Paul T. Finger, MD, FACS
With your care in mind, Dr. Finger has collected latest advanced medical technologies for the diagnosis and treatment of ocular tumors and eye cancer. With respect for collaboration, he works closely with you and your referring doctor to provide the most excellent care possible. The New York Eye Cancer Center was designed to be a responsive and caring environment, we strive to be your and your doctor's first choice for eye cancer care.
Dr. Finger is a Clinical Professor of Ophthalmology at New York University School of Medicine and Director of Ocular Tumor Services at: The New York Eye and Ear Infirmary of Mt. Sinai, Manhattan Eye, Ear and Throat Hospital of Northwell Health and New York University School of Medicine.
A world-recognized expert in radiation and surgical techniques to conserve the eye and vision; Dr. Finger has pioneered the use of palladium-103 plaque radiation for choroidal melanoma, 3D and high-frequency ultrasound to image intraocular tumors, and created this world-renowned web site. Dr. Finger publishes in the major clinical journals and lectures frequently at local, national and international meetings. He graduated from Tulane Medical School, the Manhattan Eye, Ear and Throat Hospital, and then completed specialty training in treatment of ocular tumors and orbital diseases.
Dr. Finger is certified by the American Board of Ophthalmology and is a Fellow of both the American College of Surgeons and the American Academy of Ophthalmology and sees patients from all over the world.
Dr Finger was a principle investigator for The Collaborative Ocular Melanoma Study. He advised The American Brachytherapy Society in its published work on plaque radiation therapy, is currently participating in the Plaque Radiation Therapy (Task Group 129) of the American Association for Physicists in Medicine (AAPM), and is Chair of the Ophthalmic Oncology Task Group of The American Joint Committee on Cancer (AJCC) - International Union Against Cancer (UICC). The AJCC-UICC is creating a universal language (TNM-classification) to be used to describe the most common eye tumors.
Dr. Finger has a particular interest in melanoma of the choroid, ciliary body and iris. He has written extensively about new ways to detect and treat retinoblastoma, conjunctival melanoma, squamous carcinoma, metastatic cancer to the eye and orbital tumors.
Dr. Finger has assembled a team to care for patients with eye tumors. By picking the best doctors from several institutions, his team includes the top radiation, medical and pediatric oncologists in New York City.
Dr. Finger has spent his career inventing and improving new methods of diagnosis and treatment for eye cancer:
Dr. Finger's Ocular, Orbital and Systemic Imaging Techniques
Ophthalmic Ultrasound Imaging
Dr. Finger has broken new ground with the use of new and improved diagnostic imaging techniques, including high frequency and 3D ultrasound for imaging tumors on and in the front of the eye. Specifically, Dr. Finger and his associates first described the use of 3D ultrasound for measurement of choroidal melanomas, to document proper radioactive plaque placement and for extrascleral tumor extension. He now recommends the use of high-resolution 20 MHz B-scan in movie-mode to measure most intraocular tumors. He also recommends the use of 3D ultrasound in cases where there is no ophthalmoscopic view into the eye.
Dr. Finger and his colleagues have pioneered the use of computerized coronal C-scan ultrasound sections to measure the orbital portion of the optic nerve, to detect optic nerve sheath meningiomas and invasion of retinoblastoma into the optic nerve.
Dr. Finger has established the use of high-frequency ultrasound (UBM) for anterior segment tumors. He has written on the use of this technique for the diagnosis of conjunctival (squamous, oncocytoma, sarcoma) and eyelid tumors. He has shown how high frequency ultrasound can be used to detect retinoblastoma that are hidden behind the iris, invasion of conjunctival tumors into the eye, for measurement of iris and ciliary body tumors before and after plaque radiation therapy. Movie mode allows him to replay and show patients their tumors and how he measures them.
High-Definition (HD) Digital Photography
Dr. Finger currently uses specialized high definition digital photography (TopCon/Heidelberg) to document and compare eye tumors to monitor for growth, patterns of circulation and response to treatment. Dr. Finger believes there is no substitute for side-by-side comparative photography to detect small changes on or around tumors of the eye. In addition, Dr. Finger has shown that early detection and treatment of radiation eye damage (laser or anti-VEGF medications) offers the best chance to maintain vision and use of the eye.
Dr. Finger has obtained a state-of-the-art OCT (Heidelberg 2) imaging system. He uses it to monitor patient response to treatment and new vision-sparing anti-VEGF treatments (for radiation retinopathy and optic neuropathy).
Total Body FDG PET/CT Imaging
Dr. Finger led a group of scientists to determine the efficacy of total body 18 FDG PET/CT imaging for choroidal melanoma. This is because he recognized that what had been the standard metastatic work up was inadequate. In contrast, positron emission tomography allowed for a physiologic assessment of the tumor's metabolism, while computed tomography (CT) allowed us to measure its size, shape and relationship to normal anatomic structures. Dr. Finger's group was the first to find that intraocular melanomas had different metabolic intensities, that metastatic melanoma was more likely to be found outside the liver (primarily bone) and that even with FDG PET/CT, microscopic metastasis would not be found. However, since bone was the second most common site of metastasis and only a total body physiologic scan could detect bone metastasis, any other test comes up short. Since that time, Dr. Finger and co-workers have used this technique to diagnose patients with metastatic sebaceous carcinoma, conjunctival melanoma and orbital lymphoma.
More recently, Dr. Finger has performed a study to compare the metabolism of choroidal melanomas as measured by PET against epidemiologic, anatomic, ultrasonographic and histopathologic risk factors for the development of metastatic choroidal melanoma. This study suggests that a high metabolic rate as measured by PET - SUV may be a biomarker (indicator) for the risk of metastasis.
Dr. Finger's New Surgical Techniques
Dr. Finger has invented numerous new surgical techniques and instruments specifically for patients with eye cancer. Over the years he pioneered the use of microwave hyperthermia, palladium-103 plaque radiation therapy, Finger-tip Cryotherapy Applicators, the Finger Iridectomy Technique, and Finger's Slotted Plaques.
Radiation Plaque Therapy
Though microwave hyperthermia provided excellent results for patients with choroidal melanoma, this technique could not find a commercial sponsor. Fortunately, Dr. Finger found similar vision-sparing qualities offered by substituting palladium-103 for the more commonly used iodine-125 seeds in ophthalmic plaques. His medical physics staff currently performs pretreatment comparative dosimetry studies so that each patient is treated with the best plaque radiation source.
Finger-tip Cryotherapy Applicators
Dr. Finger introduced the "Finger-tip" cryotherapy applicators for treatment of malignant conjunctival tumors. Unlike standard cryotherapy probes, these devices are spatulated and offer a larger and more uniform targeted zone. Simply, using these probes will decrease the chance of missing a small area of tumor. These large probes can also be used to grasp tumors of the orbit and provide traction to help in their removal. It has also been used to facilitate enucleation surgery.
The Finger Iridectomy Technique
Dr. Finger was unhappy about the safety and ability of needle biopsy for tumors of the iris and ciliary body. In response, he invented the "Finger Iridectomy Technique." This technique uses a safer rounded aspiration cutter through a self-sealing corneal incision to biopsy intraocular tumors. Unlike needle biopsy that only retrieves cells for cytology, the Finger Iridectomy Technique typically obtains both cells and small chunks of tumor. This allows Dr. Finger's pathologists to evaluate cytology, histopathology and perform immunohistochemical analysis. This technique has also been used to remove iris tumors and to create an iridotomy for narrow angle glaucoma.
Finger's Slotted Plaques
Dr. Finger wanted to offer and eye and vision-sparing alternative to removal of the eye for patients with tumors touching or surrounding the optic nerve. So, he invented "Finger's Slotted Plaques." These new devices incorporate the orbital portion of the optic nerve within the plaque, so that the treatment zone can be extended as to cover the entire tumor. Now that we have extra-large 24 mm diameter and slotted plaques, Dr. Finger says that removing eyes with choroidal melanoma is now typically a last resort.
Reviews of Important Clinical Subjects and Problems in Ophthalmic Oncology
Dr. Finger believes a subspecialist must review, analyze and present important subjects for others in his field. So far, he has written or participated in the following reviews of the literature:
- Radiation Therapy For Choroidal Melanoma
- Chemotherapy for Eye Cancer
- Anterior segment tumors: Current Concepts and Innovations
- Adenocarcinoma of the Retinal Pigment Epithelium
- Kidney, Cancer and the Eye: Current Concepts
- Melanocytic Conjunctival Tumors
- Risk Factors for Metastasis in Retinoblastoma
- Chemotherapy for Retinoblastoma: A Current Topic.
- View more of Dr. Finger's Most Recent Papers Online!
- Visit Dr. Finger's Practice Web Site