Purpose: To evaluate the potential of swept-source anterior segment optical coherence tomography (AS-OCT) in assessing uveitis in children with juvenile idiopathic arthritis (JIA) by quantifying anterior chamber (AC) hyper-reflective foci (HRF).

Methods: 71 eyes of 40 children younger than 18 years of age with JIA were enrolled and imaged with swept-source AS-OCT (ANTERION, Heidelberg Engineering). Eyes were categorized as: 1) active JIA-associated chronic anterior uveitis (JIA-U, ≥0.5+ cell); 2) inactive JIA-U, and 3) JIA without prior uveitis. Standardization of Uveitis Nomenclature (SUN) criteria were used to grade AC cells clinically. A custom algorithm was used to automate HRF quantification. Analysis of variance (ANOVA) followed by a post-hoc Tukey test was performed to determine statistical significance.

Results: Of the 71 eyes, 30 eyes (42.3%) had a history of JIA-U and 41 eyes (57.7%) had JIA without prior uveitis. The SUN grade of eyes with JIA-U was as follows: Grade 0, 15/30 eyes (50.0%); Grade 0.5+, 6/30 (20.0%); and Grade 1+ or greater, 9/30 eyes (30.0%). The median count of HRF in the uninvolved, inactive, and active eyes were 1 (IQR 0,1), 2 (IQR 0, 3), and 26 (IQR 9, 59), respectively. ANOVA demonstrated a significant difference between the three groups (p<0.001). Post-hoc Tukey analysis showed a significant difference between active versus inactive uveitic eyes (p<0.001) and active uveitis versus uninvolved eyes (p<0.001), but no significant difference between inactive uveitic eyes versus uninvolved eyes (p=0.94).

Conclusions: Automated analysis of swept source AS-OCT images effectively differentiated active JIA-U from both inactive JIA-U and JIA without prior uveitis, reinforcing the potential of swept-source AS-OCT as a noninvasive tool for detecting AC inflammation in children with JIA-U. Larger, longitudinal studies are needed to elucidate the utility of AS-OCT for screening and monitoring of JIA-U.