In demyelinating disease-associated uveitis, ultra-widefield fluorescein angiography (UWF-FA) may reveal persistent peripheral vascular leakage despite a clinically inactive examination and stable OCT.
The 2026 American Journal of Ophthalmology cohort by Levant, Ray, and Venkat found angiographic-clinical discordance in nearly 70% of clinically inactive eyes, supporting the concept of subclinical retinal vasculopathy.
These findings align biologically with the known retinal periphlebitis phenotype of multiple sclerosis (MS), but they do not yet establish that angiographic leakage alone should trigger treatment escalation.
Prospective studies are needed to determine whether UWF-FA-defined activity predicts relapse, visual decline, structural damage, or neurologic disease burden, and whether it should become a therapeutic endpoint.
