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The VISA system was developed a decade ago and is used predominantly in North America. The mnemonic stands for vision, inflammation, strabismus and appearance/exposure. The protocol for assessment of both inflammatory features and strabismus is less detailed than that of EUGOGO, and this may influence its relevance to scientific studies. However, its main use is in clinical patient management, and comparison of grading between 2 experienced observers showed good correlation relevant to clinical management decisions [79]. Both VISA and EUGOGO systems provide not only a diagnostic classification, but also an assessment with practical implications for guiding the management of patients, something valuable compared to the NOSPECS classification [68].