Two Extensive ECF-Sponsored Studies Presented at the AAOOP Annual Meeting

The New York Eye Cancer Center and the Eye Cancer Foundation were quite actively represented at the 2017 American Association of Ophthalmic Oncologists and Pathologists (AAOOP) Annual Meeting. The meeting was held on Friday, November 10, 2017 at the Hampton Inn & Suites Convention Center, located in the vibrant city of New Orleans, Louisiana, and was attended by Dr. Paul Finger as well as notable ECF-ICO Fellowship alumni, Dr. Sonal Chaugule, Dr. Ekatrina Semenova, and Dr. Abhilasha Maheshwari.

At the conference, Dr. Chaugule gave an oral presentation titled Adjuvant intravitreal triamcinolone acetate (ITA) for radiation maculopathy (RM) recalcitrant to high-dose intravitreal bevacizumab. This research was supported by the Eye Cancer Foundation and conducted at the New York Eye Cancer Center, where Dr. Chaugule worked alongside Dr. Richard Kaplan (ophthalmologist) and Dr. Paul T. Finger. She is pictured speaking on this paper at AAOOP below:

Now, what are ITA, RM, and Bevacizumab? Often, patients undergoing eye plaque radiation in order to treat their cancerous tumor can be subject  to vision-impairing radiation side-effects, or radiation maculopathy (RM), as a result of treatment. Intravitreal anti-VEGF therapy (which is otherwise commonly used to treat macular degeneration) such as Bevacizumab (Avastin), Lucentis, and Eyelea, are used to prolong the effects of radiation maculopathy. Itravitreal triamcinolone acetate (ITA) is a steroid used in conjunction with this anti-VEGF therapy to treat swelling that occurs in the affected eye, called macular edema.

The paper aims to evaluate the effects of using ITA for the treatment of RM in patients with choroidal melanoma after plaque radiotherapy. Eight choroidal melanoma patients undergoing this treatment were studied, having ITA treatment at 4-16 week intervals in addition to continued injections of Avastin. Results found that after starting ITA, vision was stable or improved for patients, leading to the conclusion that ITA can be used as a supplement to decrease macular edema (swelling) and preserve vision in choroidal melanoma patients with RM.

The evaluation of ITA steroids as valuable treatment for RM is not to be underestimated. It provides a new treatment option for patients experiencing loss of vision due to radiation therapy, patients whose loss of vision can no longer be controlled with maximum, standard anti-VEGF therapy. To read more on the findings of this paper and its effect on eye cancer patients, click here. And to read this paper in full, published in the British Journal of Ophthalmology, click here.

Dr. Abhilasha Maheshwari had separately presented ECF-supported research — a 12-year study evaluating patients with slotted, low energy photon eye plaque radiation therapy. The purpose? To measure the efficacy of this treatment for eye cancer patients, especially those who have tumors located near, touching, or surrounding the optic disc (a critical area that allows for  vision) were treated. Forty six patients of these eye cancer patients were treated with eye plaque radiation therapy, using seeds of the chemical isotope Palladium-103 to radiate the affected eye. Over the next 12 years, these patients were monitored for any changes to tumor thickness, visual acuity, and whether or not the cancer had reoccured or metastasized. Results found that the local control rate (i.e, total tumor destruction) was 95.6%, and lead to the conclusion that Slotted Eye Plaque Radiation Therapy is indeed an efficient method of treatment for eye cancer patients.  To read the paper, published in the American Journal of Ophthalmology, click here.

But the AAO updates do not end here! Stay tuned for upcoming information on even more presentations at AAO 2017 by ECF alumni.


Patient Stories: Maureen’s Journey

As part of an ongoing initiative from the Eye Cancer Foundation, The ECF accepts submissions where patients share their personal story through diagnosis and treatment. Of course, the ECF is always accepting submissions for Patient Stories and would love to hear from you. Below is the first publication, sent in by a patient by the name of Maureen. 

In December 1994, I went to see my optometrist, Dr. Quist, at Pildes in New York. I was going to Boston for New Year’s and my contacts were bothering me. Well, Dr. Quist pointed out that I had not had a good exam in a while and she wanted to do one. I said sure.

As she studied my left eye, she took a bit more time than she did with the right eye. Afterward, she wrote out a note, put it in a sealed envelope, and said that I should see my ophthalmologist. That was the beginning.

Upon consulting my ophthalmologist, Dr. Muldoon, I discovered that the little freckle Dr. Quist luckily saw was a possible cancerous condition which would have to be monitored. In May 1995, I went for what I thought would be another routine visit with Dr. Muldoon. It was not routine. After the exam, he asked his receptionist to see if Dr. Finger was in the hospital that day. He was, and I was sent down to his office at the New York Eye and Ear Infirmary. It was only when I saw the words Melanoma Study beside the door that I actually realized: Ah. Not just cancer, but melanoma.

In the blink of an eye, so to speak, life changed. I was immediately sent for the first of ever-so-many fluorescein injections and pictures, ultrasounds — the works. Dr. Finger observed the nevus until November 1995 and then decided that treatment was needed. At the time of all this I was a volunteer at Sloan-Kettering and I knew how helpful it was to speak to patient-to-patient volunteers. Well, there weren’t any; the ailment was so rare. My medical doctor, who had practiced for years, had never heard of it and had to research it. While having experience seeing the courage of the cancer patients I worked with, and the research being done with all sorts of cancers, I myself was scared enough with my disease to determine that I would go with enucleation for treatment. The idea of the melanoma was very upsetting to me.

Dr. Finger set me up with an appointment at Johns Hopkins’ Wilmer Institute, where they were doing the national study on ocular melanoma. My husband and I went to Baltimore for a consultation and I was grateful that I took the opportunity to participate in research. The doctor did the exam, discussed his findings and – what I remember most clearly – discussed prosthesis. The reality of removing the eye (which he was, in our opinion, recommending) was what I heard, and it was the dose of reality I needed.

In New York, my husband accompanied me to my next consultation with Dr. Finger. I had not involved him directly up until then – perhaps it was a way of not really acknowledging what was happening. But, Dr. Finger then launched into a description of Palladium-103, the isotope he planned to use to radiate the tumor, with hopefully a good chance at not affecting the surrounding tissue. My tumor was a choroidal melanoma.

I went for it. I was in the New York Eye and Ear Infirmary for 8 days – one day longer than estimated. While I was disappointed to have to stay even one day longer, in retrospect, the nursing care was much better than handling treatment on my own. From my room I had a view of the Empire State lit up for Christmas, and I still see that building out of my office window every day — with both eyes. I was released on December 13, 1995 – St. Lucy’s Day – Santa Lucia – the day celebrated as the festival of light.

I am fortunate to have had a good recovery and to have retained my eyesight. As I say, so far so good, and still, I go to each 6 month follow up with caution. I don’t think anyone would be arrogant enough to forget the trauma. I am grateful to this day to the two patients whom Dr. Finger put me in touch with, who spoke to me before treatment and shared their experiences. Only someone who has been there truly knows what the experience feels like. I have made two wonderful friends who took the road after I did.

Meeting with the fine, young doctors who are being trained through The Eye Cancer Foundation especially is truly inspiring. And I know that patients today have a wide support network with people who share so generously and bravely.


NYECC’s How-To for Chemotherapy Eye Drops

Whether treating a dry eye through artificial tears or over-the-counter anti-allergy drops, many people around the word have experienced using eye drops in their every day drops — however, using chemotherapy drops to treat malignant eye tumors may seem daunting. You may be wondering how these eye drops differ from simple artificial tears, what specific instructions, or additional precautions must be made to install them into the eye, and so on. Luckily, the New York Eye Cancer Center has written a comprehensible step-by-step process that can help put your mind at ease when understanding chemotherapy drops.

Before you read the instructions, here are some helpful reminders and tips regarding your drops:

Put one drop in the affect eye 4 times a day, while awake, for the directed amount of time. You may administer the drops to your own affected eye by yourself, or you may have someone else do it for you. Remember to refrigerate your drops at all times! If you plan on being outside for the majority of your day, keep your drops in an insulated bag with ice packs. Do not put your drops in the freezer.

Now, regardless of the drops you are using (for example, interferon A or 5-FU), please take care to follow these instructions.

STEP 1: Sterilization is important — wash your hands! If possible, put on latex gloves.

STEP 2: Lie down flat, or recline in a chair.

STEP 3: Look down, pulling back your upper eyelid.

STEP 4: Put the drop on the top part of your eye.

STEP 5: Slowly close your eye, keeping it closed for 5 minutes.

STEP 6: If there is any excess, gently wipe it away.

STEP 7: Sterilization remains important! If you did not put on gloves, wash your hands again.

And of course, should you be experiencing any eye pain, blurred vision, or flu-like symptoms, do not hesitate to contact NYECC at 212-832-8170.

Want to keep this information on hand at all times? We have put this information into a simple PDF available for download. You can download and print this PDF to keep with you by clicking here.


AAO Newsletter Features Paper Published by ECF Fellow

From the summer of 2016 to 2017, Dr. Sonal S. Chaugule gained a wealth of knowledge as an Eye Cancer Foundation (ECF) fellow under the tutelage of Dr. Paul T. Finger at the NYECC. From shadowing Dr. Finger’s surgeries at the New York Eye and Ear Infirmary, to speaking at the Second Eye Cancer Working Day in March 2017, Dr. Chaugule has since returned to India, using the knowledge she has gained as tools to continue in the footsteps of her mentors. Her efforts manifest in her paper, in collaboration with Dr. J. Park and Dr. Paul Finger, being published by the American Academy of Ophthalmology.

Featured in the headlines of the AAO Newsletter, the paper was first published by the Indian Journal of Ophthalmology in December 2017, and discusses the effectiveness and safety of topical chemotherapy as sole treatment for giant ocular surface squamous neoplasia (OSSN). Ten patients (3 female, 7 male) with biopsy-confirmed giant OSSN were treated with topical chemotherapy drops (interferon alpha 2b and/or 5 flurouracil 1%). Then, patients were monitored for changes in tumor response, vision, recurrence of disease, metastasis, and treatment complications.  

Pictured below are samples from the paper, revealing slit-lamp photographs of patients afflicted with OSSN before treatment (A, C) and after treatment (B, D). Pre-treatment for both patients (A, C) and post-treatment (B, D) reveal complete tumor regression after treatment via topical chemistry therapy drops. You may note that there is no evidence of opacity, or haziness, to the cornea in the after photos.

Results found that there was no evidence of vision-limiting complications due to treatment by chemotherapy drops — no thinning of the sclera (the white of the eye), no cloudiness in the cornea, and no stem cell deficiency. Noteworthily, there were no tumor recurrences, and none of these 10 patients required additional treatment for their giant OSSN such as surgical excision or cryotherapy. For all patients in this study, there was tumor regression, concluding to researchers that topical chemotherapy drops were not only safe, but effective as treatment for giant OSSN. To read the published study in full, click here.

 

The ECF offers fellowships to doctors from unserved and underserved countries, providing specialized training in the treatment of retinoblastoma and other eye cancers. Once they complete their training, ECF fellows commit to return home to create eye cancer treatment programs. Dr. Chaugule has begun oncology services at HV Desai Eye Hospital in Pune, India, a vital center for eye cancer research and patient treatment, serving a wide population of not only Indians, but also those from the neighboring countries of Pakistan, Bangladesh, and Nepal.   

Through its  2020 Campaign, The Eye Cancer Foundation plans to multiply this success story across the world. With your help, we can train 20 eye cancer specialists to work in 20 countries by 2020.

Our immediate 2020 Campaign goal is to save the lives of 1,000 children by 2020. But that’s only the beginning. Our ability to train doctors and supply them with the equipment they need to properly diagnose and treat retinoblastoma is only limited by the generosity of our donors.

You can become part of the cure with a one-time or recurring donation to The Eye Cancer Foundation. Click HERE to donate today.


When Choosing A Doctor, Results Matter: NYECC Breaks Ground with Clinical Results Available to the Public

Our new Results page began with a question:

how can patients choose the best doctor without knowing their past performance?

In the age of the internet, when HealthGrades and RateMDs are ready to profile a physician with the push of a button, it is now easier than ever to browse for healthcare options. Five-star reviews remarking on wait times and a doctor’s beside manner, while certainly valuable, miss the most important question a patient would like to know: how capable is this doctor of delivering good health outcomes?

For eye cancer patients in particular, understanding where to receive the best possible treatment is paramount. With these patients in mind, The New York Eye Cancer Center is now the first practice of its kind to report patient outcomes on the web in a patient-accessible format. Click here to see our latest Results.

Understanding the Report

We have launched the Results page with reports on three common conditions treated at NYECC: choroidal melanoma, iris-ciliary body melanoma, and squamous conjunctival malignancy. Though Dr. Finger’s clinical practice and peer-reviewed outcomes span his 30 years of practice, this new method of reporting starts with patients treated after December 1, 2017 and will be updated weekly going forward.

For each disease, we report on:

Patients Entered: The number of patients included in these results.

Visual Acuity: The median visual acuity, or eye chart test score, after finishing treatment.

Local Tumor Control: The percentage of patients whose tumors are successfully eliminated through treatment.

Loss of Eye: The percentage of patients whose cases require enucleation, or the removal of the eye, in order to complete treatment.

Metastases: The percentage of patients whose tumors spread to other organs after treatment.

Average Follow Up: Number of years after treatment before additional treatments are required.

The data, located on our Results page and observable through an interactive table, reports on patients treated only by Dr. Finger. Patient data is strictly confidential, HIPPA-compliant and anonymous.

A Piece of the Puzzle

This trailblazing Results page is the next step in a multi-year initiative by Dr. Finger and his colleagues to empower patients and improve outcomes across the ocular oncology specialty.

While medical journals have provided a forum to publish and compare treatment techniques, medicine does not currently have a strong framework to compare overall physician performance in a quantitative, objective manner. In response, a group of eye cancer specialists including Dr. Finger have formed the International Doctor Reported Outcomes (DRO) Initiative.” This initiative is developing a standardized way for doctors to report their results to the public and each other.

Comparing outcomes is a great way to find areas for improvement in medical practice. More importantly for each individual patient, DRO reporting is a clear way to address that essential question: what are the past results of the doctor who is about to treat me? 

The DRO Initiative has been developed over the course of the last two Eye Cancer Working Day conferences, which gathered ocular oncologists from around the world. But identifying a need and making a plan are but a prelude to the achieving our goal: a world in which all medical centers routinely publish their results for the public.

The launch of our results page is the first step, and we encourage other centers to join us in this effort. The Eye Cancer Foundation will offer assistance to any center or solo practitioner in setting up a page akin to the new NYECC Results page.

Let’s hold ourselves accountable to our outcomes and empower patients to make their life-changing choice of eye cancer specialist based on visible results.


Patient Stories

"Very well treated by Dr. Finger. He explained everything I needed to know about my issue with detail and attention, putting me at ease and giving me confidence to handle this problem for the rest of my life.”
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