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