The Essential Eye Cancer Podcast
Episode 11: COVID-19 Update from The New York Eye Cancer Center
During these difficult times, it is important to protect our patients and our staff. Herein, is the March 16th, 2020 COVID19 update from The New York Eye Cancer Center. I describe the steps taken to ensure safety for patients during their eye examination as well as safety for our personnel working in their care. Make sure to listen to the local authorities, stay home, wash your hands and try not to touch your mouth and nose. Isolate and care for family members with upper respiratory tract infections. Shield your elderly from exposure and accept our best wishes for your continued good health.
Episode 12: Big Data Registries in Ophthalmic Oncology
Some things are better done in groups. With rare tumors, multicenter, international collaboration has allowed the collection of HIPPA compliant, anonymized data on several rare eye tumors. This data has been or is in the process of being analyzed to answer questions that were not previously possible. Registries on choroidal melanoma, conjunctival melanoma and ocular adnexal lymphoma are described. Dr. Finger reports on their most important findings as well as those likely to be found (from this data) over the next couple of years.
Episode 13: Chorodial Melanoma Surveillance
Initial work up prior to surgery and subsequent surveillance after definitive local treatment varies from center to center. In this PodCast, Dr. Finger explains his methods of initial staging and subsequent surveillance for metastatic choroidal melanoma. Herein, we discuss the history of what was done by the Collaborative Ocular Melanoma Study, how socio-economic issues affect what might be available in the patient's health care system and how sensitive each type of examination is for detecting metastatic choroidal melanoma.
Episode 14: Informed Consent for Chorodial Melanoma
We must remember that our patients have very limited knowledge of their cancer, our methods of diagnosis and treatment options. Therefore, it is necessary for the eye cancer specialist to educate their patient for shared decision making.
This podcast describes how any eye cancer specialist can approach informed consent prior to treatment of choroidal melanoma. It includes information about assessing the patient, visual aids and counseling.
This podcast describes how any eye cancer specialist can approach informed consent prior to treatment of choroidal melanoma. It includes information about assessing the patient, visual aids and counseling.
Episode 15: Research and Publication Types
Dr. Finger discusses the process of research and publication in ophthalmic oncology. This podcast reveals the foundational elements of peer-review publication, what screening is applied and how that research is relatively unavailable to the public. Clearly, there is a need to present "Real-World Outcomes" both for patients and less learned doctors. In addition, we need transparency on how the process works and the real meaning of published work. Learn about Doctors Reported Outcomes and Dr. Finger's online average outcome initiative.
Episode 16: Chorodial Hemangioma
Hemangiomas are typically benign blood vessel tumors. Like the cherry-red spots sometimes seen on the skin, these tumors form within the eye, beneath the retina in the vascular choroid. Unfortunately, sometimes the choroidal hemangioma's blood vessels leak. This fluid collects on and around the tumor, beneath the retina, forming retinal cysts and retinal detachment. It is those “exudative” retinal detachments that can threaten or cause loss of vision. Doctors have tried to treat these leaking tumor blood vessels with laser, PDT-laser, and radiation. Of these, a single course of fractionated low dose radiation therapy has offered the most profound and durable cure. This podcast discusses clinical aspects related to the diagnosis, management, and treatment of choroidal hemangioma.
Episode 17: Muscles, Muscles, Muscles... Improving Local Control
The best way to prevent metastatic melanoma is to destroy the primary intraocular cancer during the first treatment. Dr. Finger explains why the American Brachytherapy Societry Eye Plaque Guidelines defines normal plaque placement as covering the entire tumor and at least a 2-3 mm free margin of normal-appearing tissue. In order to make sure that happens, it is important to make sure all the muscles on the outside of the eye are temporarily moved away from the plaque. Simply, the radiation plaque should not be pushed to the side or lifted away from the eye by an extraocular muscle. Even if the patient has secondary double vision that must be later fixed, it is better than local regrowth that has been proven to be associated with a 6.3 Hazard of metastatic disease.
Episode 18: Radiation Optic Neuropathy
Though the optic nerve is a relatively radiation-resistant tissue; both plaque and external beam irradiation for eye cancer can cause radiation optic nerve damage. Divided by location, anterior radiation optic neuropathy and radiation papillitis has been most commonly seen after plaque and proton beam therapy. In contrast, posterior radiation optic neuropathy can be seen after external beam radiation therapy for orbital, sinus and brain tumors. Posterior radiation optic neuropathy is best seen as optic nerve illumination during gadolinium-enhanced magnetic resonance imaging (MRI). Such is a sign of extravasation of dye into the optic nerve sheath and orbit. In those cases, the intraocular optic disc can appear normal, there is no known effective treatment and vision loss occurs within 4-8 weeks. In contrast, anterior radiation optic neuropathy typically presents with disc-swelling, hemorrhages and retinal exudates. Early treatment with periodic intravitreal anti-VEGF therapy offer the best chance for years of vision preservation. However, it is important to consider that anterior radiation optic neuropathy is a chronic disease that requires long-term anti-VEGF therapy. This PodCast reviews Dr. Finger’s experience with the pathophysiology and methods used to preserve vision in eyes affected by radiation optic neuropathy.
Episode 19: Office Visual Aids helps Patients Understand their Problem and Probability Outcomes
This podcast describes the methods used at The New York Eye Cancer Center to show and thus teach patients about their disease, need for treatment and probable outcomes (for sight and life). For example, each examination room has a 55" 4K screen to display clinical photographs of tumors, radiation side effects and 3D OCT images of inside the eye. Images of important photographs and figures from publications are framed and displayed to show risk of tumor spread and methods of treatment. Model eyes with plastic intraocular tumors, laminated photographs and devices can be used to show exactly what is involved during surgery. They say a picture is worth a thousand words!
Episode 20: Second Opinions
One of the most difficult subjects is second opinions. Dr. Finger says, "second opinions are great as long as both doctors agree." When they don't, sometimes they create more problems than expected. So, what is the patient to do when their two opinions don't agree? Typically, the patient will want a second opinion because they didn't like what they heard from the first opinion. Second, albeit less commonly, they want confirmation of the first opinion. Lastly, they have a relative who wants the patient to see "their" person. Dr. Finger's suggestion is to go to each opinion with a checklist of what is important to you. For example, ask which doctor will perform the surgery, ask who will answer the phone if the patient has an emergency, and ask what the likely outcomes will be for sight and life?