Though the optic nerve is a relatively radiation-resistant tissue; both plaque and external beam irradiation for eye cancer can cause radiation optic nerve damage. Divided by location, anterior radiation optic neuropathy and radiation papillitis has been most commonly seen after plaque and proton beam therapy. In contrast, posterior radiation optic neuropathy can be seen after external beam radiation therapy for orbital, sinus and brain tumors. Posterior radiation optic neuropathy is best seen as optic nerve illumination during gadolinium-enhanced magnetic resonance imaging (MRI). Such is a sign of extravasation of dye into the optic nerve sheath and orbit. In those cases, the intraocular optic disc can appear normal, there is no known effective treatment and vision loss occurs within 4-8 weeks. In contrast, anterior radiation optic neuropathy typically presents with disc-swelling, hemorrhages and retinal exudates. Early treatment with periodic intravitreal anti-VEGF therapy offer the best chance for years of vision preservation. However, it is important to consider that anterior radiation optic neuropathy is a chronic disease that requires long-term anti-VEGF therapy. This PodCast reviews Dr. Finger’s experience with the pathophysiology and methods used to preserve vision in eyes affected by radiation optic neuropathy.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170