title: Failure to Integrate Quantitative Measurement Methods of Ocular Inflammation Hampers Clinical Practice and Trials on New Therapies for Posterior Uveitis.
abstract: Uveitis is one of the fields in ophthalmology where a tremendous evolution took place in the past 25 years. Not only did we gain access to more efficient, more targeted, and better tolerated therapies, but also in parallel precise and quantitative measurement methods developed allowing the clinician to evaluate these therapies and adjust therapeutic intervention with a high degree of precision. Objective and quantitative measurement of the global level of intraocular inflammation became possible for most inflammatory diseases with direct or spill-over anterior chamber inflammation, thanks to laser flare photometry. The amount of retinal inflammation could be quantified by using fluorescein angiography to score retinal angiographic signs. Indocyanine green angiography gave imaging insight into the hitherto inaccessible choroidal compartment, rendering possible the quantification of choroiditis by scoring indocyanine green angiographic signs. Optical coherence tomography has enabled measurement and objective monitoring of retinal and choroidal thickness. This multimodal quantitative appraisal of intraocular inflammation represents an exquisite security in monitoring uveitis. What is enigmatic, however, is the slow pace with which these improvements are integrated in some areas. What is even more difficult to understand is the fact that clinical trials to assess new therapeutic agents still mostly rely on subjective parameters such as clinical evaluation of vitreous haze as a main endpoint; whereas a whole array of precise, quantitative, and objective modalities are available for the design of clinical studies. The scope of this work was to review the quantitative investigations that improved the management of uveitis in the past 2-3 decades.
authors.affiliation: 1 Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialized Care, Montchoisi Teaching Centre , Lausanne, Switzerland .|2 Department of Ophthalmology, University of Lausanne , Lausanne, Switzerland .
authors.forename: Carl P
authors.initials: CP
authors.lastname: Herbort
authors.affiliation: 3 Department of Ophthalmology, Istanbul University , Istanbul Faculty of Medicine, Istanbul, Turkey .
authors.forename: Ilknur
authors.initials: I
authors.lastname: Tugal-Tutkun
authors.affiliation: 4 Department of Clinical and Experimental Medicine, The Eye Clinic-The Ocular Immunology Service, Università Politecnica delle Marche , Ancona, Italy .
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Neri
authors.affiliation: 5 National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology , London, United Kingdom .
authors.forename: Carlos
authors.initials: C
authors.lastname: Pavésio
authors.affiliation: 6 Department of Ophthalmology, School of Medicine, Koc University , Istanbul, Turkey .|7 Department of Ophthalmology, V.K. Foundation, American Hospital , Istanbul, Turkey .
authors.forename: Sumru
authors.initials: S
authors.lastname: Onal
authors.affiliation: 8 Department of Ophthalmology, DHU View Maintain, La Pitié Salpêtrière University Hospital , Université Pierre et Marie Curie, Paris, France .
authors.forename: Phuc
authors.initials: P
authors.lastname: LeHoang
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015817:Eye Infections / Q000188:drug therapy*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D015866:Uveitis, Posterior / Q000188:drug therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: fundus fluorescein angiography; indocyanine green angiography; laser flare photometry; optical coherence tomography; outcome measures; uveitis