A 61-year-old man was referred for a vascularized lesion of the conjunctival limbus suspicious for carcinoma in situ (Fig A). However, excisional biopsy demonstrated superficially invasive melanoma arising within conjunctival melanocytic intraepithelial neoplasia (C-MIN). Both the epithelial and invasive components lacked visible melanin. Roughly 80% of the conjunctival epithelium was replaced by atypical melanocytes (Fig B); that expressed MART-1 (melanocyte antigen marker; Fig C). The tumor extended 0.6 mm into substantia propria (Fig D).

A 40-year-old woman noted fullness of her right upper eyelid for 3 months (Fig A). She had a history of recurrent conjunctival melanoma with multiple excisions over 7 years. One year earlier, she had unrelated filtering surgery for elevated intraocular pressure. Orbital biopsy confirmed the diagnosis of melanoma, and she underwent orbital exenteration. The specimen demonstrated orbital and intraocular extension of conjunctival melanoma (Fig B) with replacement of the choroid (Fig C) and retina (Fig D) with melanoma cells.

The following Letter to the Editor (Ophthalmology 2015;122:e18) was posted without the Reply. Below please find the Letter and Reply.

A 60-year-old man with Fuchs' endothelial dystrophy underwent Descemet's stripping endothelial keratoplasty (DSEK) in his right eye because of corneal edema and deterioration of visual acuity to 20/100. Six years earlier he underwent DSEK in his left eye due to pseudophakic bullous keratopathy.

The report by Chan et al1 in the current issue (p. 2278) details how screening for both diabetic retinopathy and age-related macular degeneration (AMD) can be conducted using fundus photographs obtained with nonmydriatic cameras. Exactly how cost-effective is such a screening? Could this be a recommendation for the future? Herein, we explore the potential for such a model for the management of 2 of the leading causes of blindness worldwide.