An international modified Delphi process has produced consensus definitions for retinal vasculitis and seven related terms. Twenty-seven experts across ophthalmology, rheumatology, pathology, imaging and methodology took part; the five executive committee members who drafted the preliminary definitions were excluded from voting, leaving 22 independent voters across two rounds. Consensus was set at 75% agreement and comfortably exceeded — 83.3% to 95.5% in the first round, 95.2% to 100% after refinement.
The eight terms defined are retinal vasculitis, vascular leakage, infectious retinal vasculitis, non-infectious retinal vasculitis, retinal perivasculitis, retinal vasculopathy, primary retinal vasculitis, and far-peripheral vascular leakage. The organising purpose is stated plainly: to separate vascular leakage from true vasculitis, and inflammatory from non-inflammatory vascular disorders.
That distinction is not academic. Leakage on wide-field angiography — particularly in the far periphery, which is why it gets its own term — is common, often non-specific, and regularly reported as vasculitis. The consequence of the word is systemic immunosuppression, a rheumatology referral, and sometimes an extensive infectious workup. A patient described as having retinal perivasculitis and one described as having far-peripheral vascular leakage may have the same angiogram and will not receive the same treatment.
For the reporting ophthalmologist this is a vocabulary to adopt in letters now, not a guideline to wait for. It costs nothing, and it makes the referral to a rheumatologist — who has no way of knowing which of these things was meant — interpretable.
- Adopt the terminology in clinic letters and imaging reports from now; the benefit is entirely in communication
- Describe far-peripheral leakage as leakage, not as vasculitis, unless the other features are there
- State infectious versus non-infectious explicitly when you use the word vasculitis — it changes the workup
- Say whether the finding is perivascular sheathing, true vessel wall inflammation, or leakage alone
- Do not start systemic immunosuppression on the basis of angiographic leakage described without qualification
Why it matters
The word chosen on an imaging report decides whether a patient gets systemic immunosuppression, and until now it has meant different things to different readers.
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