Posterior Segment
Radiation Retinopathy
Also known as: radiation retinopathy, radiation maculopathy, radiation vasculopathy, radiotherapy retinopathy, retinopathy after radiotherapy, plaque brachytherapy retinopathy, radiation optic neuropathy
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Radiation retinopathy is a slowly progressive, occlusive disease of the retinal vessels that follows radiation to the eye, orbit, sinuses, nasopharynx or brain. It looks like diabetic retinopathy: microaneurysms, telangiectasia, haemorrhages, cotton wool spots, hard exudates and macular oedema, and later new vessels. It appears months to years after treatment, so the patient may not connect the two. The optometry role is to ask about past radiotherapy when these signs are found, especially in a patient without diabetes or in one eye only, document the findings, and refer to ophthalmology.
Recognition
Symptoms: what patients report
- Often none in the early stage.
- Gradual blur or distortion when the macula is involved.
- Sudden vision loss or floaters with a vitreous haemorrhage.
- A painful red eye raises concern for neovascular glaucoma.
Signs: what the examination shows
- Microaneurysms and telangiectatic vessels, usually first at the posterior pole.
- Intraretinal haemorrhages, cotton wool spots and hard exudates.
- Macular oedema on OCT.
- Capillary non-perfusion, with new vessels on the disc, retina or iris in advanced disease.
- Disc swelling or pallor where the optic nerve was also in the radiation field.
What OptoGuide™ covers for radiation retinopathy
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Centre for Eye Health — Chair-side Reference: Retinal Vascular Disease (history questions when retinal vascular signs are found)
- Sahoo NK et al. Radiation Retinopathy: Detection and Management Strategies. Clin Ophthalmol 2021;15:3797-3809 (occlusive vasculopathy; onset from 1 month to 15 years)
- Zamber RW, Kinyoun JL. Radiation retinopathy. West J Med 1992;157:530-3 (sites of irradiation; dose, fraction size, chemotherapy and vascular disease as risk factors; resemblance to diabetic retinopathy)
- Monroe AT et al. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005;61:856-64 (head and neck series: median 2.6 years to diagnosis, range 11 months to 5.3 years)
- Giuliari GP et al. Current treatments for radiation retinopathy. Acta Oncol 2011;50:6-13 (sequence of signs; frequency after plaque radiotherapy)
- Rayess N, Mruthyunjaya P. Anti-Vascular Endothelial Growth Factor Therapy for Radiation Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2020;51:S44-S49 (macular oedema, ischaemia, proliferative disease and neovascular glaucoma)
- Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci 2008;15:95-100 (acute, profound visual loss; hyperbaric oxygen may help if started within 72 hours)