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Retinal Physician

Article | 2025 American Academy of Ophthalmology Annual Meeting

Avoiding Radiation in Uveal Melanoma

Findings presented at AAO 2025 demonstrated that treatment with ablation and anti-VEGF injections allowed patients to avoid radiation-related damage, with most maintaining 20/40 vision or better.

By: Timothy G. Murray, MD, MBA, FACS
Retinal Physician October 18, 2025

Clinical Report: Avoiding Radiation in Uveal Melanoma

Overview

Ablation therapy combined with anti-VEGF injections effectively avoids radiation-related damage in uveal melanoma patients, with most maintaining vision of 20/40 or better over an average follow-up of 79 months. This study highlights the potential for improved visual outcomes without the complications associated with radiation therapy.

Background

Uveal melanoma is a common primary intraocular malignancy, and traditional treatments often involve radiation therapy, which can lead to significant complications such as radiation retinopathy and vision loss. Recent advancements in treatment strategies aim to minimize these risks while maintaining tumor control and preserving vision. Understanding alternative treatment options is crucial for optimizing patient outcomes.

Data Highlights

ParameterValue
Number of Patients105
Entry-Level Vision20/63
Average Apical Thickness1.9 mm
Vision at Study End20/32
Patients Better than 20/4085%

Key Findings

  • Ablation therapy and anti-VEGF injections can effectively avoid radiation-related damage.
  • All patients in the study achieved tumor control over an average follow-up of 79 months.
  • Initial vision of 20/63 improved to 20/32 by the end of the study.
  • Only one patient with GEP class 2 tumor developed metastatic disease.
  • Patients received an average of six bevacizumab injections per year, with treatment intervals adjusted based on OCT findings.

Clinical Implications

The findings suggest that clinicians may consider ablation therapy and anti-VEGF injections as viable alternatives to radiation therapy in managing small uveal melanoma. This approach not only preserves vision but also minimizes the risk of radiation-associated complications, particularly in carefully selected patients.

Conclusion

The study presents promising evidence for non-radiation treatment strategies in uveal melanoma, emphasizing the importance of ongoing research to refine management approaches, explore patient selection criteria, and improve overall patient outcomes.

References

  1. Retinal Physician, 2025 -- Avoiding Radiation in Uveal Melanoma
  2. Retinal Physician, 2025 -- Reducing the Risk of Radiation Retinopathy
  3. Retinal Physician, 2025 -- Brachytherapy for Uveal Melanoma: Is the Dose Too High?
  4. ScienceDirect, 2026 -- Uveal melanoma: ESMO–EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up
  5. Retinal Physician — Reducing the Risk of Radiation Retinopathy
  6. the ophthalmologist — Modeling the Genetics of Uveal Melanoma
  7. Uveal melanoma: ESMO–EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up - ScienceDirect
  8. The COMS Randomized Trial of Iodine 125 Brachytherapy for Choroidal Melanoma, III: Initial Mortality Findings: COMS Report No. 18 | Melanoma | JAMA Ophthalmology | JAMA Network
  9. Avoiding Radiation in Uveal Melanoma | Retinal Physician