Hospital de Cruces, University of Milan, Luigi Sacco Hospital, National Institute for Health and Care Research, University of Bristol, Bristol Eye Hospital, Moorfields Eye Hospital, University College London, Université Paris Cité, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Hospital Universitario Austral, Pitié-Salpêtrière Hospital, University of Siena, Azienda Ospedaliera Universitaria Senese, Duke University, Duke Medical Center, Vita-Salute San Raffaele University, Hospital Universitario Fundación Jiménez Díaz, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, University of Miami, University Medical Center Utrecht, Johns Hopkins Medicine, University of California, San Francisco, Thomas Jefferson University, Wills Eye Hospital, Flinders University, Sankara Nethralaya, University of Modena and Reggio Emilia, Fondazione G.B. Bietti, University of Wisconsin–Madison, Stanford University, Singapore National Eye Center
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
Funders: AstraZeneca, Alnylam Pharmaceuticals, University of Miami, Northwestern University, Cleveland Clinic, University of Washington, Johns Hopkins University, Novartis Pharmaceuticals Corporation, Thomas Jefferson University, Università Degli Studi di Modena e Reggio Emila, Regeneron Pharmaceuticals, Alimera Sciences, Apellis Pharmaceuticals, Flinders University, Heidelberg Engineering, Genentech, Allergan, University of California, San Francisco, Feinberg School of Medicine, Johns Hopkins Bloomberg School of Public Health, Leonard M. Miller School of Medicine, Novartis Pharma, NYU Grossman School of Medicine, Janssen Pharmaceuticals
OpenAlex ID: W4411605967