Eye Cancer Foundation

This study quantitatively assessed data protection practices in U.S. revenue cycle management (RCM) by applying an evidence-oriented measurement instrument and summarizing results as an overall RCM Data Protection Index (RCM-DPI) with five domain subscales. A cross-sectional, observational design was used, and data were obtained from 120 organizations representing provider-operated, outsourced vendor, and hybrid RCM operating models. The overall RCM-DPI averaged 67.4 (SD = 9.8; median = 68.1; range = 41.0–88.5), indicating mid-range protection maturity with meaningful variability. Subscale means were highest for workforce safeguards (74.2, SD = 8.6) and data security controls (70.8, SD = 10.1), while auditability and monitoring (62.7, SD = 12.7) and vendor oversight (60.3, SD = 13.4) showed lower central tendency and wider dispersion. The overall index correlated strongly with auditability and monitoring (r = 0.85), identity and access governance (r = 0.82), vendor oversight (r = 0.80), and data security controls (r = 0.77), and moderately with workforce safeguards (r = 0.69), supporting coherent index composition. Organizational descriptors were negatively associated with protection outcomes, including toolchain complexity (r = -0.36 overall; r = -0.41 for auditability) and outsourcing proportion (r = -0.33 overall; r = -0.44 for vendor oversight). In multivariable regression, governance cadence positively predicted the overall index (B = 3.12, p < .001), while outsourcing intensity (B = -2.76, p < .001), toolchain complexity (B = -2.21, p = .003), and clearinghouse concentration (B = -1.48, p = .034) predicted lower scores; size tier was not significant (p = .18). Model fit was R² = 0.49 (adjusted R² = 0.46). Subscale reliability ranged from 0.81 to 0.88, supporting measurement consistency.

Radiation is the most common life and sight-sparing treatment for eye cancer patients. However, it can subsequently lead to a dose-dependent, progressive radiation vasculopathy, which results in retinopathy- or optic neuropathy-related vision loss. Before the advent of intravitreal drug therapy, laser destruction of the ischemic retina was found to be effective for select patients. However, in 2006, the anti-vascular endothelial growth factor bevacizumab was found to trigger regression and suppress radiation maculopathy and optic neuropathy. Anti-vascular endothelial growth factor drugs were administered initially to forestall vision loss in patients with clinically significant disease. Advancements in retinal imaging and a better understanding of their capabilities resulted in earlier intervention with anti-vascular endothelial growth factor treatment. Still, not all the radiation damage to the retina was reversible. To prevent this irreversible injury, periodic anti-vascular endothelial growth factor therapy was given to those patients at the highest risk of developing radiation-related maculopathy within six months of high-dose foveal plaque radiation therapy. This research found that treating patients before clinically evident radiation maculopathy prevented or delayed the onset of radiation maculopathy with preservation of vision. Other strategies to prevent vision loss due to progressive, recalcitrant retinopathy have included the off-label use of alternative therapeutic agents and polypharmacy with intravitreal steroids. These therapeutic agents should be evaluated in protocols where intervention can be guided by optical coherence tomography angiography as subclinical obliterative retinal microangiopathy appears to start at the time of or soon after ocular irradiation. Treatment strategies have evolved, especially as our understanding of the condition has improved. We propose that future protocols take advantage of new therapies, use advances in retinal imaging, and employ novel technologies to establish optimal treatment regimens.

Purpose:To evaluate presenting features, tumor size, and treatment methods for risk of metastatic death due to advanced intraocular retinoblastoma (RB).Design:International, multicenter, registry-based retrospective case series.Participants:A total of 1841 patients with advanced RB.Methods:Advanced RB was defined by 8th edition American Joint Committee on Cancer (AJCC) categories cT2 and cT3 and new AJCC-Ophthalmic Oncology Task Force (OOTF) Size Groups (1: < 50% of globe volume, 2: > 50% but < 2/3, 3: > 2/3, and 4: diffuse infiltrating RB). Treatments were primary enucleation, systemic chemotherapy with secondary enucleation, and systemic chemotherapy with eye salvage.Main Outcome Measures:Metastatic death.Results:The 5-year Kaplan–Meier cumulative survival estimates by patient-level AJCC clinical subcategories were 98% for cT2a, 96% for cT2b, 88% for cT3a, 95% for cT3b, 92% for cT3c, 84% for cT3d, and 75% for cT3e RB. Survival estimates by treatment modality were 96% for primary enucleation, 89% for systemic chemotherapy and secondary enucleation, and 90% for systemic chemotherapy with eye salvage. Risk of metastatic mortality increased with increasing cT subcategory (P < 0.001). Cox proportional hazards regression analysis confirmed a higher risk of metastatic mortality in categories cT3c (glaucoma, hazard ratio [HR], 4.9; P = 0.011), cT3d (intraocular hemorrhage, HR, 14.0; P < 0.001), and cT3e (orbital cellulitis, HR, 19.6; P < 0.001) than in category cT2a and with systemic chemotherapy with secondary enucleation (HR, 3.3; P < 0.001) and eye salvage (HR, 4.9; P < 0.001) than with primary enucleation. The 5-year Kaplan–Meier cumulative survival estimates by AJCC-OOTF Size Groups 1 to 4 were 99%, 96%, 94%, and 83%, respectively. Mortality from metastatic RB increased with increasing Size Group (P < 0.001). Cox proportional hazards regression analysis revealed that patients with Size Group 3 (HR, 10.0; P = 0.002) and 4 (HR, 41.1; P < 0.001) had a greater risk of metastatic mortality than Size Group 1.Conclusions:The AJCC-RB cT2 and cT3 subcategories and size-based AJCC-OOTF Groups 3 (> 2/3 globe volume) and 4 (diffuse infiltrating RB) provided a robust stratification of clinical risk for metastatic death in advanced intraocular RB. Primary enucleation offered the highest survival rates for patients with advanced intraocular RB.

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.