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To determine the trends in the utilization of different techniques of radiation treatment in localized uveal melanoma in the United States and to determine the difference in outcome between brachytherapy (BT) and proton-beam therapy (PT). Using the North American Association of Central Cancer Registries (NAACCR), we identified 17451 patients with localized uveal melanoma with known both surgical and method of radiation therapy between 1995-2018. Univariate and multivariable analyses were performed to identify factors and characteristics that may have a potential impact on the treatment. Net survival was calculated using Relative survival in Ederer II cumulative expected method with actuarial. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier method and life-tables. The registries included 28.312 patients with uveal melanoma, out of them 22,983 patients with localized disease. Patients with known both surgical and method of radiation therapy were 17451 patients. We have studied this group further. The median age of this group was 61 (IQR 51-71), males were 51.9% (N = 9063), whites were 98.1% (N = 16921), and choroidal tumors were 87.8% (N = 15330). The median tumor thickness was 3.9mm (IQR 24-70), while, the median maximum tumor diameter was 11.3mm (IQR 8.0-14.4). The median follow-up time was 5.9 years (IQR 3.1-10.3). Among all patients, 57.5% (n = 10032) received BT, and 9.8% (n = 1708) received PT. Collectively, 30.1% (n = 5247) of the patients received no radiation treatment. BT constituted 14% of treatment modalities in 1995 and steadily increased to 65% in 2017. PT utilization was minimal in 1995 (1.4%) and also increased to 14.3% in 2017. Younger age and thinner tumor thickness were independently associated with better Cancer-specific survival (CSS) and overall survival (OS). For all patients who were treated primarily with radiation treatment, the 5-year OS was 85,9% and the 10-year OS was 77.2%. There were no differences in rates of OS or CSS between patients who were treated with BT or PT. There is a continuous increase in the utilization of both BT and PT in the treatment of localized uveal melanoma. Similar survival outcomes could be anticipated for both radiation treatment techniques. [ABSTRACT FROM AUTHOR]