Modeling variable interactions using Bayesian networks to identify direct predictors of radiation-induced optic neuropathy after proton therapy: implications for personalized toxicity risk stratification.

Even with modern proton therapy and adherence to dose constraints, about 6% of patients develop near-blindness from radiation-induced optic neuropathy.

Visual field deficit served as surrogate for grade ⩾2 clinically-relevant radiation-induced optic neuropathy.

Of 179 eyes (105 patients), 24% developed radiation-induced optic neuropathy.

The bayesian network identified 15 directional associations, 12 were clinically valid, 2 conceivable and 1 weak.