How do you manage Cancer-Associated Retinopathy (CAR) in a patient who doesn’t have a known cancer diagnosis, given the difficulty in finding the underlying cancer and the risks of using immunosuppressive treatments to preserve vision?

Auto-immune retinopathy, whether paraneoplastic or non-paraneoplastic, can be a very difficult condition to diagnose and manage. There are a few features that raise suspicion for a paraneoplastic cause particularly, such as rapid progression and more significant intraocular inflammation (anterior chamber cell, vitreous cell/haze, retinal vasculitis).

In patients who I suspect auto-immune retinopathy, I will obtain malignancy screening that includes CT or PET/CT of the chest/abdomen/pelvis (reali...