Ultrasound is valuable because it provides objective measurements that cannot be derived from photography alone. ² For choroidal lesions, ultrasound helps determine:
- Thickness (a major risk discriminator) ¹
- Internal acoustic characteristics (reflectivity patterns)
- Tumour configuration and any concerning contour changes
Thickness greater than 2 millimetres is a key threshold in widely used risk frameworks. ² Ultrasound findings are interpreted alongside OCT (fluid), autofluorescence (lipofuscin/orange pigment), symptoms, and lesion location.
For anterior segment lesions (iris/ciliary body), ultrasound biomicroscopy offers high-resolution imaging of structures that may not be fully visible on slit-lamp examination, particularly for assessing angle or ciliary body involvement. ³
The practical point is that ultrasound supports defensible decisions: confirming a low-risk lesion suitable for surveillance, or identifying features that warrant earlier ocular oncology input. ² ³
References
- Pavlin CJ, Harasiewicz K, Sherar MD, Foster FS. Clinical use of ultrasound biomicroscopy. Ophthalmology. 1991;98(3):287-295. PMID: 2023747.
- Shields CL, Furuta M, Berman EL, Zahler JD, Hoberman DM, Dinh DH, et al. Choroidal nevus transformation into melanoma: analysis of 2514 consecutive cases. Archives of Ophthalmology. 2009;127(8):981-987. doi:10.1001/archophthalmol.2009.151. PMID: 19667334.
- Shields CL, Dalvin LA, Ancona-Lezama D, Yu MD, Di Nicola M, Williams BK Jr, et al. Choroidal melanoma: clinical features, classification, and top 10 pseudomelanomas. Indian Journal of Ophthalmology. 2019;67(12):1959-1974. doi:10.4103/ijo.IJO_2004_19. PMID: 31755418.
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