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PubMed This is a summary of 9 peer-reviewed journal articles Updated
Ophthalmology

Decoding Your Reports: Imaging & Diagnosis

At a Glance

Diagnosing and monitoring Multifocal Choroiditis (MFC) requires specific eye imaging, including OCT, OCTA, and FAF scans. These tests help your eye doctor detect active inflammation, track lesion sizes, and monitor damage to the retina to prevent permanent vision loss.

When you receive an imaging report for Multifocal Choroiditis (MFC), it can feel like reading a foreign language. However, these reports contain the “road map” of your condition. By understanding these terms, you can ensure your doctor is using the most current standards for monitoring your sight.

The Gold Standard: 2021 SUN Criteria

In 2021, an international group of experts established definitive criteria to classify Multifocal Choroiditis with Panuveitis (MFCPU) [1]. To meet this diagnosis, a patient’s eyes typically show:

  1. Large Lesions: Most inflammatory spots are larger than 125 µm (roughly the size of a large retinal vein) [1].
  2. Wide Distribution: Lesions are found beyond the central part of your vision [1].
  3. Signs of Inflammation: This includes active inflammation in the vitreous (the clear gel filling the eye) or the presence of classic “punched-out” scars [1].

Decoding Your Imaging Report

Your doctor uses quick, non-invasive light camera scans to see different layers of the eye.

OCT (Optical Coherence Tomography)

This is a high-resolution “cross-section” of your retina. It is completely painless and takes only a few seconds.

  • Ellipsoid Zone (EZ) Disruption: The EZ is the layer where your light-sensing cells live. When your report says “disrupted,” it means these cells are damaged, which often corresponds to a blind spot in your vision [2][3].
  • Bruch’s Membrane Disruption: This shows where past inflammation has physically broken the barrier between the retina and its blood supply [4].

OCTA (OCT Angiography)

This newer technology looks at blood flow without the need for injected dyes.

  • Choroidal Flow Voids: These are “dark patches” where blood is not reaching the tiny vessels due to inflammatory blockage [5]. These can sometimes appear before you have symptoms [6].

FAF (Fundus Autofluorescence)

This maps the “metabolic glow” of your retina.

  • Hyperautofluorescence (Bright Spots): Usually indicates active or stressed tissue [7].
  • Hypoautofluorescence (Dark Spots): Usually indicates a permanent scar [7].

Your Monitoring Checklist

Your medical records should ideally include these tests at every major check-up:

  • OCT: To check for active inflammation or fluid.
  • OCTA: To monitor for flow voids or abnormal blood vessels.
  • FAF: To track whether lesions are active or stable.

Having this baseline imaging is vital for catching inflammation before it leads to permanent vision loss [8][9].

Common questions in this guide

What do choroidal flow voids mean on my OCTA scan?
Choroidal flow voids appear as dark patches on your scan where blood flow is blocked by inflammation. These voids can sometimes show up before you even experience vision symptoms, making them an important early warning sign.
What does Ellipsoid Zone (EZ) disruption mean?
The ellipsoid zone is the layer of your retina where light-sensing cells live. If your imaging report says this zone is disrupted, it means those cells are damaged, which often corresponds directly to a blind spot in your vision.
How do doctors tell if my multifocal choroiditis is currently active?
Doctors often use Fundus Autofluorescence (FAF) imaging to check for disease activity. On these scans, bright spots typically indicate active inflammation or stressed tissue, while dark spots usually mean there is a permanent scar.
How large are the lesions in multifocal choroiditis?
According to the standard diagnostic criteria, most inflammatory spots in multifocal choroiditis are larger than 125 micrometers. This is roughly the size of a large retinal vein in your eye.
How often should I have OCT and FAF imaging done?
These tests should ideally be performed at every major check-up. Having baseline imaging from OCT, OCTA, and FAF scans helps your doctor catch new inflammation early, even if your vision feels stable.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do my imaging reports show any 'choroidal flow voids' on the OCTA that might indicate an upcoming flare?
  2. 2.Based on the 2021 SUN criteria, are my lesions larger than 125 µm, and where are they located relative to my central vision?
  3. 3.Is my ellipsoid zone (EZ) currently intact, or is there disruption that explains my current blind spots?
  4. 4.When you look at my FAF images, are the spots bright (hyperautofluorescent) or dark, and what does that tell us about disease activity?
  5. 5.Can we review my OCT for 'finger-like projections' or 'Bruch's membrane disruption' to determine if my condition is currently active or inactive?

Questions For You

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References

References (9)
  1. 1

    Classification Criteria for Multifocal Choroiditis With Panuveitis.

    American journal of ophthalmology 2021; (228()):152-158 doi:10.1016/j.ajo.2021.03.043.

    PMID: 33845016
  2. 2

    Disorganization of the Retinal Inner Layers after Anti-VEGF Treatment for Macular Edema due to Branch Retinal Vein Occlusion.

    Nakano E, Ota T, Jingami Y, et al.

    Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 2018; (240(4)):229-234 doi:10.1159/000490809.

    PMID: 30089307
  3. 3

    Optical Coherence Tomography Findings of Underlying Choroidal Neovascularization in Punctate Inner Choroidopathy.

    Agarwal A, Handa S, Marchese A, et al.

    Frontiers in medicine 2021; (8()):758370 doi:10.3389/fmed.2021.758370.

    PMID: 35004727
  4. 4

    Optical Coherence Tomography (OCT) Features of Inactive Multifocal Choroiditis With Panuveitis and Punctate Inner Choroidopathy (MFCPU/PIC) Lesions.

    Trinco A, Ferdeghini D, Zicarelli F, et al.

    American journal of ophthalmology 2026; (289()):145-154 doi:10.1016/j.ajo.2026.05.027.

    PMID: 42191103
  5. 5

    Non-Infectious Choroiditis Subdivided into Its Diverse Pathophysiological Sub-Groups Is the Best-Known and Most Appropriate Nomenclature to Date for the Reclassification and Diagnosis of Former White Dot Entities.

    Herbort CP, Silpa-Archa S, Papasavvas I, et al.

    Diagnostics (Basel, Switzerland) 2026; (16(11)) doi:10.3390/diagnostics16111735.

    PMID: 42279602
  6. 6

    DISAPPEARING CHOROIDAL SPOTS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PRECEDING RECURRENCE OF MULTIFOCAL CHOROIDITIS WITH CHORIORETINAL ATROPHY.

    Marchese A, Bar-Meir A, Jampol LM, Mirza RG

    Retinal cases & brief reports 2025; (19(1)):14-18 doi:10.1097/ICB.0000000000001501.

    PMID: 37769259
  7. 7

    Fundus autofluorescence imaging.

    Hwang J, Ameri H

    Handbook of clinical neurology 2026; (218()):87-108 doi:10.1016/B978-0-443-22212-2.00023-9.

    PMID: 42217992
  8. 8

    Distribution and Progression of Inflammatory Chorioretinal Lesions Related to Multifocal Choroiditis and Their Correlations with Clinical Outcomes at 24 Months.

    Erba S, Cozzi M, Xhepa A, et al.

    Ocular immunology and inflammation 2022; (30(2)):409-416 doi:10.1080/09273948.2020.1800048.

    PMID: 32946308
  9. 9

    CORRELATION BETWEEN INFLAMMATORY FOCI REACTIVATION AND ATROPHY GROWTH IN EYES WITH IDIOPATHIC MULTIFOCAL CHOROIDITIS.

    Airaldi M, Zicarelli F, Forlani V, et al.

    Retina (Philadelphia, Pa.) 2023; (43(3)):472-480 doi:10.1097/IAE.0000000000003682.

    PMID: 36730577

This page explains Multifocal Choroiditis imaging terminology for educational purposes. Your ophthalmologist or retina specialist is the best source for interpreting your specific eye scans and determining your treatment plan.

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