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Comment & Response
July 18, 2019

Survival of Young Patients With Posterior Uveal Melanoma—Reply

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
JAMA Ophthalmol. 2019;137(9):1091-1092. doi:10.1001/jamaophthalmol.2019.2552

In Reply We appreciate the opportunity to respond to comments submitted by Al-Jamal et al, who point out differences in the results of our study compared with theirs, which was published 3 years ago based on a multicenter survey conducted in Europe.1 In particular, they question our finding that the long-term survival of young patients with posterior uveal melanoma was similar with that of older patients with comparable disease, and they speculate that referral bias may have affected our results.2 This seems unlikely, given that tumor stage distribution was similar between the 2 studies. We believe that a more likely explanation is that the study design was very different between the 2 studies. A strength of their study1 was its large size and inclusion of multiple centers; however, this also may have been a weakness. The quality of retrospectively collected data from multiple centers that do not adhere to uniform methodology may have inherent limitations compared with data collected from a single center using consistent practices, as was the case in our study.2 It is also possible that differences in genetic background, health status, immune system, or other factors may play a role in the different study findings. Thus, although we are confident in the accuracy of our results, we do not discount the need for further investigation using high-quality clinical research methods to adjudicate the discrepancies between the 2 studies.1,2 In the meantime, we hope we can all agree that long-term surveillance is important in young patients with uveal melanoma.