Imaging‐Based Uveitis Surveillance in Juvenile Idiopathic Arthritis: Feasibility, Acceptability, and Diagnostic Performance

Abstract

Objective Children with juvenile idiopathic arthritis (JIA) need regular examinations for uveitis to avoid visual morbidity from the most common extraarticular manifestation of disease. This study was undertaken to investigate the feasibility, acceptability, and performance of optical coherence tomography (OCT) imaging‐based diagnosis of uveitis. Methods This observational cross‐sectional study included children with and those without uveitis. The children underwent routine clinical examinations and anterior segment OCT scanning of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analog scale and length of time needed to acquire images. Interobserver and intraobserver variability of manual counting of acquired images (Bland‐Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of anterior segment OCT detection of active inflammation were assessed. Results Of the 26 children ages 3–15 years (median age 8 years) who underwent imaging, 12 had active inflammation. All patients rated the acceptability of image acquisition as at least 8.5 on a scale of 0–10. Time taken to acquire images ranged from 1.5 minutes to 22 minutes (median time 8 minutes). There was good positive correlation between clinical assessment and image‐based cell quantification (R2 = 0.63, P = 0.002). Sensitivity of anterior segment OCT manual image cell count for diagnosis of active inflammation was 92% (95% confidence interval [95% CI] 62–99%), specificity was 86% (95% CI 58–98%), and negative predictive value (ruling out uveitis) was 92% (95% CI 65–99%). Conclusion Non‐contact, high‐resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming pediatric practice. Further work is needed to determine the analytic and clinical validity of anterior segment OCT quantification of active inflammation, and the clinical utility and cost‐effectiveness of imaging‐based disease monitoring.

Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis

“…16,17 Thus, the more robust cell markers have been used in this study. This study is also limited by the relatively small number of eyes at the higher grades of inflammation (+3 and +4 SUN ACC), a limitation typical of studies of anterior uveitis, 11,12,16,17 reflecting the 'real-world' distribution of disease severity.…”

“…Children and their family were shown an image of hyper-reflective particles ('cells') on a cross sectional AS-OCT from a previous study 12 as part of the participant information procedure, asked to rate the acceptability of image acquisition on a 10cm visual analogue scale ("What did you think of the scan"), and invited to comment ("Please let us know if you have any other comments") on study aims.…”

“…Recent studies have reported that anterior segment optical coherence tomography (AS-OCT) quantification of inflammation is feasible, with reasonable diagnostic indices, 11,12 but there is little evidence on the repeatability and responsiveness of imaging derived metrics. We aimed to address this evidence gap, and describe the performance of AS-OCT in a paediatric population.…”

Development of a Nationally Agreed Core Clinical Dataset for Childhood Onset Uveitis

“…Our findings of low adoption of LFP across the UK is consistent with other evidence of poor uptake of the technology internationally ( 44 ). Anterior segment optical coherence tomography (AS-OCT) scanning may, in future, provide validated objective metrics of disease activity ( 45 , 46 ), with AS-OCT being another potential addition in an updated dataset.…”

Multimodal imaging in pediatric uveitis

“…In a feasibility study, AS-OCT was found to be reliable and well-tolerated for quantitative evaluation of JIA-associated uveitis. 47 Using a cohort of children with uveitis and normal controls, Akbarali et al 47 evaluated the correlation of AS-OCT cell with slit lamp exam, and AS-OCT was found to have a sensitivity of 91.7% and specificity of 85.7% for detecting anterior chamber cell in this population.…”