Hailing from Kampala, Uganda, Dr. Ann Musika has completed her 6-month ophthalmic oncology fellowship training sponsored by the Eye Cancer Foundation.
From Left: Dr. Ann Musika, Dr. Alezam, Dr. Didi Fabian, and Dr. Vicktoria Vishnevska-Dai
For the past six months, Dr. Musika has trained at Sheba Medical Centre at the Goldschleger Eye Institute under supervision of the director of the ocular oncology unit, Dr. Vicktoria Dai. Her training included all aspects of eye cancer care––from diagnosis, to treatment, to intravitreal injections for radiation retinopathy. Additionally, she took part in various research studies at Goldschleger’s ophthalmology department.
The Eye Cancer Foundation places an emphasis world-class training as well as practical and applicable training. So while Dr. Musika learned all aspects of eye cancer treatment practiced at Goldschleger’s, she specifically focused on treatments and techniques that would be just as readily available to her in Kampala.
Dr. Ann Musika (second from the left) alongside Senior ocular oncologists (Presenters) with after the ocular oncology training at the University of Sienna Italy on December 6th-7th, 2018
“It is with great pleasure that I express my sincere gratitude
to you for the great support that you offered me…all this wouldn’t have been possible without your generous support. The knowledge and skills acquired from this training I hope to apply to improve the quality of care for our ocular oncology patients in my nation. I am forever grateful.”
Prior to Dr. Musika, there were no fellowship-trained eye cancer specialists in Uganda. Consequently, patients with eye cancer suffered not only from their disease, but also from a lack of specialized care. However, now upon the completion of her training, Dr. Musika intends to return to Uganda and provide her nation with much-needed specialty care.
To Learn More about the Eye Cancer Foundation, its mission, and fellowship opportunities, visit the website at www.eyecancercure.com.
Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.
For details on the ISOO Biennial Conference, read more here.
The final day of the ISOO was dedicated solely to cancers of the conjunctiva, lid, and orbit. Another day filled with research findings and discussion on proper treatment and lesser-known, evidently effective therapeutic techniques.
OSSN: Is Surgery Really Necessary?
Poster by Dr. Paul T. Finger and Dr. Chaugule
Is surgery necessary? Dr. Sonal Chaugule asked the question in the paper, Topical chemotherapy for giant ocular surface squamous neoplasia of the conjunctiva and cornea, published alongside Dr. Paul Finger and Dr. Jennifer Park. In the case of ocular surface squamous neoplasia (OSSN), the standard of treatment for years has been surgical excision with adjuvant cryotherapy. However, Chaugule and Finger performed this study in order to compare chemotherapeutic eye drops versus the surgical standard. The eye drops alone have the benefits of convenience and avoidance of complications (however unlikely) from surgery. Ultimately, chemotherapy was found to be sufficient treatment for even giant OSSN. The found that “ topical therapy treated the entire ocular surface and avoided surgical intervention … topical chemotherapy [also] resulted in less scarring and stem cell loss compared to [surgery]. Clearly, larger tumors than widely expected can be controlled with topical chemotherapy alone.”
From Left: Dr. Ekaterina Semenova, Dr. Paul Finger
Our now-graduated fellow Dr. Ekaterina Semenova presented on an already-blogged about, very unique case. A patient had only one functioning eye, and had previously undergone a corneal transplant in this eye. After treating this patient with Palladium-103 plaque brachytherapy through the natural and transplanted cornea, the tumor was found to be controlled and the patient’s vision was conserved.
Read about this case in greater detail on our blog here.
Super-Thick Amniotic Membrane Grafts for Eye Cancer Patients
From Left: Dr. Paul Finger, Dr. Puneet Jain
Another ECF graduate, Dr. Puneet Jain, presented on Super Thick Amniotic Membrane Graft (ST-AMG) Successfully Used for Ocular Surface Reconstruction. Compared to the often-used single-layer amniotic membrane graft, the larger grafts allow for greater patient comfort, as well as greater ease of suture, increased likelihood of remaining in place for the required duration, as well as decreased likelihood of tearing.
Read about this case in greater detail on our blog here.
Keratoacanthoma: An Unusual Location!
A fellow of Dr. Santosh Honavar at The Centre for Sight in Hyderabad, India, Dr. Ankit Singh Tomar will be joining us as the most recent Eye Cancer Foundation fellow. He presented a unique case of a conjunctival keratoacanthoma on the tarsal conjunctiva. It was the first reported case of this extremely unique pathology, and was managed surgically without complications at The Centre for Sight.
We hope to see more great research from Dr. Tomar after he joins us for his fellowship training in ophthalmic oncology her at The New York Eye Cancer Center.
Welcome to our new fellow, Dr. Tomar!
The End, For Now
This marks the final day of the conference and it has since come to a close, though many plans have been made for international cooperation, multi-center databases, and collaborative research so that eye cancer patients worldwide will one day not only have access to care, but have access to the best care we have available. Progress is being made behind the scenes as we speak, and we hope to bring you amazing news for the next conference in 2021.
Until then, thank you for your attention and we thank the amazing physicians and researchers for their great work.
Dr. Finger with delegates from RussiaDr. Finger with our most recent ECF fellowship graduate, Dr. Ann Musika (right) and her mentor, Dr. Vicktoria Dai (left)
Remember — you can always be a part of our research and international fellowship training by giving a gift to The Eye Cancer Foundation. Dozens of papers this year were presented due to funding from The ECF.
Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.
For details on the ISOO Biennial Conference, read more here.
Preventing Retinoblastoma
Dr. Helen Dimaras opened with her talk on clinically preventable retinoblastoma, having analyzed the frequency of unfavorable outcomes such as death, metastasis, enucleation, EBRT, and how we can avoid such outcomes. Looking at data retrospectively allows physicians to “review how patients do and improve practice by looking at the past, reducing errors, and improving documentation and precision of care.”
In high-income nations, frequency of poor outcomes is low, and we need to work on expanding such rates abroad. Not only this, but a comment from the audience emphasized the significance of this study’s call to action: even just one child who succumbs to retinoblastoma is a child lost, and such outcomes need to be taken very seriously. We need to avoid misdiagnosis and under-treatment as much we humanly can to ensure that unfavorable outcomes do not happen in the future.
“Chemoplaques”
Dr. Brenda Gallie presented an interesting study regarding a device named “chemoplaques” in Chemoplaque (sustained-release topotecan episcleral device) for retinoblastoma: Opportunity for rapid clinical evaluation of toxicity and efficacy to support safe eye salvage. The devise works through continuous exposure via diffusion, and has thus far produced promising results. By day 28, most of the studied tumors had gone away, and many were gone even earlier, by day 18.
International Fellowship Training Guidelines
Forming Plans for Future Fellowships
In an auxiliary lecture hall, many of us gathered to discuss training fellows all over the world in order to create and develop international treatment centers that will allow greater access to eye cancer care in underdeveloped countries and underserved areas. Sound familiar? As this is one of the primary missions of The Eye Cancer Foundation, Chairman of the ECF, Dr. Finger gave a lecture and lead the discussion.
Dr. Finger with fellows trained by Dr. Honavar in Hyderabad, India. From left: Dr. Sumeet Lahane, Dr. Paul Finger, Dr. Puneet Jain, Dr. Mrithika Sen, Dr. Ankit Tomar, and Dr.
So what is the plan of action? Flexible fellowships with candidates sent from the ophthalmic society of the unserved or underserved region. Being underserved locations, we must be open to 3-month long fellowships, since the physician is needed in their country to give care. 12-month fellowships oftentimes are unfeasible. We must also make a collaborative effort to increase funding for such programs. Dr. Finger says “It has been my experience that funding can come from unexpected places. All you need to do is discuss this wonderful work we are doing and relate how we need help. It is a blessing to allow others to share in the accomplishment of saving children’s sight and life.”
Day 3 at the ISOO: Melanoma, Other Intraocular Cancers, and Basic Retinoblastoma Science
Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.
For details on the ISOO Biennial Conference, read more here.
Dr. Puneet Jain presenting his iris varix poster
Dr. Puneet Jain returned to give us some insight on iris varix by presenting his paper Iris varix: 10-year experience with 28 eyes, published alongside Dr. Paul Finger during his Eye Cancer Foundation fellowship. The study began with the intention to more clearly define iris varix, consistent characteristics, imaging findings, and note any consistent change that might occur with observation. The results showed that iris varix is “primarily located in the inferotemporal quadrant, not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy.” Essentially, “iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.”
Dr. Ekaterina Semenova’s poster presentation
Why are some cases naturally suppressed by the immune system? Dr. Ekaterina Semenova raised the question, noting five cases in which choroidal melanoma in the patient had spontaneously regressed in her paper Spontaneously Regressed and Apparently Dormant Choroidal Melanomas, also published alongside Dr. Finger. She opened up discussion to the audience, though consensus was that this would be an interesting topic for future research in order to determine the cause. Now that such cases have been documented, we have this data to look back on and, hopefully, make additions to.
Dr. Abhilasha Maheshwari (left) and Dr. Paul Finger (right) after another successful poster presentation!
Finger’s Slotted Plaques was recognized in Dr. Abhilasha Maheshwari presentation, A 12-Year Study of Slotted Eye Plaque Radiation for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve. Over a decade’s worth of data was analyzed and slotted plaques were found to be very effective and resulted in good patient outcomed for patients whose tumor lies close to the optic nerve. These plaques offer more proper positioning of the plaque, allowing radiation to the entire melanoma plus a 2-3 mm margin. Dr. Maheshwari concluded that even after 12 years, “slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.”
That’s all for today’s ECF highlights! Day 4 will be fully dedicated to retinoblastoma. Stay tuned!
To help sponsor fellowships and fellow research, donate to The Eye Cancer Foundation at www.eyecancercure.com/donate.
Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.
For details on the ISOO Biennial Conference, read more here.
How Can You Tell a Choroidal Melanoma is Regressing?
Dr. Abhilasha Maheshwari, ECF fellow
Dr. Abhilasha Maheshwari was the first Eye Cancer Foundation fellow to lecture today with her presentation on the paper Regression Patterns of Choroidal Melanoma after Plaque Brachytherapy, published alongside Dr. Paul T. Finger. In the two-minute rapid-fire session, Dr. Maheshwari filled us in on her data points from the study, concluding that there are various markers that show us when a choroidal melanoma is controlled after treatment with plaque brachytherapy. She provided us various markers, such as:
Dr. Finger and Dr. Maheshwari
Increased tumor pigmentation.
Ultrasonography results:
maintenance of dome/mushroom shape
decreased tumor thickness
increased internal reflectivity
Fundus autofluorescence imaging showed a pattern of increased followed by decreased organge pigment lipofuscin
OCT showed decreased exudative subretinal fluid, and resolved drusenoid retinal pigment epithelial detachments (DRPED)
Flurocein angiography showed resolution of intrinsic tumor vascularity
Each of these characteristics serve as indicators of tumor regression. Dr. Maheshwari gave us one final take-away message: better initial local control means extremely less systemic spread, which overall means better patient outcomes.
Dr. Finger and Dr. Maheshwari in the “hot seats” up on stage – Every new session rotates a panel of doctors who have given lectures in order to ask and answer questions and foster discussion.
Interesting New Finding: One talk updated us on recent clinical trials for a drug that showed promise in laboratory studies for reversal of the effect of BAP1-related tumor progression. Perhaps we will hear more on this at the next ISOO!
Unique Case Report: Two, Simultaneous Primary Melanomas
Dr. Maheshwari returned for her second talk of the day, presenting results from Bilateral Simultaneous Primary Choroidal Melanomas: Treated with Palladium-103 Plaque Radiation, published along with Dr. Paul Finger. She elaborated on an interesting case who presented with separate, unrelated choroidal melanomas, one in each eye. After sequential treatment to maximize outcomes, the patient remains at 20/25 vision and shows great outcomes since their latest follow-up.
Unique Case Report: 7 Years After Treatment of a Primary Melanoma, A Second Primary is Found
Dr. Finger gave his first talk of the event to present a unique case of a patient who had been successfully treated for a stage T1 ocular melanoma. Seven years after treatment, however, she developed choroidal metastasis (this one, T3). Following intensive immunotherapy, the patient showed tumor controlled and marked decrease in liver metastasis. Upon follow-up, the patient still sees 20/25 and is maintained with anti-VEGF therapy.
With this talk, Dr. Finger wants to emphasize “the importance of consistent, long-term, post-treatment periodic ophthalmic and systemic surveillance for patients with choroidal melanoma.”
Dr. Finger Presents a Unique Case!
Identifying Genes Associated with Cancer Predisposition
Dr. Colleen Cebulla presented interesting findings in her presentation, Whole exome sequencing to identify candidate genes associated with hereditary predisposition to uveal melanoma. She covered various, possibly cancer-related genes other than the well-known, BAP1 mutation. At the beginning stages of research, the project has already analyzed 29 cases and identified a significantly large incidence of the genes SMARCE1,, PALB2, and MLH1. Particularly of interest are PALB2, which has already been linked to breast, ovarian, and pancreatic cancer risk, and MLH1, which has been linked to Lynch syndrome and has been deemed responsible for multitudes of different tumors.
Dr. Cebulla is happy to welcome additions to the study and to be contacted if any centers are willing!
“SORTT” for Short: Study of Ophthalmic Radiation Therapy Toxicity
Unfortunately unable to attend, Dr. Wolfgang Sauerwein requested Dr. Finger to present on Study of Ophthalmic Radiation Therapy Toxicity (SORTT): a prospective international survey. A major talk of the day, SORTT proposes “a prospective, multicenter, international data registry that collects structured information on toxicities after radiotherapy for eye cancer. This will offer the medical evidence needed for ophthalmic radiation side effect staging and modality selection.” This data may also help to create an AI to help physicians select the optimal radiation modality for each individual case.
Another jam-packed session of presentations, lectures, research findings, and plans for greater multicenter cooperation. As Day 2 comes to a close, Day 3 promises more on melanoma, other intraocular cancers, and the beginning of retinoblastoma discussions.
Day 1 at the ISOO: International Collaboration & Eye Cancer Care Worldwide
Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.
For details on the ISOO Biennial Conference, read more here.
International Collaboration
The day began with a few talks instigating discussion on how to approach international, collaborative efforts, and how to improve on how we currently approach international cooperation. How do we get over international boundaries and laws restricting data-sharing, and varying laws surrounding research across countries? Much is yet to be done, though discussion is expected to continue as specialists from all over the world have convened at this conference.
Read on how Dr. Finger encourages international cooperation here.
What Do We Register and Why?
Featured ECF Fellow: Dr. Puneet Jain
Dr. Puneet Jain, on Registering Conjunctival MelanomaDr. Paul Finger (left) and ECF fellow Dr. Puneet Jain (right) immediately after his debut lecture.
Registries were a huge topic of discussion today. What is possible to be registered, what details should we include within the registry, how do avoid duplicate cases within separate registries, and how do we apply this to international cooperation? Among other points of discussion, however, it was unanimous that functional registries would assist greatly both with research and patient outcomes. The New York Eye Cancer Center’s recently graduated fellow, Dr. Puneet Jain, spoke particularly on the registering of conjunctival melanoma. His research with Dr. Finger evidenced the accuracy of the AJCC’s TMN classification for predicting metastasis.
Developing Worldwide Retinoblastoma Care
Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.
Dr. Brenda Gallie discussed the development of retinoblastoma care worldwide. She noted the growing importance of genetic testing, stating a case in which laser treatment was sufficient enough to control the disease. She briefly mentioned project DepictRB as a way to display anonymized patient data, and offered the audience a demo of the program.
Conclusion
The day concluded with unanimous agreement that worldwide collaboration within the field of eye cancer needs to continue and needs to improve. With enhanced cooperation and worldwide registries, the
amount of shared data will assist greatly in advancement of research, diagnosis, and patient outcomes.
Tomorrow we cover ocular melanoma in great detail. Stay tuned, out fellows and Dr. Finger will be informing us with their expertise!
Dr. Finger and one of his many happy patients in high spirits, just one week after her plaque removal. Her recent follow-ups show steady progress and her characteristic, amazing positivity! (Here she is with Dr. Finger, and googly-eyes attached to her glasses!!)
This patient, along with all Dr. Finger’s patients who require plaque brachytherapy, received a Palladium-103 plaque. Compared to iodine and ruthenium, palladium offers more targeted treatment, and, as a consequence, yields better results and better outcomes.
Prior to involvement of The Eye Cancer Foundation (ECF), Jordan had no practicing eye cancer specialists. We trained Dr. Yacoub Yousef and he established the first eye cancer referral center at The King Hussein Cancer Center in Amman. After years of building this center, Dr. Yousef has trained many eye cancer specialists for the surrounding countries and has offered life and vision-sparing treatments for patients throughout the Middle East. Finally, with a place to go, patients requiring eye treatment inundated these hospitals. With more and more patients needing eye cancer services, Jordan and the Middle East needed a specialist in eye pathology.
In response to this need, The ECF supported Dr. Jakub Khzouz’s fellowship in ophthalmic pathology and oncology with Dr. Sarah Coupland at the Royal Liverpool Hospital in Liverpool, England. Dr. Khzouz has so far spent one year learning modern methods of ophthalmic pathology (adult and pediatric), as well as the diagnosis and treatment of eye cancers.
Dr. Khzouz reports that his exposure to Eye and general Pathology with Dr. Coupland at Liverpool Hospital’s pathology laboratory was significantly different from his prior experience in Jordan. He learned that eye cancer specimens should be handled by trained eye pathology specialists. “Proper sample grossing and detailed reporting are important for staging and aid management,”says Dr. Khzouz. He intends to reassess prior pathology reports, stating that “once back in Jordan, my first project will be to review all the retinoblastoma cases archived in our pathology laboratory, independently report and stage them according to the latest 8th edition AJCC-TNM system, and then compare that with the original reports.” Such will be important for research purposes, as well as defining the impact and importance of fellowship-training with respect to complicated pathologies.
Our fellows have even greater plans for the future of eye cancer treatment in Jordan. Dr. Khzouz intends topartner with the first eye cancer specialist in Jordan, ECF Fellow Dr. Yacoub Yousef. “I have discussed with my colleague Yacoub, and by working together we will improve the quality of the King Hussein Ocular Tumor Service and reach out to other laboratories and countries to perform molecular and genetic testing for eye cancer patients.”
Through our fellowship programs, The Eye Cancer Foundation has sought to provide unserved and underserved countries with the best quality fellowship education and training from some of the most experienced specialists in the world. We motivate our fellows to bring new techniques and advancements to their home countries so that access to optimal eye cancer treatment becomes universal. We will continue to support our fellows, Dr. Yousef and Dr. Khzouz and now offer Jordan two fellowship-trained eye cancer specialists who are dedicated to saving sight, saving life and “paying it forward” by teaching fellows from other middle eastern countries.
However, our goal is not yet complete. Many more countries are in great need, and we hope to place at least one eye cancer specialist in each country. Click here to donate to our cause.
For nearly 20 years, the Union for International Cancer Control has brought the world together in a unified front against cancer. World Cancer Day aims to “unite the cancer community to reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and development agenda” (worldcancerday.org).
The Eye Cancer Foundation’s goals closely align with those put forth by World Cancer Day. Life-saving diagnostic techniques and treatment methods for cancer should be accessible to everyone throughout the world. This is the exact reason why the ECF has emphasized and supported the placement of fellowship-trained cancer specialists in unserved and underserved countries for the past 20 years. While we continue researching and innovating for more precise treatment, we also want interventions available in order to halt the preventable deaths of children with retinoblastoma and patients with cancers of the eye and orbit.
“We believe that access to life-saving cancer diagnosis, treatment, and care should be equal for all – no matter where you live, what your income, your ethnicity or gender…We believe that individuals, together can create change.” –worldcancerday.org
This coming World Cancer Day, consider supporting and raising awareness for eye cancer, a rare cancer variety in critical need of worldwide acknowledgement.
More about World Cancer Day: https://www.worldcancerday.org/
Donate to the ECF: https://eyecancercure.com/donate
We at The Eye Cancer Foundation are pleased to celebrate the graduation of our two most recent recent fellows: Dr. Puneet Jain from India and Dr. Moanes Morkos from Egypt. In traditional ECF manner, both fellows return to their country with goals to care for eye cancer patients, advocate for patients, improve treatment and training. They will present their ECF sponsored research work at eye meetings in their countries and around the world.
Having successfully completed their training, Dr. Jain and Dr. Morkos now join the ranks of over forty fellows trained and sponsored by the ECF. Not only have we reached the goal of our 2020 Campaign––to train 20 eye cancer specialists in 20 unserved and underserved countries by the year 2020––we have doubled it.
With the support of our donors, we have taken on and answered many previously unsolved questions about eye tumor diagnosis and treatment this year. We hope that this momentum does not decline, but rather accelerate, and bring us to a future where ocular melanoma, retinoblastoma and eye cancer deaths do not exist.
To become a patron, simply give a gift to The Eye Cancer Foundation. You can sponsor fellows like Dr. Jain and Dr. Morkos, buy prosthetic eyes for retinoblastoma children, or aid in any of our numerous goals for a clearer, brighter future.
"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.”
– N.N.
Prior to involvement of The Eye Cancer Foundation (ECF), Jordan had no practicing eye cancer specialists. We trained Dr. Yacoub Yousef and he established the first eye cancer referral center at The King Hussein Cancer Center in Amman. After years of building this center, Dr. Yousef has trained many eye cancer specialists for the surrounding countries and has offered life and vision-sparing treatments for patients throughout the Middle East. Finally, with a place to go, patients requiring eye treatment inundated these hospitals. With more and more patients needing eye cancer services, Jordan and the Middle East needed a specialist in eye pathology. 
For nearly 20 years, the Union for International Cancer Control has brought the world together in a unified front against cancer. World Cancer Day aims to “unite the cancer community to reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and development agenda” (
