Visual Outcome and Millimeter Incremental Risk of Metastasis in 1780 Patients With Small Choroidal Melanoma Managed by Plaque Radiotherapy.


Importance:Early detection of choroidal melanoma at a small tumor size is emphasized in the literature. However, there is little published information on the specific risks of plaque-irradiated small choroidal melanoma on visual acuity and metastasis. Objective:To analyze outcomes of plaque radiotherapy for small choroidal melanoma 3 mm in thickness or less. Design, Setting, and Participants:This retrospective noncomparative series at a tertiary referral center included 1780 consecutive patients who had received plaque radiotherapy treatment for small choroidal melanoma. Main Outcomes and Measures:Visual acuity outcomes and melanoma-associated metastasis, assessed by Kaplan-Meier analyses. Results:The mean (SD) patient age at melanoma diagnosis was 58 (14) years. Of 1780 patients, 908 were female (51.0%), and 1752 were white (98.4%). Visual acuity was 20/40 OU or better in 1276 of the patients (71.7%), and the mean (SD) visual acuity was 20/40 (20/50) OU (median, 20/30; range, 20/20 to counting fingers). The mean (SD) tumor basal dimension was 8.8 (2.9) mm (median, 8.0 mm; range, 2.0-20.0 mm) and mean (SD) tumor thickness was 2.6 (0.5) mm (median, 2.7; range, 0.2-3.4 mm). Mean (SD) distance to the foveola was 3.4 (3.9) mm and to the optic disc was 3.7 (3.7) mm. The Kaplan-Meier rate of visual acuity loss (≥3 Snellen lines) was 9.5% (95% CI, 8.2%-11.0%) at 1 year, 39.2% (95% CI, 36.5%-42.0%) at 5 years, and 48.9% (95% CI, 45.6%-52.3%) at 10 years, whereas poor visual acuity (≤20/200) was 7.1% (95% CI, 5.9%-8.4%) at 1 year, 38.2% (95% CI, 35.5%-41.1%) at 5 years, and 53.5% (95% CI, 50.1%-57.1%) at 10 years. Regarding melanoma-associated metastasis, the rate was 0.2% (95% CI, 0.09%-0.6%) at 1 year, 4.5% (95% CI, 3.4%-5.9%) at 5 years, and 8.8% (95% CI, 6.9%-11.1%) at 10 years. Using 1.0-mm thickness increments, the 10-year risk for metastasis was 25.0% (95% CI, 3.9%-87.2%) at 0-mm to 1.0-mm thickness, 5.9% (95% CI, 2.5%-13.5%) at 1.1-mm to 2.0-mm thickness, 8.1% (95% CI, 5.9%-11.0%) at 2.1-mm to 3.0-mm thickness, and 13.4% (95% CI, 8.7%-20.4%) at thicknesses greater than 3.0 mm. The greater relative risk (RR) for metastasis in thinnest tumors was 1.83 (95% CI, 1.09-3.07), which likely represented more aggressive diffuse (flat) melanoma. By multivariable analysis, clinical features predictive of melanoma-associated metastasis included increasing patient age (RR, 1.32 [95% CI, 1.07-1.63] per decade; P = .01), tumor diameter (RR, 1.15 [95% CI, 1.06-1.24] per mm; P < .001), tumor thickness (RR, 2.22 [95% CI, 1.22-4.05] per mm; P = .01), photopsia symptoms (RR, 2.45 [95% CI, 1.35-4.43]; P = .003), and prior treatment before plaque radiotherapy (RR, 3.31 [95% CI, 1.31-8.33]; P = .01). Conclusions and Relevance:This retrospective study suggests that small choroidal melanoma treated with plaque radiotherapy has a 10-year risk for visual acuity loss of 48.9% (95% CI, 45.6%-52.3%) and a 10-risk of systemic metastasis of 8.8% (95% CI, 6.9%-11.1%). In this analysis, each millimeter of increasing thickness and diameter contributed risk for metastatic disease.


JAMA Ophthalmol


JAMA ophthalmology


Shields CL,Sioufi K,Srinivasan A,Di Nicola M,Masoomian B,Barna LE,Bekerman VP,Say EAT,Mashayekhi A,Emrich J,Komarnicky L,Shields JA




Has Abstract


2018-12-01 00:00:00














  • The effect of amblyopia on visual-auditory speech perception: why mothers may say "Look at me when I'm talking to you".

    abstract:IMPORTANCE:Children with a history of amblyopia, even if resolved, exhibit impaired visual-auditory integration and perceive speech differently. OBJECTIVE:To determine whether a history of amblyopia is associated with abnormal visual-auditory speech integration. DESIGN, SETTING, AND PARTICIPANTS:Retrospective observa...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Burgmeier R,Desai RU,Farner KC,Tiano B,Lacey R,Volpe NJ,Mets MB

    更新日期:2015-01-01 00:00:00

  • Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment.

    abstract:OBJECTIVE:To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study. DESIGN:Prospective, interventional, multicenter follow-up of a randomized clinical trial. METHODS:Patients who agreed to participate bet...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Do DV,Nguyen QD,Khwaja AA,Channa R,Sepah YJ,Sophie R,Hafiz G,Campochiaro PA,READ-2 Study Group.

    更新日期:2013-02-01 00:00:00

  • Individual Risk Prediction for Sight-Threatening Retinopathy of Prematurity Using Birth Characteristics.

    abstract:Importance:To prevent blindness, repeated infant eye examinations are performed to detect severe retinopathy of prematurity (ROP), yet only a small fraction of those screened need treatment. Early individual risk stratification would improve screening timing and efficiency and potentially reduce the risk of blindness. ...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Pivodic A,Hård AL,Löfqvist C,Smith LEH,Wu C,Bründer MC,Lagrèze WA,Stahl A,Holmström G,Albertsson-Wikland K,Johansson H,Nilsson S,Hellström A

    更新日期:2019-11-07 00:00:00

  • Physician-Industry Interactions and Anti-Vascular Endothelial Growth Factor Use Among US Ophthalmologists.

    abstract:IMPORTANCE:The publication of the US Physician Payments Sunshine Act provides insight into the financial relationship between physicians and the pharmaceutical industry. This added transparency creates new opportunities of using objective data to better understand prior research that implicates pharmaceutical promotion...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Taylor SC,Huecker JB,Gordon MO,Vollman DE,Apte RS

    更新日期:2016-08-01 00:00:00

  • Prospective study of common variants in CX3CR1 and risk of macular degeneration: pooled analysis from 5 long-term studies.

    abstract:IMPORTANCE:The CX3CR1 gene is implicated as a candidate gene for age-related macular degeneration (AMD) through several lines of evidence. There is uncertainty, however, as to whether common genetic variants in CX3CR1 alter risk of AMD, since prior studies have been inconsistent and mostly limited to evaluation of 2 no...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,meta分析,随机对照试验


    authors: Schaumberg DA,Rose L,DeAngelis MM,Semba RD,Hageman GS,Chasman DI

    更新日期:2014-01-01 00:00:00

  • Age, survival predictors, and metastatic death in patients with choroidal melanoma: tentative evidence of a therapeutic effect on survival.

    abstract:OBJECTIVE:To determine whether treatment of choroidal melanoma influences survival by correlating age at death, cause of death, age at treatment, and survival predictors. DESIGN, SETTING, AND PARTICIPANTS:Prospective cohort study performed at the Liverpool Ocular Oncology Centre, a supraregional, tertiary referral ser...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Damato BE,Heimann H,Kalirai H,Coupland SE

    更新日期:2014-05-01 00:00:00

  • Economic Evaluation of Low-Vision Rehabilitation for Veterans With Macular Diseases in the US Department of Veterans Affairs.

    abstract:Importance:Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently. Objective:To examine the costs and consequences of LV rehabilitation or basic LV services. Design, Setting, and Participants:The US Departmen...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,随机对照试验


    authors: Stroupe KT,Stelmack JA,Tang XC,Wei Y,Sayers S,Reda DJ,Kwon E,Massof RW,LOVIT II Study Group.

    更新日期:2018-05-01 00:00:00

  • Severe Acute Respiratory Syndrome Coronavirus 2 Nucleocapsid Protein in the Ocular Tissues of a Patient Previously Infected With Coronavirus Disease 2019.

    abstract:Importance:Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also infect tissues besides the respiratory system, such as the ocular tissues, remains unclear. Objective:To determine whether SAR...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Yan Y,Diao B,Liu Y,Zhang W,Wang G,Chen X

    更新日期:2020-10-08 00:00:00

  • Myocilin Mutations in Patients With Normal-Tension Glaucoma.

    abstract:Importance:Mutations in the myocilin (MYOC) gene are the most common molecularly defined cause of primary open-angle glaucoma that typically occurs in patients with high intraocular pressures (IOP). One MYOC mutation, p.Gln368Ter, has been associated with as many as 1.6% of primary open-angle glaucoma cases that had a ...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Alward WLM,van der Heide C,Khanna CL,Roos BR,Sivaprasad S,Kam J,Ritch R,Lotery A,Igo RP Jr,Cooke Bailey JN,Stone EM,Scheetz TE,Kwon YH,Pasquale LR,Wiggs JL,Fingert JH,NEIGHBORHOOD Consortium.

    更新日期:2019-05-01 00:00:00

  • β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study.

    abstract:Importance:β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). Objective:To test whether the association between the presence and...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,多中心研究


    authors: De Moraes CG,Murphy JT,Kaplan CM,Reimann JJ,Skaat A,Blumberg DM,Al-Aswad L,Cioffi GA,Girkin CA,Medeiros FA,Weinreb RN,Zangwill L,Liebmann JM

    更新日期:2017-06-01 00:00:00

  • Glaucoma-Related Adverse Events at 10 Years in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial.

    abstract:Importance:Glaucoma-related adverse events constitute serious complications of cataract removal in infancy, yet long-term data on incidence and visual outcome remain lacking. Objective:To identify and characterize incident cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among childr...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Freedman SF,Beck AD,Nizam A,Vanderveen DK,Plager DA,Morrison DG,Drews-Botsch CD,Lambert SR,Infant Aphakia Treatment Study Group.

    更新日期:2020-12-17 00:00:00

  • Sildenafil for pediatric orbital lymphangioma.

    abstract:IMPORTANCE:Orbital lymphangiomas, congenital hamartomas of the lymphovascular tissue, are often associated with significant ocular complications and can be challenging to treat. To date, therapeutic approaches have demonstrated variable results and have significant ocular and systemic risks. We present 2 cases of pedia...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Gandhi NG,Lin LK,O'Hara M

    更新日期:2013-09-01 00:00:00

  • Incidence, Risk Factors, and Timing of Elevated Intraocular Pressure After Intravitreal Triamcinolone Acetonide Injection for Macular Edema Secondary to Retinal Vein Occlusion: SCORE Study Report 15.

    abstract:IMPORTANCE:The Standard of Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study showed that intravitreal triamcinolone acetonide (IVTA) is effective at reducing macular edema and improving visual acuity in participants with retinal vein occlusion. Secondary analysis of the incidence, risk factors, and timing...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Aref AA,Scott IU,Oden NL,Ip MS,Blodi BA,VanVeldhuisen PC,SCORE Study Investigator Group.

    更新日期:2015-09-01 00:00:00

  • Clinical Effectiveness of Intravitreal Therapy With Ranibizumab vs Aflibercept vs Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion: A Randomized Clinical Trial.

    abstract:Importance:The comparative clinical effectiveness of ranibizumab, aflibercept, and bevacizumab for the management of macular edema due to central retinal vein occlusion (CRVO) is unclear. Objective:To determine whether intravitreal aflibercept or bevacizumab compared with ranibizumab results in a noninferior mean chan...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Hykin P,Prevost AT,Vasconcelos JC,Murphy C,Kelly J,Ramu J,Hounsome B,Yang Y,Harding SP,Lotery A,Chakravarthy U,Sivaprasad S,LEAVO Study Group.

    更新日期:2019-08-29 00:00:00

  • Quantitative Fundus Autofluorescence in Early and Intermediate Age-Related Macular Degeneration.

    abstract:IMPORTANCE:Increased lipofuscin accumulation is assumed to be an important factor in the pathogenesis of age-related macular degeneration (AMD), although direct evidence for this hypothesis is missing. OBJECTIVE:To quantitatively investigate lipofuscin-associated fundus autofluorescence (AF) in patients with early and...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Gliem M,Müller PL,Finger RP,McGuinness MB,Holz FG,Charbel Issa P

    更新日期:2016-07-01 00:00:00

  • Cost-effectiveness of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema Treatment: Analysis From the Diabetic Retinopathy Clinical Research Network Comparative Effectiveness Trial.

    abstract:IMPORTANCE:Anti-vascular endothelial growth factor (VEGF) medicines have revolutionized diabetic macular edema (DME) treatment. A recent randomized clinical trial comparing anti-VEGF agents for patients with decreased vision from DME found that at 1 year aflibercept (2.0 mg) achieved better visual outcomes than repacka...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Ross EL,Hutton DW,Stein JD,Bressler NM,Jampol LM,Glassman AR,Diabetic Retinopathy Clinical Research Network.

    更新日期:2016-08-01 00:00:00

  • Effect of Oral Voriconazole on Fungal Keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II): A Randomized Clinical Trial.

    abstract:Objective:To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design, Setting, and Participants:The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India ...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Prajna NV,Krishnan T,Rajaraman R,Patel S,Srinivasan M,Das M,Ray KJ,O'Brien KS,Oldenburg CE,McLeod SD,Zegans ME,Porco TC,Acharya NR,Lietman TM,Rose-Nussbaumer J,Mycotic Ulcer Treatment Trial II Group.

    更新日期:2016-12-01 00:00:00

  • Two-Year Efficacy of Ranibizumab Plus Laser-Induced Chorioretinal Anastomosis vs Ranibizumab Monotherapy for Central Retinal Vein Occlusion: A Randomized Clinical Trial.

    abstract:Importance:Adding a laser-induced chorioretinal anastomosis (L-CRA) to current treatments for central retinal vein occlusion (CRVO) may improve outcomes and lessen therapy burdens. Objective:To determine the 2-year efficacy of intravitreal ranibizumab with an L-CRA vs ranibizumab alone for patients with macular edema ...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,随机对照试验


    authors: McAllister IL,Smithies LA,Chen FK,Mackey DA,Sanfilippo PG

    更新日期:2018-12-01 00:00:00

  • A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery.

    abstract:Importance:Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries. Objective:To compare the prices of topical glaucoma medications, laser trabeculoplasty, and trabeculec...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Zhao PY,Rahmathullah R,Stagg BC,Almobarak F,Edward DP,Robin AL,Stein JD

    更新日期:2018-11-01 00:00:00

  • Association of the Indoor Environment With Dry Eye Metrics.

    abstract:Importance:The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking. Objective:To determine associations between the indoor environ...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Huang A,Janecki J,Galor A,Rock S,Menendez D,Hackam AS,Jeng BH,Kumar N

    更新日期:2020-08-01 00:00:00

  • Self-reported Eye Care Use Among US Adults Aged 50 to 80 Years.

    abstract:Importance:Contemporary data on use of eye care by US adults are critical, as the prevalence of age-related eye disease and vision impairment are projected to increase in the coming decades. Objectives:To provide nationally representative estimates on self-reported use of eye care by adults aged 50 to 80 years, and to...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Ehrlich JR,Ndukwe T,Solway E,Woodward MA,Singer DC,Newman-Casey PA,Kirch M,Delott LB,Kullgren JT,Stagg BC,Musch DC,Malani PN

    更新日期:2019-06-20 00:00:00

  • Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial.

    abstract:IMPORTANCE:Myopia is a significant public health problem, making it important to determine whether a bifocal spectacle treatment involving near prism slows myopia progression in children. OBJECTIVE:To determine whether bifocal and prismatic bifocal spectacles control myopia in children with high rates of myopia progre...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章,随机对照试验


    authors: Cheng D,Woo GC,Drobe B,Schmid KL

    更新日期:2014-03-01 00:00:00

  • Trends in Visual Health Inequalities in Childhood Through Associations of Visual Function With Sex and Social Position Across 3 UK Birth Cohorts.

    abstract:Importance:Despite the existing country-specific strategies tackling social inequalities in visual health in adults, little is known about trends in visual function in childhood and its association with social position. Objective:To investigate the distribution of childhood visual function in the United Kingdom and as...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Bountziouka V,Cumberland PM,Rahi JS

    更新日期:2017-09-01 00:00:00

  • Evaluation of a Home-Printable Vision Screening Test for Telemedicine.

    abstract:Importance:Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. Objectives:To evaluate the repeatability of visual acuity m...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Crossland MD,Dekker TM,Hancox J,Lisi M,Wemyss TA,Thomas PBM

    更新日期:2021-01-07 00:00:00

  • Structural characteristics of the acquired optic disc pit and the rate of progressive retinal nerve fiber layer thinning in primary open-angle glaucoma.

    abstract:IMPORTANCE:The optic disc pit (ODP) has been considered a region of localized susceptibility to the damage of glaucoma. OBJECTIVE:To determine whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the presence and structural characteristics of an ODP in primary open-angle glaucoma. DESIGN...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Lee SH,Lee EJ,Kim TW

    更新日期:2015-10-01 00:00:00

  • Global burden of eye and vision disease as reflected in the Cochrane Database of Systematic Reviews.

    abstract:IMPORTANCE:Eye and vision disease burden should help guide ophthalmologic research prioritization. The Global Burden of Disease (GBD) Study 2010 compiled data from 1990 to 2010 on 291 diseases and injuries, 1160 disease and injury sequelae, and 67 risk factors in 187 countries. The Cochrane Database of Systematic Revie...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Boyers LN,Karimkhani C,Hilton J,Richheimer W,Dellavalle RP

    更新日期:2015-01-01 00:00:00

  • Presentation of TRPM1-Associated Congenital Stationary Night Blindness in Children.

    abstract:Importance:Congenital stationary night blindness (CSNB) implies a stable condition, with the major symptom being nyctalopia present at birth. Pediatric clinical presentation and the course of different genetic subtypes of CSNB have not, to our knowledge, been well described in the era of molecular genetic diagnosis. O...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Miraldi Utz V,Pfeifer W,Longmuir SQ,Olson RJ,Wang K,Drack AV

    更新日期:2018-04-01 00:00:00

  • Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma.

    abstract:Importance:Vitreoretinal lymphoma is a diagnostic challenge and the pathophysiology is still unclear. Objective:To describe an imaging finding seen on optical coherence tomography (OCT) of patients with vitreoretinal lymphoma. Design, Setting, and Participants:This case series study was a retrospective medical record...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Deák GG,Goldstein DA,Zhou M,Fawzi AA,Jampol LM

    更新日期:2019-02-01 00:00:00

  • Development and Evaluation of Diagnostic Criteria for Vogt-Koyanagi-Harada Disease.

    abstract:Importance:To our knowledge, a set of well-defined diagnostic criteria is not yet developed for the diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Objective:To develop and evaluate a set of diagnostic criteria for VKH disease using data from Chinese patients. Design, Setting, and Participants:This case-control stud...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Yang P,Zhong Y,Du L,Chi W,Chen L,Zhang R,Zhang M,Wang H,Lu H,Yang L,Zhuang W,Yang Y,Xing L,Feng L,Jiang Z,Zhang X,Wang Y,Zhong H,Jiang L,Zhao C,Li F,Cao S,Liu X,Chen X,Shi Y,Zhao W,Kijlstra A

    更新日期:2018-09-01 00:00:00

  • Clinical Features, Metastasis, and Survival in Patients Younger Than 21 Years With Posterior Uveal Melanoma.

    abstract:Importance:Given the rarity of posterior uveal melanoma in patients younger than 21 years, reporting clinical experience in this area has relevance. Objective:To describe the baseline clinical features, treatment, and clinical course of a group of patients younger than 21 years who have primary posterior uveal melanom...

    journal_title:JAMA ophthalmology

    pub_type: 杂志文章


    authors: Fry MV,Augsburger JJ,Corrêa ZM

    更新日期:2019-01-01 00:00:00