Researchers recently developed a nomogram that may help clinicians predict visual acuity outcomes for patients with uveal melanoma undergoing plaque radiotherapy and prophylactic intravitreal anti-VEGF. 

This retrospective review, by ocular oncology experts at Wills Eye Hospital in Philadelphia and the Mayo Clinic of Rochester, MN, included 1,131 cases that were treated at four-month intervals for two years. The team used two point systems for visual acuity outcome—one with clinical risk factors and the other with both clinical and treatment risk factors.

They found that the most important clinical risk factors—ranked with a point system—for poor visual acuity  included: 

• subretinal fluid involving four quadrants (100pts)
• tumor thickness >4mm (69pts)
• presenting visual acuity ≤20/30 (65pts)
• non-Caucasian race (58pts)
• mushroom-shaped and bilobed or multilobulated tumor (57pts)
• insulin-dependent diabetes (54 pts)

The researchers note that the risk of poor visual acuity at two and four years increased from 11% and 24%, respectively, with 40 points to 97% and >99%, respectively, with 304 points. 

The second nomogram including both clinical and treatment risk factors, with differing points: 

• presenting visual acuity ≤20/30 (100pts)
• tumor largest basal diameter >11mm (80pts)
• radiation dose rate to tumor base ≥164cGy/hour (78pts)
• tumor thickness >4mm (76pts)
• insulin-dependent diabetes (75pts)
• abnormal foveolar status by optical coherence tomography at presentation (72pts)

When using this system, the risk of poor visual acuity at two and four years increased from 6% and 14%, respectively, with 56 points, to 88% and 99%, respectively, with 496 points.

The nomogram is available online at fighteyecancer.com/nomograms/.