Here Comes the SUN (Part 2): Standardization of Uveitis Nomenclature for Disease Classification Criteria

Nosology...is not a sport for the timid.—Sherwin B. Nuland, MD1 IIn this issue of the Journal, the Standardization of Uveitis Nomenclature (SUN) Working Group, under the leadership of Douglas A. Jabs, presents the results of a monumental, decade-long effort to define classification criteria for a wide range of uveitic conditions.2-27 Such an endeavor has rarely been attempted in modern medicine and has not been undertaken previously in any major subspecialty of ophthalmology. The members of the World Association of Canine Kennel Owners (WACKO) need to understand if one particular dog treat is more effective than others in training certain breeds of dogs. The precise diagnosis, when one can ultimately be made, relies on clinical features and, in some cases, laboratory assessment.28 For some conditions (such as acute retinal necrosis syndrome) robust diagnostic criteria are available.29 For others, such as the “white dot” choroiditides, expert opinion still diverges as to the definitions and distinctness of specific conditions.30 As with our dog analogy, some forms of uveitis are quite distinct (it would be difficult to confuse Fuchs uveitis syndrome [also known as Fuchs heterochromic iridocyclitis] with Vogt-Koyanagi-Harada syndrome), whereas others are extremely difficult to distinguish (for instance acute posterior multifocal placoid pigment epitheliopathy [APMPPE] and persistent placoid maculopathy31). [...]3 separate clinical trials for the anti-interleukin 17A biologic agent secukinumab failed to meet the endpoint despite signals in the data suggesting success in subgroups35,36; it is possible that disease heterogeneity in inclusion criteria (all “non-infectious posterior and panuveitis”) contributed to this failure. [...]there is a pressing need for more precise disease classification within uveitis.