For radiation optic neuropathy, no consensus exists as to whether intravitreal injections with steroids or anti-VEGF provide long-term advantages in visual acuity compared with observation alone. Researchers in Berlin believe that the “wait and see” observation option is just as effective as intravitreal therapy, as their study determined similar long-term results regarding function and anatomy in patients with uveal melanoma and proton beam radiation-induced optic neuropathy.

The study compared 48 patients who were only observed after radiation optic neuropathy and 45 who were treated with intravitreal therapy (triamcinolone, bevacizumab, and/or dexamethasone). Median follow-up was 55 months (29 to 187 months), median interval between onset of radiation optic neuropathy and the last patient visit was 34 months (24 to 125 months).

In the 48 observed patients, 85.4% developed an optic atrophy after a median of 14 months. In the 45 intravitreally treated patients, 75.5% presented with an optic atrophy after a median of 12.5 months, indicating no statistically significant difference between the groups. When comparing the change in visual acuity at the onset of optic neuropathy to final visual acuity, the study found no statistical significant difference between the two groups.

While practitioners should tailor therapy for each patient, researchers believe that the indication for intravitreal therapy after the development of radiation optic neuropathy should be very strict, and the patient should be informed about the “wait and see” option and the long-term visual prognosis. The study does note that approaches to the prevention of optic neuropathy in the first place are of particular interest.

Eckstein D, Reichardt AI, Heufelder J, et al. Radiation-induced optic neuropathy – observation versus intravitreal treatment. Am J Ophthalmol. July 16, 2019. [Epub ahead of print].