Visual acuity results after plaque radiotherapy

Abstract

We were pleased to read the analysis of visual acuity results after plaque radiotherapy for choroidal melanoma from the Collaborative Ocular Melanoma Study (COMS).1Collaborative ocular melanoma study (COMS) randomized trial of I 125 brachytherapy for medium choroidal melanoma: I. Visual acuity after 3 years, COMS report no. 16. Ophthalmology 2001;108:348–66.Google Scholar Their results corroborate our previously published results from the Oncology Service at Wills Eye Hospital.2Shields C.L Shields J.A Cater J et al.Plaque radiotherapy for uveal melanoma. Long-term visual outcome in 1106 consecutive patients.Arch Ophthalmol. 2000; 118: 1219-1228Crossref PubMed Scopus (179) Google Scholar Unfortunately our comprehensive analysis was not included in their list of references, perhaps because their article was in press for publication at the time that our article was published. A comparison of the two studies shows similar results. The COMS group of 556 patients with good vision (better than 20/200) showed poor vision (20/200 or worse) after treatment in 17% at 1 year and 43% at 3 years follow-up. Longer follow-up was not available. In our group of 1106 patients with good vision, poor ultimate vision was found in 3% at 1 year, 34% at 5 years, 68% at 10 years, and 87% at 15 years. Even though many patients lose central vision on longer follow-up, this should not discourage the use of plaque radiotherapy in the management of uveal melanoma. Retention of the globe and retention of some central and peripheral visual function can be beneficial to the patient. Both studies reported risk factors for poor visual acuity to be greater initial tumor thickness, proximity of the tumor to the foveola, presence of subretinal fluid, and others. In our large cohort, we were able to additionally provide in table format a stratified risk for poor vision based on each combination of clinical risk factors. Thus, based on our data, the best-case scenario would be a thinner tumor, without subretinal fluid, anteriorly situated in the uvea at a great distance from the foveola in a young patient with only 20% risk for poor vision at 5 years follow-up. The worst case scenario would be a thicker tumor greater than 8 mm with subretinal fluid in an older patient (older than 60 y) with 80% risk for poor vision at 5 years follow-up. It is satisfying to witness corroboration of scientific results. We congratulate the COMS for providing us with important information regarding visual function after plaque radiotherapy for uveal melanoma. The results of both the COMS and the Wills Eye Hospital studies will be helpful in counseling the patient in whom plaque radiotherapy is to be used. Visual acuity results after plaque radiotherapy: Author replyOphthalmologyVol. 108Issue 10Preview Full-Text PDF