Long-term visual acuity results of treated and untreated radiation retinopathy (an AOS thesis)

To report ocular findings in eyes with radiation retinopathy and visual acuity (VA) results of photocoagulation for macular edema and proliferative retinopathy.

This retrospective case series compared VA after photocoagulation treatment and nontreatment of radiation macular edema. Visual outcomes were assessed with regression analyses.

Eighty-seven eyes (78 [89.7%] treated with external beam irradiation and 9 treated with local plaques) were studied. Fifty-nine (67.8%) and 28 (32.2%) eyes had nonproliferative and proliferative retinopathy, respectively; macular edema developed in 42 nonproliferative eyes (71.2%) and 24 proliferative eyes (85.7%). Initial VAs (median) were 20/40 and 20/65 for nonproliferative and proliferative eyes, respectively, and final VA was 20/80 and 20/400. Initial VA (median) in eyes with macular edema was 20/50 compared to 20/25 in eyes without edema; final VAs were 20/200 and 20/30. Comparing treated (19 [45.2%]) and untreated (23[54.8%]) macular edema in 42 eyes with nonproliferative retinopathy, initial median VA (20/40 and 20/50) and final VA (20/100 and 20/200) were better in treated eyes. Regression analysis showed significant treatment effect (P = .003) when initial VA (logMAR) and months of follow-up were kept constant; treated eyes had mean final VA (logMAR) 0.36 (95% CI, 0.12-0.60) better than untreated eyes.

The presence of macular edema and proliferation indicates more severe retinopathy and worse visual prognosis than for eyes without macular edema and proliferation. Although these VA results suggest macular photocoagulation is beneficial, eyes with macular edema continue to lose vision despite treatment. Better prevention and treatment methods are needed for radiation retinopathy.