Ocular (uveal) melanoma is a rare but dangerous disease. It involves the iris, ciliary body, and/or choroid, which are collectively referred to as the uvea, and the tumors develop in the pigmented cells within the uvea. Many patients do not experience any symptoms, and most uveal melanomas are typically first detected during a dilated eye exam.

Diagnosing and Treating Ocular Melanoma

Only a small number of doctors in the United States treat ocular/uveal melanoma. At Texas Retina, we have been caring for patients with ocular melanoma for more than 40 years and currently have two physicians who sub-specialize in treating this rare eye cancer: Dr. Timothy Fuller and Dr. Rajiv Anand.

Although rare, uveal melanoma (ocular melanoma) can be aggressive and spread (metastasize) to other parts of the body. To address patients’ concerns about this, Texas Retina provides the most advanced genetic analysis of ocular melanomas by performing fine needle aspiration biopsy at the time of treatment. This allows for more customized metastatic screening and greater peace of mind.

The standard-of-care radiation therapy used to treat uveal melanoma is called plaque therapy. A small disc-shaped shield made of gold, known as a plaque, encases radioactive seeds which are used to treat the tumor. It is surgically attached to the outside surface of the eye, over the tumor. The gold protects the surrounding areas from radiation damage. The plaque is left in place for several days, allowing the radiation to treat the tumor. Once complete, it is then removed, and no radioactive material remains on or within the patient.

For tumors that are too large to be treated with plaque therapy, enucleation, which is surgical removal of the eye, is often the only treatment option.

Current Clinical Trials for Ocular Melanoma 

To help advance care for patients with ocular melanoma, Texas Retina has participated in clinical research for over four decades and serves as an active member of the Collaborative Ocular Oncology Group, a network of most major ocular oncology physicians in North America who are pursuing the latest research into ocular (uveal) melanoma.

Under the leadership of Dr. Timothy Fuller, Texas Retina is currently participating in two clinical trials for ocular melanoma, offering access to promising new treatment options:

  • Aura — AU-011-301: A Phase 3 randomized, masked, controlled trial to evaluate the efficacy and safety of belzupacap sarotalocan (AU-011) treatment, a light-activated viral nanoparticle, compared to sham control in subjects with primary indeterminate lesions or small choroidal melanoma.
  • IDE196-010: A randomized, Phase 3, open-label study of neoadjuvant darovasertib in subjects with primary non-metastatic uveal melanoma (Optim-UM-10).

“In the 1980s, brachytherapy revolutionized how ocular melanoma was treated,” shares Dr. Timothy Fuller. “However, it unfortunately almost always comes with vision loss. With AU-011, we are investigating the potential to treat this deadly disease with less harmful effects on vision. AU-011 has been shown in prior studies to selectively destroy cancer membrane cells while sparing the overlying retina, a tissue essential for good vision.”

With the IDE196-010 trial, researchers are trying to determine if neoadjuvant therapy with an oral agent called darovasertib, which is given before plaque radiation, will lead to less vision loss from plaque therapy.

“For patients with tumors too large for radiation, darovasertib could possibly provide an option to maintain their eye rather than have it enucleated,” says Dr. Timothy Fuller. “Our hope is that it can shrink the tumor enough to allow for plaque treatment.”

Additional Resources for Patients with Ocular Melanoma
Because ocular cancer can be an overwhelming diagnosis, Texas Retina has a dedicated Oncology Services Coordinator, Sophie Sotero, who serves as a personal resource to our patients and families, helping them navigate their medical journey.

Here are a couple of additional national resources:

Click HERE to access a brief video where Dr. Timothy Fuller explains ocular melanoma, including current treatment options and promising new research. 

You can also learn more about ocular melanoma HERE.