Memorial Day weekend is right around the corner. The holiday traditionally kicks off the summer season. That means boating out on the lake, lazy days at the beach, yard work, and long road trips.
As you get ready for all of your summer activities, you’ll probably run by the store and pick up some sunscreen and slather it on before you head out. While you’re at it, don’t forget to get some sunglasses. After all, you should “think of sunglasses as sunblock for your eyes.” tm
Wearing sunglasses isn’t just about making a fashion statement, or even comfort. They may actually serve as an important line of defense against eye cancer.
Sun can damage tissues in your eyes just like it does the skin. Of course, you can’t rub sunscreen on your eyes. That’s why you need to have (and wear) ultraviolet blocking sunglasses.
And ultraviolet blocking is key.
To protect your eyes, you need quality sunglasses that provide 100% UV protection. You want to wear sunglasses that block all UVA, UVB, and UVC rays. Many optical shops have a machine called a photometer that measures UV transmission through glasses. You want to make sure your sunglasses filter out all UV radiation or light under 400 nm in wavelength.
Ocular melanoma is the most common primary eye tumor in adults. Doctors diagnose around 2,000 new cases every year. These tumors are closely related to skin cancer. Since exposure to the sun is a known risk factor for skin, eyelids and conjunctival cancers, it follows that UV rays from the sun may also increase the risk of developing this form of eye cancer. There is circumstantial evidence linking exposure to sunlight and ocular melanoma. This form of eye cancer is more common in patients with blue eyes, arc-welders and those who work in outdoor occupations.
So don’t take a chance. Make sure you have sunblock for your eyes – a quality pair of sunglasses.
This eye and vision sparing treatment utilizes a metallic plaque, sometime called a “radiation implant” or “radioactive source.” The doctor surgically implants the plaque on the wall of the eye, covering the base of the intraocular tumor. The implant remains in place for five to seven days, delivering a highly concentrated radiation dose to the tumor. The plaque’s location on the eye means surrounding healthy tissues get relatively less radiation exposure.
Once the plaque is in place, The New York Eye Cancer Center patient spends the rest of the treatment period at home or at a hotel. After the prescribed amount of time, the patient returns to the hospital to have the plaque safely removed.
The following video explains the procedure, what to expect, and the safety measures that must be followed during the course of treatment.
A new study by Dr. Sonal Chaugule and Dr. Paul Finger has identified a promising treatment for patients diagnosed with iris melanoma. This is a first study describing regression characteristics in published literature.
Uveal melanoma is the most common primary intraocular malignancy in adults. Iris melanoma is the rarest cancer in this family, making up only 2% to 3% of cases. However, recent studies have found that biopsy-proven iris melanomas can spread outside the eye in up to 11% of cases. These findings support the treatment of iris melanomas.
In the past, most patients with melanoma of the iris were treated by removal of the tumor along with the surrounding iris. Though the tumor is removed, the surgical procedure usually leaves a giant pupil with a non-functional iris sphincter and symptoms of glare.
“After part of the iris is removed, it is like having one pupil constantly dilated, even in the sun,” Dr. Finger said.
In their new study Chaugule and Dr. Finger describe patterns of tumor regression and side effects after iris-sparing treatment for iris melanoma using palladium-103 (103Pd) plaque brachytherapy. At the New York Eye Cancer Center, plaque brachytherapy has been found to be a conservative treatment modality with low local recurrence rate. Treatment with plaque radiation to sterilize the melanoma eliminates the need to open the eye, remove the tumor and make the pupil abnormally large.
Dr. Chaugule sought to examine and document the patterns of change after plaque radiation therapy for iris melanoma. The study included 50 patients with iris melanoma who underwent 103Pd plaque brachytherapy with at least 6 months of follow-up. Pre-treatment and post-treatment tumor morphology, gonioscopy and high frequency ultrasound imaging was studied and analysed.
In this study, palladium (103Pd) plaque brachytherapy of iris melanomas showed dissappearance of blood vessels within the tumor,, darkening of tumor surface, and decreased tumor thickness. With 100% local and systemic control at a mean duration of 5.2 years, the study shows this to be a safe and effective pupil sparing treatment.
Lulu was less than 2 months old when doctors in China diagnosed her with retinoblastoma. When doctors located tumors in her eyes, they scheduled her to have her eyes removed that afternoon. But her parents, who are both blind, were determined to do everything in their power to save their daughter’s eyes.
“My husband and I both lost our vision when we were very young,” Feifei Lin said. “Having gone through this, we have to grasp her ever-so-little remaining vision.”
In order to get their daughter treatment, the family raised over $100,000 to travel to United States.
Their journey brought them to New York, where doctors treated Lulu using intra-arterial chemotherapy. This procedure involves treading a catheter into an artery on top of the leg and into the ophthalmic artery. This allows doctors to profuse the chemotherapy medication only into the eye.
Retinoblastoma is the most common intraocular childhood cancer. It affects approximately 300 children in the United States annually, but about 2,000 children in China are diagnosed with the disease each year. Dr. Paul Finger said lack of access to adequate care in many countries turns retinoblastoma into a deadly killer.
“In the United States, less than 2% of children die from retinoblastoma, but around the world, 70% of children die from retinoblastoma. So, what’s the difference? The difference is early diagnosis and treatment.”
The Eye Cancer Foundation is working to change that by training eye cancer specialists to work in underserved countries such as China , India, Bolivia, Vietnam, Mexico, Ethiopia, Yemen, and others.
As part of these efforts, The Eye Cancer Foundation launched its 2020 Campaign. The organization plans to train 20 eye cancer specialists to work in 20 countries by 2020. This will save thousands of children’s lives.
You can become part of the cure with a one-time or recurring donation to The Eye Cancer Foundation. Click HERE to donate today.
Radiation macular degeneration is the most common cause of permanent vision loss in patients treated with plaque or proton radiation for intraocular “choroidal” melanoma. Without treatment, radiation macular degeneration causes substantial vision loss in up to two-thirds of patients at 10 years after their initial radiation therapy.
Dr. Finger’s recently published 10-year study showed that intraocular injections of anti-VEGF medications (Avastin, Lucentis) were effective in preserving vision 80% of patients. However, despite maximum doses of these medications, some patients experience progression of their macular disease.
The recently published study focused on patients who were not responding to maximum doses of anti-VEGF medication. They treated by adding 4 mg of periodic intraocular triamcinolone acetonide (a steroid injection) to continued maximum anti-VEGF injections.
Kaplan and colleagues noted that adding steroid injections, stabilized or improved vision in 100% of patients at 3 months, 88% at 6 months, 88% at 9 months and 75% at 12 months. A side effect of increased eye pressure after starting the steroid injections was noted in 2 patients. However, the steroid-induced glaucoma was controlled with eye drop medications in both cases. One patient had progression of cataract.
The study authors concluded that intraocular triamcinolone steroid injection is an exciting new option to for patients who no longer respond to maximum, standard anti-VEGF treatment.
The Second Eye Cancer Working Day, hosted by The Eye Cancer Foundation, International Society of Ocular Oncology, and American Joint committee on Cancer took place on March 24th, 2017 at International Convention Center, Sydney, Australia.
The working day provided a unique opportunity for eye cancer specialists from around the world to work together, face-to-face. The goal was to help the subspecialty move forward into the mainstream of oncological care.
The day was divided into five sections, each dealing with important, critical problems faced by the ocular oncology specialty. Each session followed the same general format, beginning with an overview presentation by the section convenors, followed by extensive interactive group discussions. These brainstorming sessions allow participants to offer suggestions for work completion and for increasing international collaborations within each subject area.
Following is an overview of the sessions.
Session 1: Comprehensive Open Access Surgical Textbook (COAST)
Conveners: Santosh G Honavar, MD; Sonal S Chaugule, MD; Carol Shields, MD; Dan Gombos, MD; Zenyel Karcioglu, MD; Paul T Finger, MD; Hardeep Mudhar, MD
Authors who coordinated various sections of this oncology surgical guide presented their work at various levels of completion. Participants offered welcomed suggestions to make each chapter both more comprehensive and better focused toward outreach to doctors in underserved areas of the world.
Session 2: Ophthalmic Radiation Side Effect Registry (RASER)
Conveners: Wolfgang Sauerwein, MD; Paul T. Finger MD; Brenda Gallie MD
Presenters discussed information relating to a grading system for ophthalmic radiation side effects. Committed participating centers were announced, and there was an outreach to include new partners. Questions were raised that helped to modify the staging systems and create data fields for this prospective registry.
The proposed curriculum for fellowship training in retinoblastoma management was opened for discussion. Input from participating experts from various training institutes was documented. Excellent feedback offered by participants will be used to help finalize the first curriculum for ophthalmic oncology fellowship education.
Dr. Kivelä utilized an hour-long question and answer period to help guide ophthalmic oncology toward outcome reporting. Participants discussed available methods for data collection related to DRO aimed to improve quality assurance of centers worldwide. Subjects ranging from online reporting of published outcomes to prospective collection of outcome data were also discussed. Additionally, participants considered the results of an ongoing multicenter project of Patient Reported Outcomes (PRO).
Session 5: Multicenter International Registries (MIR)
Conveners: Bita Esmaeli, MD; Brenda Gallie, MD; Martine Jager, MD
New, completed, and ongling international multicenter projects were summarised. The panel highlighted accomplishments, including retrospective registry-derived answers to important clinical questions related to choroidal melanoma staging, the failure of local control, retinoblastoma staging, and ocular adnexal lymphoma. Ongoing registries were enumerated and attendees were invited to participate. These included vitreoretinal lymphoma, conjunctival melanoma, and eyelid tumors. The process and requirements for participation of new centers in the registries was also discussed. Dr. Zeynel Karcioglu called for establishment of a chemotherapy side effects registry (in consideration of the advent of IAC and the many biotherapies with ophthalmic side effects).
The day was concluded with discussion by doctors Paul T Finger, Martin Jager, Ashwin Mallipatna, Brenda Gallie, Tero Kivelä, Wolfgang Saurwein, and Bita Esmaeli relating to future courses of action. Dr. Finger strongly suggested that the WD initiatives should be part of the International Society of Ophthalmic Oncology (ISOO), noting that most cancer subspecialties have them, and that ISOO committees need be formed to move forward.
Here is a video clip of the discussions that took place in Sydney, Australia’s, Second Working Day.
Led by its chair Dr. Paul Finger, The Ophthalmic Oncology Task Force (OOTF) is building a foundation of multicenter, international consensus guidelines to allow for better communication and patient care.
Along with the AJCC and the Union for International Cancer Control (UICC), the American Brachytherapy Society (ABS), The American Association of Physicists in Medicine (AAPM), and The Eye Cancer Foundation (ECF) have all supported or adopted the work of the OOTF. Each has contributed to important steps toward collaboration in the field of ophthalmic oncology.
AJCC-UICC tumor staging allows every eye cancer specialists to describe each patient’s cancer in a standardized way. It provides descriptions of the size, shape and distribution of the primary eye tumor, as well as the involvement of lymph nodes, or its spread within the body. Using the AJCC-UICC eye cancer classification, each medical professional can communicate the exact extent of each patient’s local and systemic cancer. As a result of an intensive a world-wide effort, the eighth edition of the AJCC Cancer Staging Manual is the most clinically useful TNM-based staging system for ophthalmic oncology.
In addition, The American Association of Physicists in Medicine Task Group-129 offered standardized methods to create eye plaques, calculate their radiation doses, describe quality assurance safety guidelines, and to review ophthalmic radiation therapy.
The American Brachytherapy Society also asked Dr. Finger to lead the OOTF in creation of consensus guidelines for plaque radiation of intraocular melanoma and for the childhood cancer retinoblastoma.
These efforts have provided a framework for multicenter, international cooperation in ophthalmic oncology.
In a recent editorial published by the American Academy of Ophthalmology, Dr. Finger explains the process that led to publication of the manual, and its importance.
“By speaking a scientific language understood by our nonophthalmic colleagues around the world, AJCC-UICC staging allows ophthalmology access to the mainstream of cancer care.”
We urge you to adopt the eighth edition of the AJCC-UICC classification system in your clinic, for research and in all eye cancer publications.
The Working Day provides an opportunity for eye cancer specialists from around the world to work together, face-to-face. The day will be divided into several sections, each dealing with a critical problem facing the specialty. Sections begin with an overview presentation from the moderators, followed by an interactive group session to brainstorm, complete work, and plan for the next meeting.
The 2017 Working Day will feature five separate committees focused on evidence-based medicine, educational programs, outreach to underserved areas, and multicenter quality assurance.
Ultrasound imaging is an effective method to visualize tumors on, within, and behind the eye. Ocular ultrasound machines generate sound waves that are reflected back by tissue in its path. The sound waves are then translated (by a computer) into an image.
Dr. Paul Finger has helped pioneer the use of ophthalmic ultrasound imaging in the diagnosis and treatment of eye cancers. In the following video, he presents the basic skills needed to perform ophthalmic ultrasound imaging. This includes the history of the evolution of these techniques as well as The New York Eye Cancer Center’s preferred practice patterns for evaluation of cancers of the eye and orbit.
This is important because high frequency ultrasound imaging is usually the best way to detect retinoblastoma hidden behind the iris, invasion of conjunctival tumors into the eye, and for measurement of iris and ciliary body tumors.
“High frequency ultrasound imaging has enabled eye cancer specialists to accurately measure anterior – iris and ciliary body – tumors, which in turn allows for eye and vision-sparing plaque radiation therapy,”Dr. Finger said.
This video not only provides a good overview of the techniques involved in ophthalmic ultrasonography, it will also point you to other resources where you can learn more.
“You have to know a little bit about ultrasound physics to be a great ophthalmic ultrasonographer. You have to understand why you’re seeing what you’re seeing on the screen,” Dr. Finger said.
International Society in Ocular Oncology and The Eye Cancer Foundation will sponsor the Second Eye Cancer Working Day on the first day of the ISOO meeting, Friday, March 24, at the International Convention Centre in Sydney, Australia, at the Cookle Bay Room 1.
The Working Day provides an opportunity for eye cancer specialists from around the world to work together, face-to-face. Our goal is to help the subspecialty move forward into the mainstream of oncological care. This will require the creation of evidence-based medicine, educational programs, outreach to underserved areas, and multicenter quality assurance.
The 2017 Working Day will feature five separate committees focused on these ongoing initiatives. These include the topics of international medical evidence, retinoblastoma fellowships, quality assurance, surgical standards, and consensus guidelines.
MIR:Multicenter International Registries create statistically significant evidence. These registries will improve patient care and help us defend our methods of diagnosis and treatment.
FOR- RB: Retinoblastoma fellowship initiative to address the worldwide RB mortality.
DRO: Quality assurance through Doctors Reporting Outcomes. Eye cancer specialists cannot know how to improve, unless they know the outcomes of their work.
COAST: A Comprehensive, open-access, consensus-based surgery text.
RASER: A prospective ophthalmic Radiation Side Effects Registry
We are excited to have the SECOND Working Day integrated with the biannual ISOO meeting. If you’re an eye cancer specialist attending the conference, be sure to mark your calendars and arrive by Thursday night!
Second Eye Cancer Working Day Schedule
Time: 8:00am – 5:00pm
Room: Cookle Bay Room 1, International Convention Centre
Convenors: Paul T Finger, Santosh G Honavar
Registration and Coffee
8:30am – 9:00am
8:30am – 8:45am
8:45am – 9:00am
Paul T Finger
Santosh G Honavar
9:00am – 10:00am
Comprehensive Open Access Surgical Textbook (COAST)
Convenor: Santosh G Honavar
Faculty: Fairooz P Manjandavida, Carol Shields, Zeynel Karcioglu, Mandeep Sagoo, Paul T Finger, Santosh G Honavar, Hardeep Mudhar, Sonal S Chaugule
10:00am – 11:00am
Radiation Side Effect Registry (RASER)
Convenor: Wolfgang Sauerwein
Faculty: Wolfgang Sauerwein, Paul T Finger, Brenda Gallie
11:00am – 11:30am
11:30am – 12:30pm
Fellowship Outreach Retinoblastoma (FOR-RB)
Convenor: Ashwin Mallipatna
Faculty: Ashwin Mallipatna, Helen Dimaras, Brenda Gallie, Guillermo Chantada, James Muecke, Nathalie Cassoux, Santosh Honavar, John Zhao, Yacoub Yousef, Peter Gabel
12:30pm – 1:30pm
1:30pm – 2:30pm
Doctor Reported Outcomes (DRO)
Convenor: Tero Kivelä
Faculty: Tero Kivelä and faculty
2:30pm – 3:30pm
Multicenter International Registries (MIR)
Convenor: Bita Esmaeli
Faculty: Bita Esmaeli, Brenda Gallie, Martine Jager, Zeynel Karcioglu, Yulia Gavrylyuk, Paul T Finger
4:00pm – 5:00pm
Faculty: Santosh G Honavar, Martine Jager, Bita Esmaeli, Tero Kivelä, Ashwin Mallipatna, Wolfgang Sauerwein, Paul T Finger
**Please note that The ISOO Working Day workshop will be using live polling. Please ensure that you bring your mobile phone so that you can be an active part of the session.
"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.”