The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with complications affecting the eyes following radiation and chemotherapy.
Subjective measures:
(1) vision
(2) light sensitivity
(3) pain and dryness
(4) tearing
Objective measures:
(1) best corrected vision
(2) cornea
(3) iris
(4) sclera
(5) optic nerve
(6) lens
(7) retina
(8) facial bones
Management measures:
(1) tearing, cornea, lacrimation
(2) pain
(3) neovascularization
(4) lens
(5) retina
(6) facial bones
Analytic studies:
(1) slit lamp exam: Assessment of intraocular pressure, pupils, ocular motility, dilated fundoscopic exam and gonioscopy.
(2) cultures and stains: Assessment of corneal infiltrates.
(3) ultrasound: Examination of posterior pole if opaque media (cornea, lens, vitreous).
(4) fluorescein angiogram: Evaluation of retinal neovascularization, macular edema, exudates.
(5) color vision: Assessment of if afferent pupillary defect or optic nerve asymmetry
(6) automated visual field: Assessment of optic nerve, papillary or color vision abnormality
(7) MRI: Assessment of sudden visual loss and abnormal optic disc; or normal appearing optic disc and no other visible reason for visual loss.
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
|
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
vision |
indistinct color vision |
blurred vision, loss of color vision |
severe loss of vision, symptomatic visual field defect with decrease in central vision, some ability to perform daily living activities |
blind, inability to perform daily living activities |
|
light sensitivity |
photophobia, no change in vision |
increased photophobia, decreased vision |
photophobia with major loss of vision |
NA |
|
pain and dryness |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
tearing |
occasional |
intermittent |
persistent |
NA |
|
best corrected vision |
> 20/40 |
20/50 to 20/200 |
< 20/200; count fingers at 1 meter |
cannot count fingers at 1 meter |
|
cornea |
increased tearing on exam |
non-infectious keratitis |
infectious keratitis, corneal ulcer |
panophthal-mitis, corneal scar, ulceration leading to perforation or loss of globe |
|
iris |
rubeosis only |
rubeosis with increased intraocular pressure |
neovascular glaucoma with ability to count fingers at 1 meter |
neovascular glaucoma unable to count fingers at 1 meter; complete blindness |
|
sclera |
loss of episcleral vessels |
<= 50% scleral thickening |
> 50% scleral thickening |
scleral or periosteal graft required due to perforation |
|
optic nerve |
afferent pupillary defect with normal appearing optic nerve |
<= 1/4 pallor with asymptomatic visual field defect |
> 1/4 pallor or central scotoma |
profound optic atrophy, complete blindness |
|
lens |
asymmetric lenticular opacities without visual loss |
moderate lenticular changes with mild to moderate visual loss |
moderate lenticular changes with severe visual loss |
severe lenticular changes |
|
retina |
micro-aneurysms, nonfoveal exudates, minor vessel attenuation, extra-foveal pigment changes |
cotton wool spots |
massive macular exudation, focal retinal detachment |
opaque vitreous hemorrhage, complete retinal detachment, blindness |
|
facial bones |
cosmetically undetectable facial asymmetry |
minimal cosmetic asymmetry |
moderate orbital contracture |
severe hypoplasia of orbital bones |
|
management of tearing, cornea, lacrimation |
lubrication if needed |
lubrication with or without pressure patch or antibiotics |
topical antibiotics with or without cyclopegia |
corneal graft, enucleation |
|
management of pain |
occasional non-narcotics |
regular non-narcotic |
regular narcotic |
parenteral narcotics |
|
management of neovascular-ization |
pan-retinal photo-coagulation |
medical management of glaucoma; pan-retina photo-coagulation |
surgical management of glaucoma; cyto-destructive procedure |
enucleation |
|
management of lens |
NA |
NA |
cataract extraction depending on visual potential |
NA |
|
management of retina |
NA |
medical management of glaucoma, focal photo-coagulation |
surgical management of glaucoma with or without pan-retinal photo-coagulation |
cytodestructive procedure; repair of retinal detachment |
|
management of facial bones |
NA |
NA |
cosmetic repair with or without orbital augmentation for anophthalmic socket |
enucleation, orbital augmentation for anophthalmic socket |
total score =
= SUM(points for all 18 items)
LENT score =
= (total score) / 18
Interpretation:
• maximum total score: 69
• minimum LENT score: 0
• maximum LENT score: 3.83
Specialty: Hematology Oncology, Ophthalmology
