Annual Ophthalmic Oncology Lectureship

At the 41st Annual Tulane Eye Alumni Day at the Renaissance New Orleans Pere Marquette Hotel, Dr. Finger lectured about how and why his important innovations came to life. In the lecture, he discusses his early work on plaque microwave hyperthermia and TRT for intraocular tumors, pd-103 plaque radiation therapy, the slotted plaque, the amniotic membrane buffer technique, epicorneal plaques, and anti-VEGF therapy for radiation maculopathy.

As Dr. Finger presented these innovations in chronological order, thanking his mentors along the way, he provides data to support the success of these creations. As an ophthalmic oncologist and specialist in ophthalmic radiation therapy, Dr. Finger’s inventions have not only paved way for safer radiation therapy practice and reduced vision loss in patients suffering from eye cancer, but also significantly increased patient comfort.

Select Innovations Discussed:

  • Pd-103 Plaque Radiation Therapy:
      • Ophthalmic plaque radiation therapy is used as treatment for choroidal melanoma. The first plaques incorporated radioactive material Cobalt-60 and later Ruthenium-106 and Iodine-125. However, palladium-103 became available for the first time treatment of intraocular tumors.
      • Pd-103 had more advantages than Iodine-125. For example, while in both cases the eye tumor is destroyed, palladium-103 radiation is absorbed faster than iodine-125. This difference relatively spares and thus preserves critical normal intraocular tissues used for seeing and preserving the treated eye.
  • Amniotic Membrane Buffer Technique:
      • By placing an amniotic membrane on top of the cornea and below the gold plaque during treatment of iris melanoma, Dr. Finger was typically able to reduce patient pain from 9/10 to 2/10. In addition, the cornea had less surgical irritation. All this was done for patient care while effectively curing the cancer.
  • Slotted Radiation Plaques: Peripapillary. Juxtapapillary, Circumpapillary melanomas:
    • Only Fingers’ Slotted Plaques will allow melanomas near, touching, or covering the optic nerve to be completely irradiated. The slotted plaque was created to overcomes orbital optic nerve obstruction which prevents round and notched plaques from encircling these melanomas. That is why, Dr. Finger created a slot in the plaque big enough to accommodate the optic nerve sheath (typically 6mm wide). Sliding the plaque posterior to the optic nerve obstruction normalizes plaque position to completely surround the tumor.
  • Anti-VEGF suppresses radiation vasculopathy(retinopathy and optic neuropathy):
    • Originally described by Dr. Finger. Intraocular anti-VEGF injections have allowed patients to retain their vision after radiation treatment causes retinal and optic nerve side effects. In a study done by Dr. Finger, it was found that, after a decade, 80% of patients treated with anti-VEGF therapy were within 2 lines of pre-irradiation visual acuity.

“Best” Ophthalmologists in New York 2019

New York Magazine recently compiled their annual list of “Best Doctors,” and our very own Dr. Paul Finger is a “Best Doctor” for the 12th time. Castle Connolly Medical Ltd., a New York City research and information company, creates this list yearly by using an online database of more than 53,000 Castle Connolly Top Doctors® across the US. Of these 53,000 doctors, 7,400 are located in the New York area. Castle Connolly gives New York Magazine a shortened version of this list, which it then uses to create its list of Best Doctors in New York. In spite of this reduction to 1,390 doctors, Dr. Finger has maintained on the noble list as one of the best ophthalmologists of 2019.

Regarding the decision method, Castle Connolly interestingly conducts a peer-review survey. The firm believes that physicians and medical professionals are in the best position to pass judgement onto other physicians. These participating physicians are asked to nominate doctors who they believe are the “best” in their specialties, taking into consideration not only professional excellence and reputation, but also personal patient interaction. They choose the best well-rounded doctors who transcend required knowledge of their practice and instill trust in and show empathy to their patients. Doctors are not permitted to nominate themselves and all nominations are confidential. These licensed doctors vote online (castleconnolly.com/nominations) for the doctors they find to be exceedingly exceptional.

Other prestigious recognitions include America’s Most Honored Professionals 2019 – Top 1%, America’s Top Doctors for Cancer 2019, and New York Metro Area’s Top Doctors 2019 just to name a small portion of the 79 “Best Doctor” awards Dr. Finger has received. Furthermore, these same awards are given every year and Dr. Finger has consistently been given the “Best Doctor” award for each. This consistency points to the dedication and ambition that Dr. Finger possesses, driven daily by his desire to help – to cure sight and to save lives.

A more than well-deserved title for our exceedingly outstanding physician!

 


Surgical Ophthalmic Oncology: A Collaborative Open Access Surgical Textbook

In 2014, the First Eye Cancer Working Day was hosted by The Curie Institute in Paris, France. There, we decided to develop a Collaborative Open Access Surgical Textbook (COAST) aimed at offering guidance and international outreach for ophthalmologists in countries without eye cancer specialists.

The resultant 5-year effort was spearheaded by Drs. Sonal Chaugule, Santosh Honavar and Paul T Finger. Supported by The Eye Cancer Foundation (http://eyecancercure.com) and published by Springer Nature; The Surgical Ophthalmic Oncology: A Collaborative Open Access Reference, should be described as an easy-to-use, open-access surgical textbook supported by surgical videos. It provides surgical guidance to all the general ophthalmologists currently treating eye cancer patients in unserved and underserved countries.

In addition, this textbook can be used for surgeons, fellows, and trainees around the world who deal with these diseases in their patients. For these physicians in these areas who lack the advanced technology and instrumentation to diagnose and cure diseases, this comprehensive textbook meticulously covers various surgical techniques and provides videos needed to manage different eye cancers.

 

This text includes chapters that discuss eyelid tumors, conjunctival and corneal tumors, intraocular tumors, enucleation and exenteration, ophthalmic radiotherapy, and ocular pathology. Throughout the chapters, one will find 84 color pictures, 4 black and white illustrations, and relevant high-quality videos. For example, these videos allow the reader to review specific surgical steps in real-time, allowing the reader to benefit from the pooled knowledge of three renowned ophthalmic oncologists! These chapters also address diagnostic indications as well as pre and post operative concerns, truly serving these physicians well as they may use this valuable learning tool in providing the best, most efficient patient care that they possibly can. Lastly, this book ends with a section on ophthalmic pathology, where readers can learn the guidelines for specimen collection and transport as well as the interpretation of the pathology report.

 

A valuable and unique resource for ophthalmologists working in underserved areas to provide the best quality care for their patients who suffer from eye cancers.

Order online here!


International Multicenter Cooperative Study Supported by The Eye Cancer Foundation

 

The American Joint Committee on Cancer (AJCC) Cancer Staging Manual compiles all currently available knowledge on cancer staging at various anatomic sites. In 2016, they released the 8th edition, conjunctival melanoma staging system which features 12 new staging systems, a wide range of new staging definitions, and an emphasis on the personalized-medicine approach. This staging system is used and respected by medical, ophthalmic, and radiation oncologists because it standardizes data reporting, prognosis, and selection of the best treatment for conjunctival melanoma. Nonetheless, a collaborative multicenter international registry was organized by our very own Dr. Finger to evaluate the accuracy of such a staging system. In addition to the 19 co-authors listed, Dr. Puneet Jain led the analysis, writing and collaborative revision of this study. He completed an Eye Cancer Foundation-sponsored Fellowship. ECF fellowships are known to foster ophthalmic oncology training, curiosity, learning and ability to perform research!

This study, performs the first ever international multicenter study to evaluate the validity of the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual in estimating mortality rates of metastasis from conjunctival melanoma. The 8th edition AJCC ophthalmic oncology staging systems were written by more than 50 eye cancer specialists from 18 countries.

In this study, co-investigators utilized internet-based data sharing, reviewing 288 conjunctival melanoma patient medical histories. This study included data from 10 ophthalmic oncology centers in 9 countries over 4 continents — 2 in the United States and 1 in Canada, Colombia, Argentina, France, Netherlands, United Kingdom, Sweden, and Jordan. Clinical (cT) and pathologic (pT) staging were performed according to the staging system for conjunctival melanoma in the 8th edition of the AJCC Cancer Staging Manual.

This study was able to find new insights by conducting an analysis of large numbers of rare tumors. The findings corroborate the validity of the 8th edition of the AJCC Cancer Staging Manual. However, it also found several independent factors that are associated with increased mortality, such as tumor thickness, tumor invasion, and ulceration. Ultimately, this study supported the continued use of conjunctival melanoma staging system as published in the 8th edition of the AJCC Cancer Staging Manual.


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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