En Face Optical Coherence Tomography Imaging as a Structural Surrogate for Posterior Pole Inflammatory Retinal Vascular Activity

Yuka Mizuno; Sunil K Srivastava; Gabriel Castilho S Barbosa; Victor Bellanda; David Shin; Egan Sanchez; Cindy Chen; Kimberly Baynes; Sumit Sharma

doi:10.1016/j.ajo.2026.05.017

En Face Optical Coherence Tomography Imaging as a Structural Surrogate for Posterior Pole Inflammatory Retinal Vascular Activity

Am J Ophthalmol. 2026 May 20:289:36-44. doi: 10.1016/j.ajo.2026.05.017. Online ahead of print.

Authors

Yuka Mizuno¹, Sunil K Srivastava², Gabriel Castilho S Barbosa³, Victor Bellanda¹, David Shin², Egan Sanchez², Cindy Chen⁴, Kimberly Baynes¹, Sumit Sharma⁵

Affiliations

¹ From the Uveitis Center of Excellence (Y.M., S.K.S, G.C.S.B., V.B., D.S., E.S., C.C., K.B., S.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
² From the Uveitis Center of Excellence (Y.M., S.K.S, G.C.S.B., V.B., D.S., E.S., C.C., K.B., S.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.K.S., D.S., E.S., S.S.), Cleveland, Ohio, USA.
³ From the Uveitis Center of Excellence (Y.M., S.K.S, G.C.S.B., V.B., D.S., E.S., C.C., K.B., S.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Ophthalmology (G.C.S.B.), University of São Paulo, São Paulo, Brazil.
⁴ From the Uveitis Center of Excellence (Y.M., S.K.S, G.C.S.B., V.B., D.S., E.S., C.C., K.B., S.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA; The Ohio State University College of Medicine (C.C.), Columbus, Ohio, USA.
⁵ From the Uveitis Center of Excellence (Y.M., S.K.S, G.C.S.B., V.B., D.S., E.S., C.C., K.B., S.S.), Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.K.S., D.S., E.S., S.S.), Cleveland, Ohio, USA. Electronic address: sumitsharma.md@gmail.com.

PMID: 42155876
DOI: 10.1016/j.ajo.2026.05.017

Abstract

Purpose: To evaluate whether structural en face optical coherence tomography (OCT) can detect structural surrogates at the posterior pole associated with fluorescein angiography (FA)-defined inflammatory retinal vascular activity in uveitis.

Design: Prospective, single-center reliability and validity analysis.

Subjects: Twenty-four eyes from 12 patients with uveitis who underwent same-day ultra-widefield FA and macula-centered 12 × 12-mm spectral-domain OCT imaging.

Methods: FA-defined inflammatory retinal vascular activity was defined as vascular leakage and/or vascular wall staining on late-phase FA in the presence of intraocular inflammation. Structural en face OCT images were generated using a customized slab extending from 35 µm below the inner plexiform layer to 35 µm below the outer plexiform layer, corresponding to the outer plexiform layer-outer nuclear layer transition. Images were graded independently by 2 masked retinal specialists and compared with FA findings on an image-by-image basis.

Main outcome measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and intergrader agreement (Cohen's κ).

Results: Fifty-three images were analyzed, of which 32 demonstrated FA-defined activity. En face OCT showed a sensitivity of 0.94 (95% CI, 0.83-1.00), specificity of 0.38 (95% CI, 0.10-0.72), PPV of 0.70 (95% CI, 0.45-0.90), NPV of 0.80 (95% CI, 0.50-1.00), and an F1 score of 0.80. Intergrader agreement was moderate (κ = 0.65).

Conclusions: Structural en face OCT demonstrated high sensitivity for detecting structural changes associated with FA-defined inflammatory vascular activity at the posterior pole, although specificity was limited. These findings support its potential role as a noninvasive adjunctive tool for identifying regions that may warrant further evaluation, rather than a standalone indicator of active disease.