Kapil Mishra discusses radiation retinopathy in uveal melanoma

Kapil Mishra, MD, assistant professor of ophthalmology at the Gavin Herbert Eye Institute, University of California Irvine, discussed an overview of radiation retinopathy and its challenges in treating uveal melanoma. He presented "Radiation Retinopathy: Future Strategies" during the 2025 Retina World Congress annual meeting.

Mishra introduced a unique treatment paradigm in ocular oncology that prioritizes patient survival first, followed by globe preservation, and then vision restoration.

"When we think about treatment for ocular oncology, and specifically uveal melanoma, there's this paradigm that we follow that we don't typically consider in the world of ophthalmology, because we're so isolated in many ways," he said. "With ocular oncology, it's very similar to the rest of the body in the sense that life trumps all, and then followed by that, there's globe preservation, and then after that, there is vision. So as long as we're able to salvage life and salvage globe, then we can focus on vision."

While treatments for uveal melanoma have significantly improved local tumor control and globe salvation, vision outcomes remain problematic. According to the collaborative ocular melanoma study, approximately 50% of patients undergoing radiation treatment experience vision loss of 20/200 or worse, highlighting a critical area for medical innovation.

Radiation retinopathy emerges as a particularly challenging disease, characterized by its resistance to treatment and high prevalence among uveal melanoma patients. Mishra emphasized the need to explore both direct and indirect strategies to address this condition.

The presentation underscored the complexity of ocular oncology, where medical interventions must balance multiple competing priorities. By focusing on life preservation and globe salvation, physicians have made significant strides, but the next frontier involves improving vision outcomes for patients.

Mishra suggests there is substantial room for developing new treatments and strategies that can mitigate vision loss while maintaining the primary goals of tumor control and patient survival. His research points to potential future developments in ocular oncology that could revolutionize treatment approaches for radiation retinopathy.