In the 2008 annual report to the nation on the status of cancer in America from the collaborative work of the National Cancer Institute (NCI), American Cancer Society, Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACR), it was documented that the incidence and death rates from all cancers combined decreased significantly.¹ These decreases were driven by declines in incidence and death rate for the three most common cancers in men, including lung, colorectum, and prostate cancers. Additionally two of the three leading cancers in women declined, including breast and colorectum cancers. The lung cancer death rate in women leveled off. They emphasized that although the overall lung cancer death rate had stabilized, this finding varied by region as in areas of high cigarette smoking prevalence, such as the southern and midwestern states, where the death rate actually increased. They advised improvement in state tobacco control programs.

Systemic cancers can metastasize to the eye. The most common cancers to spread to the ocular structures include breast and lung cancer.² The decreasing incidence of these cancers could impact the frequency of ocular metastasis.

Historically, metastatic tumors to the eye were believed to be rare. A classic ophthalmic textbook in 1966 stated that few surgeons had observed more than one case of ocular metastasis.³ Later it was realized that ocular metastases were more common, and over the past 50 years, there have been several reports on the incidence and prognosis of patients with metastatic tumors to the eye.^{4,5,6,7,8,9,10,11,12} Albert et al.⁵ found that 2% of 213 patients with known systemic cancer and metastases had choroidal metastases. Bloch and Gartner⁷ reported that 8% of eyes in 230 patients with autopsy-proven carcinomas had histologically confirmed uveal metastatic foci. Nelson et al.¹⁰ found in an autopsy study that 4% of patients dying of carcinoma had ocular metastases. They estimated that in the year 1983, 22,000 patients who died of cancer had ocular metastatic disease.¹⁰

Most reports on ocular metastases come from pathology laboratories or from general cancer centers where patients have had known primary cancers or metastatic disease and the eyes were subsequently examined. These studies have focused on the source of the primary tumor, as well as on general clinical and histopathologic features of the tumor (derived from autopsy or pathology reports in some instances).^4,5,6,7,8,10 Ocular metastases on file at the Armed Forces Institute of Pathology were reviewed by Hart⁴ in 1962 and Ferry and Font⁸ in 1974.

Only a few comprehensive reports have been published on the clinical features of ocular metastases from an ophthalmologic point of view. In 1979, Stephens and Shields⁹ reviewed 70 cases of uveal metastases and provided general details on the clinical findings of these tumors. In 1997, Shields et al.² reported extensive detail on the clinical features and management of uveal metastases in a large group of 420 consecutive patients. Several authors have described metastatic tumors to the orbit, conjunctiva, and optic disc.^{13,14,15,16,17,18,19,20,21} Others have focused on the features of uveal metastases from specific primary sites, such as breast,^{22,23,24,25,26,27,28} prostate,²⁹ skin,^30,31,32,33 and carcinoid tumors.³⁴ In 1987, Freedman and Folk¹¹ reported on the clinical aspects of metastatic tumors to the choroid in 61 patients; they addressed specifically the factors affecting the median survival time after ocular diagnosis. Later, Shields and Shields^{35,36,37,38,39} summarized their experience with clinical features, diagnostic techniques, and management of ocular metastases in a textbook and two comprehensive atlases on ocular tumors.