The expanding horizon: Role of widefield imaging in uveitis

Conventional retinal imaging has historically been limited to the posterior pole, capturing only 30-50° field-of-view. The advent of widefield (WF) and ultra-widefield (UWF) imaging (WFI) technology has transformed this landscape, enabling visualization of up to 200° of retina in a single capture. This expanded field-of-view has revealed changes to help document peripheral retinal pathology like vascular leakage, areas of capillary nonperfusion, and early neovascularization, which was previously invisible to standard imaging, fundamentally changing how we stage disease, assess prognosis, and guide treatment decisions. WFI detects subclinical posterior involvement in a substantial proportion of patients initially classified as having anterior uveitis alone, necessitating diagnostic reclassification and treatment escalation in many cases. Beyond improved visualization, WFI has enabled objective quantification of disease burden through metrics such as leakage index and ischemic index. These continuous numerical biomarkers have largely replaced subjective clinical grading, providing standardized endpoints suitable for clinical trials and precision medicine applications. Recent advances in WF optical coherence tomography (OCT) and OCT angiography (OCTA) reveal layer-specific microvascular patterns and quantifiable perfusion deficits, offering unprecedented insight into disease mechanisms. Serial WF examinations document treatment response objectively, allowing clinicians to recognize therapeutic efficacy or failure earlier than subjective clinical assessment alone permits. Integration of quantitative WF metrics with artificial intelligence shows promise for automated objective analysis and prognostic modeling. This narrative review synthesizes the evidence supporting WFI across diagnostic applications, biomarker quantification, treatment guidance, complication detection, and treatment monitoring in uveitis. We examine practical implementation strategies, standardization efforts, and emerging technologies poised to advance the field further.