For ocular oncologists using brachytherapy to treat patients with uveal melanoma, primary goals include achieving excellent local tumor control and preserving vision. Techniques, such as intraoperative ultrasonography, have helped to refine brachytherapy to achieve excellent local tumor control. However, as addressed by Shields et al1 in this issue of JAMA Ophthalmology, a continued challenge remains finding ways to preserve vision in the face of radiation retinopathy and optic neuropathy. One reason that many patients choose globe-sparing radiation treatment over enucleation is to preserve some useful vision. However, in the largest, randomized study of patients with uveal melanoma, the Collaborative Ocular Melanoma Study, 43% to 49% of patients treated with brachytherapy experienced substantial vision loss within 3 years of treatment.2 Studies using anti–vascular endothelial growth factor (anti-VEGF) agents have reported improved vision outcomes associated with their use, but how to optimally use these agents to try to prevent vision loss remains an important question.3-5
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Boldt HC, Murray TG, Binkley EM. Studies Evaluating Visual Outcomes After Brachytherapy in Uveal Melanoma—Strengths and Limitations of Current Investigations. JAMA Ophthalmol. 2020;138(2):146–147. doi:10.1001/jamaophthalmol.2019.5122
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: