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This asymptomatic, healthy 45YO male was referred for age-related macular degeneration, which was diagnosed during his 30s. Vision was 20/20 OU.
Optos color RG imaging of his right eye shows mixed drusen with pigment clumps. The drusen on fundus autofluorescence (FAF) are mostly hyper-FAF. Fluorescein angiography reveals innumerable hyperfluorescent drusen. Identical findings were present in his left eye (not shown).
Learning Points:
Originally described by Gass as basal laminar drusen (AJO 1985;99:445-459), cuticular drusen were initially thought to represent nodular thickening of the RPE basement membrane. They appear clinically as numerous, round, yellow-white ‘hard drusen’, and on OCT as small, arrowhead-shaped drusen located above Bruch’s membrane and below the RPE (Spaide and Curcio, Retina 2010;30:1441-1454). Our patient’s angiographic appearance echoes Dr. Gass’ original description of “a beautiful stars-in-the-sky or Milky Way pattern” of hyperfluorescence. Cuticular drusen are classically associated with avascular vitelliform lesions (Finger et al, Retina 2010;30:1455-1464).
Can J Ophthalmol. 2026 Aug;61(4):955-966. doi: 10.1016/j.jcjo.2026.01.020.
Uveal MM: New volume-based classification provides better prognostic discrimination than AJCC system — Retrospective, 5410 consecutive patients.
Objective: To validate a newly proposed anatomic staging system for choroidal and ciliary body melanoma, based on tumour volume estimated from routine clinical measurements, and compare its prognostic performance with the American Joint Committee on Cancer (AJCC) 8th edition classification.
Design: A retrospective, multicentre cohort study.
Participants: A total of 5 410 consecutive patients diagnosed with choroidal and/or ciliary body melanoma at 6 European ocular oncology centres.
Methods: Tumours were staged according to both classifications. Prognostic performance was evaluated using competing risk regression, Cox regression, Kaplan-Meier survival analyses, and net reclassification improvement.
Results: The new classification showed better prognostic discrimination than the AJCC system, with a net reclassification improvement of 23%. In competing risk regression, it produced a higher Wald statistic (761 vs 628) and a subdistribution hazard ratio of 1.42 versus 1.22. Cox regression for melanoma-related mortality demonstrated higher hazard ratios, peaking at 24 for the new model compared with 13 for the AJCC classification. Cumulative incidence analyses revealed 15-year metastatic death rates ranging from 7% to 76% with the new system versus 11% to 69% with AJCC, widening the absolute range by 11 percentage points.
Conclusions: This large international validation study demonstrates that the new volume-based classification provides more accurate prognostic stratification for choroidal and ciliary body melanoma. Its improved risk discrimination, using readily available clinical measurements, supports its applicability in clinical practice and potential utility for guiding follow-up and resource allocation.
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