A cohort study of melanocytoma of the optic disc in the Israeli population: Factors associated with vision loss

BackgroundOptic disc melanocytoma is a rare, typically benign pigmented tumor that may occasionally lead to vision loss or tumor enlargement. Despite its usually indolent nature, the clinical behavior and risk factors associated with progression remain incompletely defined.MethodsA retrospective cohort study was conducted involving 21 patients diagnosed with optic disc melanocytoma at Sheba Medical Center, Israel, between 2009 and 2024. Data were collected on demographics, presenting symptoms, imaging characteristics, and visual outcomes. Tumor features were analyzed using fundus photography, optical coherence tomography (OCT), and B-scan ultrasonography. Statistical tests were performed to explore associations between tumor behavior and clinical variables.ResultsThe cohort had a mean age of 60.1 years; Fourteen (66.7%) were female. Most tumors appeared flat and were located inferiorly or nasally. Over a mean follow-up of 64 months, five (23.8%) patients exhibited measurable tumor growth, with one case (4.7%) resulting in severe visual decline. Vision loss of two or more Snellen lines was significantly associated with floaters at presentation (p = 0.04), optic disc edema (p = 0.002), and pigmented vitreous seeds (p = 0.04). No significant associations were found with demographic or iris pigmentation variables.ConclusionWhile optic disc melanocytoma typically follows a benign course, certain clinical features-such as floaters, disc edema, and vitreous seeding-may indicate a higher risk for tumor progression and vision loss. These findings highlight the importance of targeted surveillance strategies in patients presenting with these features to facilitate early detection and optimized management.