The number of patients enrolled in the COMS is a remarkable achievement, considering the rarity of uveal melanomas. However, neither of the randomized studies provides sufficient statistical power to state that there is no survival difference between rival treatments. In the brachytherapy study, for example, the 95% confidence intervals for unadjusted risk ratios were excessively wide (ie, 0.86-1.24 for all-cause mortality and 0.81-1.41 for histopathologically confirmed metastasis during the 12-year follow-up).5 In addition, many would not be satisfied that brachytherapy is as effective as enucleation unless they are reassured that local recurrence does not increase mortality; however, the COMS did not address this question. Furthermore, since the ocular treatments essentially aimed to prevent metastatic spread, the significance of the COMS results was diminished by the fact that in the brachytherapy and pre-enucleation radiotherapy studies, at least 10% and 35% of patients, respectively, died within 5 years of treatment and hence as a result of preexisting systemic disease, if calculations based on uveal melanoma doubling times are accepted.6,7 Finally, the follow-up times, although impressive, were perhaps insufficient to detect differences between treatments in preventing metastasis. A meta-analysis of breast cancer patients indicates that an adverse effect of local treatment failure on mortality takes about 15 years to become evident statistically.8 Few COMS patients were followed up for 10 years and there is little power to detect differences in this area of the survival curves. The reassurance provided by COMS is not as statistically sound as one might like.