Abstract
Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically “invisible” tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.
Highlights
Recent advances in imaging have made a profound impact on the diagnosis and treatment of both anterior and posterior segment ophthalmic disease
The utility of fundus photography and ultrasound (US) imaging has been magnified over the past few years by the adjunctive use of newer modalities – in particular, new forms of ocular coherence tomography (OCT) and OCT angiography (OCTA)
The present review serves as a brief update on these imaging modalities and their current role in the characterization of choroidal melanoma (CM), retinoblastoma, anterior segment tumors, and radiation retinopathy
Summary
Recent advances in imaging have made a profound impact on the diagnosis and treatment of both anterior and posterior segment ophthalmic disease. OCTA has been able to non-invasively demonstrate a significant enlargement of the deep foveal avascular zone and a decrease in superficial and deep parafoveal capillary vascular densities in eyes with CM as compared to their fellow healthy eyes[9] These changes appear to be correlated with the presence of subretinal fluid and larger tumor size, bringing to light the possible role of tumor-related pro-inflammatory factors, such as vascular endothelial growth factor (VEGF), in the pathogenesis of vision loss in CM9. Vascular changes may be first detected with OCTA, as irregular widening of the foveal avascular zone, discontinuity of retinal vasculature, and microaneurysms of the deep or superficial retina[43] These features, in combination with SD-OCT findings, including cystic macular edema and increased macular thickness, have been used to generate a new grading scheme for radiation retinopathy as well as to guide treatment with intravitreal anti-VEGF agents[43,44]
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