How would you approach management of incidentally identified unilateral retinal vasculitis with subsequent labs revealing +P-ANCA?

This anecdote raises at least 3 fascinating questions. First, how do you approach asymptomatic retinal vasculitis? Often a retinal vasculitis is defined by the dye, fluorescein, leaking from a retinal vessel on a study called a fluorescein angiogram. By this definition, pedal edema would be a pedal vasculitis. Many ophthalmologists now perform what is called wide-field fluorescein angiography and find incidental retinal vascular leakage in the retinal periphery that does not cause symptoms. There are many subsets of retinal vasculitis (central versus peripheral; unilateral vs bilateral; occlusive versus non-occlusive; ischemic vs. non-ischemic; secondary to a chorioretinal lesion (that might suggest an infection) or independent of any chori...

@Dr. First Last: thanks for your well-thought-out answer. Question (for us non-eye expert rheumys):

What factors increase the risk for progression and vision loss in someone with asx retinal vasculitis? I care for many systemic lupus patients (many SLE patients are also p-ANCA positive), and we do see retinal vasculitis, which can be devastating, especially if it affects the macula. It would be nice to know how to triage our patients and then know how closely to follow them and when to treat them without overtreating the asx patient.