The initial episode of unilateral AAU associated with HLA-B27 or axial SpA randomly affects either eye. Subsequent episodes occur more often in the same eye previously affected. Male gender and history of unilateral AAU in the same eye are associated with a shortened time interval between relapses.
ferral to the first review at the ophthalmic oncology clinic was 17 days. Among the patients, 42.1% had an initial visual acuity of 6/9 or better and 28.8% had an initial visual acuity of 6/60 or worse. The lesion diameter was less than 10 mm (small) for 50.4% of patients, 10 to 15 mm (medium) for 38.3%, and greater than 15 mm (large) for 11.3%. There were 630 interventions, including ruthenium plaque radiotherapy for 51.1%, proton beam radiotherapy for 26.4%, and enucleation for 18.3% (8.2% primary enucleation). Other interventions included cataract surgery, vitrectomy, and local resection. No treatment group was normally distributed (P Ͻ .005). There was no significant difference in the median Scottish Index of Multiple Deprivation scores between the main treatment groups (Kruskal-Wallis P=.91) (Figure). Comment. The demographic characteristics of our patients are comparable to those of patients in other documented studies of uveal melanoma. 3-5 The literature does not appear to describe clear risk factors for this uncommon malignant neoplasm. In keeping with this, socioeconomic status was not found to be a significant factor for choroidal melanoma or subsequent treatment modality in this study. This was remarkable as social deprivation has been strongly associated with poor attendance at retinal screening events for diabetic eye disease and with subsequent poor outcomes. 6 We initially expected patients from a higher area of deprivation to make their initial visit later and therefore have a higher rate of enucleation. This was not found to be the case. The patients' address (postcode) did not appear to influence management of their condition. The distribution of choroidal melanoma in Scotland was not seen to be more prevalent in any particular socioeconomic group. This is particularly relevant as the Scottish Executive has recently released funding to enable optometric practices to provide subsidized initial consultations. This is intended to improve and streamline referrals to hospital eye services. Further awareness of these subsidized services in all socioeconomic groups could result in earlier detection and influence subsequent management of uveal melanoma. This could play a future role in maintaining a low enucleation rate.
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