Artikel
Frequency and impact of color vision deficiencies in melanoma patients: a prospective case-control screening study including 300 melanoma patients and 100 healthy controls
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Veröffentlicht: | 20. März 2006 |
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Background: Patients with melanoma may experience a variety of different vision symptoms, in part associated with melanoma-associated retinopathy (MAR). For several melanoma patients with of without MAR colour vision deficiencies especially involving the tritan system have been reported. The incidence of colour vision deficiencies in a larger cohort of melanoma patients has not been investigated up to the present.
Objectives: To investigate the frequency of colour vision deficiencies in melanoma patients subject to stage of disease, prognostic factors as tumour thickness or Clark level, S100-ß and predisposing diseases (PD) with possible impact on colour vision (hypertension, diabetes mellitus, glaucoma or cataract).
Patients/Methods: 300 melanoma patients in different tumour stages and 100 healthy age- and sex-matched controls were examined with the Farnsworth panel D 15 test.
Results: Case control study: 70/300 (23.3%) melanoma patients and 12/100 (12%) controls showed pathologic results in colour testing. Increasing age could be identified as a highly significant (p=0.0005) risk factor for blue vision deficiency (BVD). While adjusting for age and PD, melanoma proved to be associated with the risk for BVD (odds ratio 2.40; 95% confidence interval [1.17-4.95]; p=0.015). The frequency of blue vision deficiencies in subjects without PD was 52/260 (20%) in melanoma and 4/78 (5.1%) in controls.
Retrospective study: In 260 melanoma patients without PD, BVD, as graded in a 5 point scale, showed a positive correlation with stage of disease (Spearman’s r=0.147; p = 0.009), tumour thickness (r=0.10; p=0.003), Clark level (r=0.12; p=0.039) and a negative correlation with time since initial diagnosis (r=0.11; p=0.045).
Conclusion: Blue vision deficiency is associated with melanoma, but is only weakly related with stage of disease. Although we saw a positive correlation with well known prognostic markers as tumour thickness and Clark level, for the use of BVD as a marker of progression, a diligent test performance and interpretation is inalienable. In patients with PD, BVD is inapplicable as a progression marker. The genesis of BVD in melanoma is still unclear, but potentially connected with subclinical forms of MAR. Further studies including melanoma patients with BVD are required. These investigations should include immunofluorescent assays to determine if these patients have antiretinal antibodies and if extensive ophthalmological examinations suggest evidence of subclinical signs and symptoms consistent with MAR.