Patients with uveal melanoma have plenty to worry about—loss of vision, pain, loss of the eye, and death from metastatic disease, not to mention all the secondary consequences of these problems. Previously, all we had to do was to remove the threat of metastatic disease by enucleation. Recently, we have been expected to conserve the eye with as much vision as possible. Nowadays, success also depends on how well we are able to restore the patient's peace of mind (and rightly so).

As always, what really matters in the end is that the patient is happy with the result. We have learnt the hard way that expensive technical excellence may be a total waste of precious time and energy if the patient is seriously inconvenienced by metamorphopsia or worried about the possibility of local tumour recurrence. We now appreciate that with a newly diagnosed patient our first priority is to get to know what that patient really wants and needs, what degree of risk that patient would feel comfortable with, and what commitment that patient is prepared to make to achieve a particular goal. It is not simply a question of deciding between enucleation and conservative treatment but more …