Patient portal messaging has rapidly expanded as a key mode of communication in modern health systems, generating large volumes of unstructured patient-generated health data. However, the clinical relevance and operational implications of these messages in ophthalmology remain poorly characterized. To characterize the clinical and administrative concerns communicated through secure ophthalmology messaging and to assess differences in message content across patient sociodemographic groups. This is a cross-sectional study of de-identified, patient-initiated secure messages sent between June 2014 and July 2024. Patients with ophthalmic conditions who initiated secure electronic health record portal messages. Of 48,516 extracted message threads, 30,390 patient medical advice request messages from 4,817 unique patients were included after exclusion of questionnaires, courtesy messages, and clinician responses. Natural language processing and large language model–assisted topic classification were used to categorize message content. Differences in message frequency by demographic subgroup were assessed using 2-proportion z tests. Participants were 55.5% female, 56.9% aged 50 years or older, 48.7% White, and 85.7% non-Hispanic. Nearly half of all messages addressed administrative issues, including scheduling, medication refills, and insurance. Among clinical concerns, vision disturbances (20.8%), glaucoma-related symptoms (8.7%), imaging or tumor-related questions (7.5%), and postoperative concerns (7.4%) were most common. Message content differed significantly by demographic characteristics. Non-White patients more frequently raised issues related to pharmacy refills, insurance, glaucoma, and disability documentation, whereas White patients more often reported surgical concerns. Older patients more frequently messaged about glaucoma, surgery, and tumor-related issues, while female patients more often reported complications and swelling or infection. Secure patient messages frequently include clinically relevant symptoms with potential triage implications and demonstrate demographic differences in care-seeking behavior. Systematic analysis of message content may support safer triage, improved workflow efficiency, and more equitable delivery of ophthalmic care.

Purpose To evaluate the repeatability and reproducibility of Starguage, a novel automated method compared with manual segmentation for measuring decreased autofluorescence (DAF) and definitely decreased autofluorescence (DDAF) in fundus autofluorescence (FAF) images of patients with Stargardt disease. Design Cross-sectional reproducibility and agreement study. Participants A total of 316 eyes from 158 genetically confirmed Stargardt patients were analyzed. For intra-grader repeatability, 114 FAF images were reassessed in a masked, repeated-measures design. Methods DAF and DDAF lesion areas were independently quantified by five certified graders using either manual delineation with Heidelberg RegionFinder or a threshold-based automated algorithm, with automated quantification and cross-method agreement analyses restricted to a prespecified central 6-mm fovea-centered region. Agreement and repeatability were assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), Lin’s concordance correlation coefficient (CCC), Bland–Altman plots, and Passing–Bablok regression. Both raw and square-root-transformed lesion areas were evaluated. Main Outcome Measures Repeatability (intra-grader ICC, SEM, MDC), reproducibility (inter-grader ICC), and agreement (CCC, bias in regression analysis) between and within manual and automated methods. Results The automated method achieved excellent intra-grader repeatability for both DAF and DDAF (ICCs ≥0.988, SEM ≤0.71 mm2, MDC ≤1.98 mm2), with minimal operator influence. Manual measurements showed variable repeatability (DAF ICCs 0.909–0.974; DDAF ICCs as low as 0.837), with square-root transformation reducing SEM and MDC. Inter-grader reproducibility was highest for automated methods (ICC = 0.989–0.992), whereas manual methods ranged from 0.764–0.939 (raw) and 0.867–0.922 (transformed). Cross-method agreement was strong (CCC = 0.91–0.96), though minor proportional and constant bias was observed in raw DAF data. Conclusions The automated approach provides near-perfect repeatability and high agreement with manual grading, offering a scalable, objective alternative for quantifying hypo-auto-fluorescent lesions in Stargardt disease. Manual methods are generally reliable but more variable, especially for DDAF, and benefit from square-root transformation. Findings reflect a pediatric/adolescent single-trial predominantly Asian cohort.

Purpose:To evaluate the repeatability and reproducibility of Starguage, a novel automated method, compared with manual segmentation for measuring decreased autofluorescence (DAF) and definitely decreased autofluorescence (DDAF) in fundus autofluorescence (FAF) images of patients with Stargardt disease. Design:A cross-sectional reproducibility and agreement study. Participants:A total of 316 eyes from 158 genetically confirmed Stargardt patients were analyzed. For intragrader repeatability, 114 FAF images were reassessed in a masked, repeated-measures design. Methods:Decreased autofluorescence and DDAF lesion areas were independently quantified by five certified graders using either manual delineation with Heidelberg RegionFinder or a threshold-based automated algorithm, with automated quantification and cross-method agreement analyses restricted to a prespecified central 6-mm fovea-centered region. Agreement and repeatability were assessed using intraclass correlation coefficients (ICCs), standard error of measurement (SEM), minimal detectable change (MDC), Lin's concordance correlation coefficient (CCC), Bland-Altman plots, and Passing-Bablok regression. Both raw and square-root-transformed lesion areas were evaluated. Main Outcome Measures:Repeatability (intragrader ICC, SEM, and MDC), reproducibility (intergrader ICC), and agreement (CCC and bias in regression analysis) between and within manual and automated methods. Results:The automated method achieved excellent intragrader repeatability for both DAF and DDAF (ICCs ≥0.988, SEM ≤0.71 mm2, MDC ≤1.98 mm2), with minimal operator influence. Manual measurements showed variable repeatability (DAF ICCs 0.909-0.974; DDAF ICCs as low as 0.837), with square-root transformation reducing SEM and MDC. Intergrader reproducibility was highest for automated methods (ICC = 0.988-0.992), whereas manual methods ranged from 0.764-0.939 (raw) and 0.867-0.922 (transformed). Cross-method agreement was strong (CCC = 0.91-0.96), though minor proportional and constant bias was observed in raw DAF data. Conclusions:The automated approach provides near-perfect repeatability and high agreement with manual grading, offering a scalable, objective alternative for quantifying hypo-auto-fluorescent lesions in Stargardt disease. Manual methods are generally reliable but more variable, especially for DDAF, and benefit from square-root transformation. Findings reflect a pediatric/adolescent single-trial predominantly Asian cohort. Financial Disclosures:The authors have no proprietary or commercial interest in any materials discussed in this article.

Background:In the world of Artificial Intelligence (AI), Generative Pretrained Transformer-3 (GPT-3), has gained significant popularity for its demonstrated potential in medical education and diagnostics. Rationale:While AI has shown promising results in healthcare thus far, its understanding of ocular urgencies, particularly uveitis, demands a focused investigation. Methods:This study explored the application of ChatGPT, a language model derived from GPT-3, in delineating uveitis based on patient presentations and investigations. We analyzed ChatGPT's communication quality through 14 qualitative metrics by computing patient data at four different levels to act as prompts. These included patient history, drug history, examination findings, and clinical investigations. Results:Our results showed that at the initial prompt, ChatGPT's responses were comprehensive for most (8 out of 14) variables and correct but inadequate for some (3 out of 14) variables in the majority (>50.0%) of uveitis cases. Ethical considerations was the only variable in terms of which responses consistently showed mixed accuracy and outdated data across all prompts in most (95.8%) uveitis cases. Also, none of the ChatGPT responses were completely inaccurate in terms of any variable at any prompt for any uveitis case. Conclusion:The results reveal ChatGPT's strengths and limitations in answering queries for patients with uveitis or its differential diagnosis while emphasizing the indispensable role of physicians in ethical decision-making.

Background and Objective:As optical coherence tomography (OCT) has enabled the identification of an expanding set of age-related macular degeneration (AMD) risk biomarkers and become central to routine clinical practice, there remains a need for a simplified grading scheme that allows physicians to communicate and synchronize AMD grading directly from standard OCT imaging rather than relying on traditional color fundus imaging. This study aims to establish a standardized OCT-based AMD classification that balances diagnostic accuracy with practicality for use across clinical and research settings. Patients and Methods:Spectral-domain optical coherence tomography scans were independently graded by two retinal specialists following the newly proposed Stanford OCT-Based AMD Classification (SOAC). Discrepancies were adjudicated by a third independent retinal specialist. Intergrader agreement was assessed using weighted kappa coefficients. Results:Among the 109 eyes from 108 patients (mean age 79.61 ± 7.57 years; 41.7% male, 58.3% female), AMD staging based on SOAC was distributed as follows: normal aging in 9 patients (8.3%), early AMD in 16 (14.7%), intermediate AMD in 32 (29.4%), neovascular AMD (nAMD) in 18 (16.5%), geographic atrophy (GA) in 20 (18.3%), and combined nAMD and GA in 14 (12.8%). The overall intergrader agreement demonstrated robust consistency, with a weighted kappa value of 0.95 (95% CI: 0.92-0.98), signifying excellent intergrader reliability and reinforcing the validity of SOAC. Conclusion:SOAC provides a standardized, OCT-based framework for AMD grading that demonstrates high intergrader agreement. By enabling consistent classification from commonly acquired OCT scans, SOAC supports reliable disease staging and facilitates integration across clinical studies and translational research. As imaging and molecular data continue to expand, SOAC can serve as a common OCT-based reference for phenotype refinement and longitudinal AMD studies.

Purpose To evaluate the repeatability and reproducibility of a novel automated method compared with manual segmentation for measuring decreased autofluorescence (DAF) and definitely decreased autofluorescence (DDAF) in fundus autofluorescence (FAF) images of patients with Stargardt disease. Design Cross-sectional reproducibility and agreement study. Participants A total of 316 eyes from 158 genetically confirmed Stargardt patients were analyzed. For intra–grader repeatability, 114 FAF images were reassessed in a masked, repeated–measures design. Methods DAF and DDAF lesion areas were independently quantified by five certified graders using either manual delineation with Heidelberg RegionFinder or a threshold-based automated algorithm. Agreement and repeatability were assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), Lin concordance correlation coefficient (CCC), Bland–Altman plots, and Passing–Bablok regression. Both raw and square–root transformed lesion areas were evaluated. Main Outcome Measures Repeatability (intra–grader ICC, SEM, MDC), reproducibility (inter–grader ICC), and agreement (CCC, bias in regression analysis) between and within manual and automated methods. Results The automated method achieved excellent intra–grader repeatability for both DAF and DDAF (ICCs≥0.988, SEM≤0.71 mm2, MDC≤1.98 mm2), with minimal operator influence. Manual measurements showed variable repeatability (DAF ICCs 0.909-0.974; DDAF ICCs as low as 0.837), with square–root transformation reducing SEM and MDC. Inter–grader reproducibility was highest for automated methods (ICC = 0.989–0.992), whereas manual methods ranged from 0.764–0.939 (raw) and 0.867–0.922 (transformed). Cross–method agreement was strong (CCC = 0.91–0.96), though minor proportional and constant bias was observed in raw DAF data. Conclusions The automated approach provides near–perfect repeatability and high agreement with manual grading, offering a scalable, objective alternative for quantifying hypofluorescent lesions in Stargardt disease. Manual methods are generally reliable but more variable, especially for DDAF, and benefit from square–root transformation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was conducted in accordance with the Declaration of Helsinki. Approval of retrospective studies was obtained from the IRB committee of Stanford University (IRB-68008). All data was anonymized and maintained with confidentiality. Stringent measures were implemented to protect patient privacy. All potential ethical concerns related to AI involvement in healthcare were considered. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Purpose: To introduce and validate Flowdef, an open–source MATLAB application that automatically excludes drusen– and vessel–related projection artifacts and enables region–specific quantification of choriocapillaris (CC) flow voids in eyes with age–related macular degeneration (AMD). Methods: Thirty eyes (10 healthy controls, 10 intermediate AMD, 10 dry AMD with geographic atrophy [GA]) underwent 6 × 6 mm OCT–angiography. Flowdef generates exclusion masks for drusen (Otsu threshold × 1.2) and superficial vessels (CLAHE + morphology) and identifies CC flow voids using a mean − 1 SD threshold. For GA eyes, an interactive affine registration aligns infrared and OCT en face images to delineate healthy, transition, and atrophic zones. Repeatability (same–day test–retest) and inter–rater reproducibility were assessed with intraclass correlation coefficients (ICC) and coefficients of variation (CV). Results: Flowdef processed all 30 eyes without failure. After artifact exclusion, atrophic zones showed the largest mean flow void area (1078 μm2) while healthy zones exhibited more numerous but smaller voids (mean area 871 μm2). Test–retest repeatability was excellent in GA (ICC 0.92−0.99) and control eyes (ICC 0.95−0.99) and variable in intermediate AMD (ICC 0.08−0.80). Inter–rater CV was <10% for most parameters except mean area in intermediate AMD (CV ≈ 200%). Conclusions: Flowdef provides a robust, freely available solution for artifact‑ reduced CC flow–void analysis and region‑ specific GA assessment, addressing key limitations of existing methods. Translational Relevance: By delivering reliable CC metrics with minimal user input, Flowdef can support longitudinal AMD monitoring and accelerate clinical research on emerging therapies. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not for profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the institutional review board of Stanford University (IRB no. 68008) and adhered to the Declaration of Helsinki. Informed consent was obtained from enrolled subjects, and their protected health information was de-identified before storage in password-protected browsers accessible to the immediate study team only. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Objective:To report safety and early pharmacodynamic results from a first-in-human trial of intravitreal (IVT) anti-semaphorin 3A antibody in participants with diabetic macular ischemia (DMI). Design:HORNBILL, a phase I/IIa study of BI 764524, comprised a nonrandomized, open-label, uncontrolled, single-rising-dose (SRD) and masked, randomized, sham-controlled, multiple-dose (MD) parts. Participants:Adults with DMI and stable diabetic retinopathy (DR) treated with pan-retinal photocoagulation and without center-involving diabetic macular edema. Methods:Twelve participants received single IVT doses of BI 764524 0.5 mg (n = 3), 1.0 mg (n = 3), or 2.5 mg (n = 6) in the SRD part. Thirty-one participants received 3 IVT doses of BI 764524 2.5 mg (n = 21) or sham procedures (n = 10) at 4-week intervals and were followed to week 22 in the MD part. Main Outcome Measures:The primary SRD end point was the number of participants with dose-limiting events; secondary end points assessed drug-related and ocular adverse events (AEs). The primary MD end point was the number of participants with drug-related AEs; secondary end points included changes from baseline in foveal avascular zone (FAZ) area, best-corrected visual acuity (BCVA), and central subfield thickness (CST). Results:No dose-limiting events or drug-related AEs were reported with SRD; the highest tested dose (2.5 mg) was selected for the MD part. In the MD part, 2 investigator-assessed drug-related AEs (vitreous floaters and increased gamma-glutamyl transferase) were reported. No intraocular inflammation or occlusive retinal vasculitis cases occurred. At week 12 (4 weeks after the final injection), the adjusted mean FAZ area change was -0.004 mm2 in the BI 764524 group and +0.019 mm2 with sham. At week 22 (14 weeks after the final injection), the adjusted mean FAZ area change was -0.001 mm2 in the BI 764524 group and +0.010 mm2 with sham. No relevant BCVA and CST changes occurred. Conclusions:HORNBILL met the primary safety end points; all evaluated BI 764524 doses were well tolerated. These findings support further investigation of BI 764524 in participants with DR and retinal nonperfusion. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Matsumiya, Wataru MD, PhD; Karaca, Irmak MD; Pham, Brandon Huy MD; Akhavanrezayat, Amir MD; Uludag, Gunay MD; Yasar, Cigdem MD; Ghoraba, Hashem MD, MSc; Mobasserian, Azadeh MD; Regenold, Jonathan BS; Halim, Muhammad Sohail MD; Sepah, Yasir J. MBBS; Do, Diana V. MD; Chong, Victor MD; Nguyen, Quan Dong MD, MSc Author Information

Uveitis is a major cause of vision loss in the developed world. Approximately 10% of the cases of reported vision loss worldwide may be attributed to uveitis. Economically, the United States alone spends more than $240 million annually on health care for patients with uveitis and its consequent morbidity. Often, uveitis patients may not be managed properly at the onset of the disease, and referral to a specialist is made only after the eye has suffered from irreversible damages. Hence, timely referral is of significant importance in the quest to reduce incidence of vision loss secondary to uveitis.

Background This analysis evaluated aqueous humour (AH) interleukin (IL)-6 concentrations and the association between AH IL-6 and visual outcomes in patients with neovascular age-related macular degeneration (nAMD) or diabetic macular oedema (DMO) receiving anti-vascular endothelial growth factor (VEGF) monotherapy.Methods Post hoc analysis of the multicentre, double-masked, randomised HARBOR (NCT00891735) and READ-3 (NCT01077401) trials. HARBOR enrolled treatment-naive nAMD patients. READ-3 enrolled treatment-naive/previously treated DMO patients. HARBOR patients received ranibizumab 0.5 or 2.0 mg monthly or as needed; AH samples were collected at month 2, after two previous intravitreal injections. READ-3 patients received ranibizumab 0.5 or 2.0 mg as needed; AH samples were collected at baseline and months 3, 6, 9, and 12. Main outcome measure: association between AH IL-6 concentrations and month 24 best-corrected visual acuity (BCVA).Results In both trials (HARBOR, N = 36; READ-3, N = 137), patients with higher AH IL-6 concentrations had worse visual outcomes. HARBOR patients with low AH IL-6 concentrations at month 2 had a mean (95% CI) BCVA change at month 24 of +2.9 (-2.6, 8.3) letters, whereas patients with high AH concentrations had a mean (95% CI) BCVA change of -9.0 (-22.7, 4.7) letters. READ-3 patients with low AH concentrations at baseline had a mean (95% CI) BCVA change at month 12 of +9.3 (7.4, 11.3) letters, whereas patients with high AH concentrations had a mean (95% CI) BCVA change of +5.6 (2.2, 9.1) letters.Conclusions Higher IL-6 AH concentrations may predict suboptimal visual responses to anti-VEGF monotherapy in patients with nAMD/DMO.

PURPOSE:To determine the outcomes of intravenous (IV) tocilizumab (TCZ) in patients with non-infectious uveitis who failed with conventional immunomodulatory and anti-TNFα therapies. METHODS:Records of seven patients with non-infectious uveitis treated with monthly IV TCZ (4-10 mg/kg) or biweekly IV TCZ (8 mg/kg) were reviewed. Outcome measures were changes in visual acuity, anterior chamber cell and flare grade, vitreous haze, central subfield thickness (CST), and fluorescein angiography (FA) score. RESULTS:Ten eyes of seven patients received TCZ therapy. Median age of patients was 14 (range, 7-24) years. Median duration of TCZ therapy was 15 (range, 5-32) months. Mean CST reduced from 373 ± 101.0 μm to 298.2 ± 40.3 μm. Mean FA score reduced from 12.5 ± 4.3 to 3.6 ± 2.6. One patient developed elevated liver transaminases. CONCLUSION:IV TCZ is a potentially effective and safe therapeutic option for the management of refractory non-infectious uveitis.

Purpose: To assess different microperimetry (MP) macular sensitivity outcome measures capturing functional deterioration in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).Design: Patients were included from 2 identically designed, phase III, double-masked, randomized controlled clinical trials, Chroma (NCT02247479) and Spectri (NCT02247531).Participants: Patients enrolled were aged >= 50 years with bilateral GA and no evidence of previous or active neovascular AMD.Methods: Patients were randomized 2:1:2:1 to receive through 96 weeks intravitreal lampalizumab 10 mg every 4 weeks (LQ4W), every 6 weeks (LQ6W), or corresponding sham procedures. For this study, mesopic macular sensitivity of the central 20 degrees was assessed using MP-1 microperimeter at selected sites.Main Outcome Measures: Two exploratory endpoints were developed, namely perilesional sensitivity (average of points adjacent to absolute scotomatous points) and responding sensitivity (average of all nonscotomatous points; > 0 dB at baseline) by using customized masks for each patient. These were compared with conventional MP endpoints (mean macular sensitivity and number of absolute scotomatous points).Results: Of 1881 Chroma and Spectri participants, 277 agreed to participate in the present study. Of these, 197 (LQ4W, n = 63; LQ6W, n = 68; pooled sham, n = 66) had reliable MP results. Enlargement of GA lesion area by approximately 2 mm(2)/year across treatment groups was accompanied by deterioration in all MP parameters. There was no difference in worsening of macular sensitivity or absolute scotomatous points among treatment groups. Perilesional and responding sensitivities showed greater decline over time than mean macular sensitivity. Change in GA lesion area at week 48 showed better correlation with perilesional sensitivity (r = -0.17) and responding sensitivity (r = -0.20) than mean macular sensitivity (r = -0.03), while the correlation was highest with the number of absolute scotomatous points (r = 0.37).Conclusions: Perilesional or responding macular sensitivity measured by MP should be considered more sensitive endpoints than mean macular sensitivity for monitoring functional decline over time in GA. Although perilesional, responding, and mean macular sensitivity had weak correlation with GA lesion area, the number of absolute scotomatous points may provide additional information on the anatomic/functional correlation.

There remain many unanswered questions on how to assess and treat the pathology and complications that arise from diabetic retinopathy (DR). Optical coherence tomography angiography (OCTA) is a novel and non-invasive three-dimensional imaging method that can visualize capillaries in all retinal layers. Numerous studies have confirmed that OCTA can identify early evidence of microvascular changes and provide quantitative assessment of the extent of diseases such as DR and its complications. A number of informative OCTA metrics could be used to assess DR in clinical trials, including measurements of the foveal avascular zone (FAZ; area, acircularity, 3D para-FAZ vessel density), vessel density, extrafoveal avascular zones, and neovascularization. Assessing patients with DR using a full-retinal slab OCTA image can limit segmentation errors and confounding factors such as those related to center-involved diabetic macular edema. Given emerging data suggesting the importance of the peripheral retinal vasculature in assessing and predicting DR progression, wide-field OCTA imaging should also be used. Finally, the use of automated methods and algorithms for OCTA image analysis, such as those that can distinguish between areas of true and false signals, reconstruct images, and produce quantitative metrics, such as FAZ area, will greatly improve the efficiency and standardization of results between studies. Most importantly, clinical trial protocols should account for the relatively high frequency of poor-quality data related to sub-optimal imaging conditions in DR and should incorporate time for assessing OCTA image quality and re-imaging patients where necessary.

Purpose To evaluate the correlation between longitudinal changes in aqueous flare measured by laser flare photometer (LFP), best-corrected visual acuity (BCVA), and clinical grade using both Standardization of Uveitis Nomenclature (SUN) and modified SUN (MSUN) scales uveitis patients. Methods Patients were classified according to both SUN and MSUN grading scales. LFP measurements were acquired (Kowa FM-700) at each visit. Mean change in LFP was assessed longitudinally, comparing with those in visual acuity, SUN, and MSUN grading scales. Results Mean change in LFP was correlated to those in BCVA (p = .018), SUN scale (p < .001), and MSUN scale (p = .008). Cases within same initial SUN (0 and 1+) and MSUN (0.5+ and 1+) grades and different longitudinal flare prognosis (decreased/unchanged/increased) had significantly different initial LFP values (all p < .05). Conclusions LFP measurement is beneficial in monitoring inflammatory activity. Cases of identical clinical flare scores with different clinical prognosis may be predicted by LFP.

Background/aimsTo use a composite endpoint scoring system in assessing efficacy of two doses of intravenous tocilizumab (TCZ), in eyes with non-infectious uveitis.MethodsData from STOP-Uveitis Study (a phase 2 multicentre, randomised, interventional clinical trial), where monthly intravenous infusions of 4 mg/kg (Group 1) or 8 mg/kg (Group 2) TCZ until month 6 (M6) were administered, were used. Efficacy was ascertained by a composite endpoint scoring system consisting of: (1) visual acuity; (2) intraocular inflammation; (3) central retinal thickness; (4) posterior segment inflammation on fluorescein angiographic and (5) steroid taper. Each component of grading system was graded as ((+1) improvement, (−1) worsening or (0) no change) based on specific criteria. The clinical response was classified as positive (improvement in at least one parameter and worsening in none), negative (worsening of any parameter) or stable (neither improvement nor worsening of any parameter). The percentage achieving various clinical responses was compared between groups.ResultsThirty-seven patients were analysed. At M6, 31 (83.8%) subjects demonstrated a positive clinical response (Group 1=14 (77.8%) and Group 2=17 (89.5%)). Three (8.1%) subjects (all Group 1) met the criteria for treatment failure, whereas three (8.1%) subjects showed a stable clinical response (Group 1=1 and Group 2=2). The difference in clinical responses between study groups was not significant (p>0.05).ConclusionsBoth doses of intravenous TCZ were effective in either improving or maintaining stability in patients using the composite endpoint scoring system. A composite scoring system as used in this study may be a better measure to assess efficacy outcomes as compared with only vitreous haze or other single outcome measures.