AUTOMATED PERIMETRY IN PATIENTS WITH CHOROIDAL METASTASES

Aims/Background-Recent work using computerised perimetry has documente d predictable visual field defects in patients with choroidal melanoma . Despite the higher frequency of occurrence of choroidal metastases, relatively little is known about their exact effects on visual perform ance, specifically with respect to visual field. This study is a pilot retrospective analysis of the results of automated perimetry testing in patients with choroidal metastatic disease. Methods-The Humphrey fi eld analyser was used to perform visual field tests on 15 eyes in 11 p atients diagnosed with choroidal metastases. All 11 primary tumours we re carcinomas originating in the breast (seven), lung (one), kidney (o ne), stomach (one), and prostate (one). All patients had either centra l 30 and/or peripheral 30-60 threshold strategies. Results-Each of the 15 eyes tested had a demonstrable visual field defect. Eight eyes (53 %) had absolute scotomas and seven (43%) had relative scotomas; the de fects did not consistently correspond in size or location to the tumou r as depicted by ophthalmoscopy or ultrasonography. This is in contrad istinction to automated perimetry results in patients with choroidal m elanoma. Three of the four eyes (75%) which were retested after treatm ent of the metastases showed improvement of the visual field. Seven of nine eyes (77%) that initially had reduced visual acuity had improvem ent after treatment. This clinical improvement corresponded well to tu mour shrinkage and resolution of subretinal fluid. Conclusion-These fi ndings may be useful in the decision to initiate treatment for symptom atic choroidal metastatic disease and in explaining to patients and th eir referring physicians what improvement could be expected from such treatment. A prospective evaluation of patients with choroidal metasta ses seems appropriate based on this pilot experience and may elucidate if the differences noted between visual field performance of these pa tients and those with choroidal melanoma may be useful in some diagnos tically difficult cases.