The Essential Eye Cancer Podcast
The podcast's main purpose is to inform, educate and disseminate topical information about eye cancer and the research being done. Hear what Paul T. Finger has to say about various topics related to ocular disease and treatment.
Episode 1: Anti-VEGF Therapy- How to Preserve Vision after Eye Plaque Radiation Therapy
Most patients can keep very close to their original visual acuity after plaque radiation therapy for intraocular melanoma. In 2006, Dr. Finger was the first to report that anti-vascular endothelial growth factor (called anti-VEGF) medications can suppress intraocular radiation damage. Like most diseases, these drugs must be given every 4-6 weeks, and like most diseases sometimes the types of these drugs must be switched or added. However, when he reported his 10-year study, 80% of patients retained close to their pre-radiation visual acuity.
Episode 2: Dr. Finger's Outcome Reporting Initiative
Dr. Finger believes that patients should know each doctor's track record. They are interested in surgical success rates and what happens to patients with similar or equivalent tumors. Dr. Finger agrees, so he started averaging together the outcomes of patients that returned to his office for follow up. Plus, his fellows add this data in near real-time to his web site where it can be viewed. Just go to http://eyecancer.com and on the upper right corner click, “Dr. Finger’s Success Rates. There you will be directed to information about choroidal melanoma, iris melanoma, and squamous carcinoma patients. Specifically, how often the eye and vision can be saved as well as how often the patient should expect a local cure.
Episode 3: Small Incision Intraocular Biopsy
Small incision surgery usually means quicker recovery. Dr. Finger has brought machine-controlled, micro-incision biopsy surgery to the eye. Utilizing a device called an aspiration-cutter as well as machine modulatable suction, the Finger-Iridectomy-Technique typically offers enough tumor-tissue for the pathologist to perform cytology, histopathology and immunohistochemistry. Dr. Finger says, “You just can’t do that with a sharp, cutting, fine-needle biopsy (FNAB) technique.” Best of all, the biopsy wound is usually so small you don’t need any stitches. Dr. Finger uses this technique for tumors of the iris, ciliary body, and orbit.
Episode 4: Slotted Eye Plaques- Treatment of Tumors Near, Touching and Surrounding the Optic Disc
Normal plaque position was defined by the American Brachytherapy Society (ABS) as covering the entire tumor and a 2-3 mm margin of normal-appearing tissue. However, the optic nerve in its sheath behind the eye is 5-6 mm wide. In order to achieve normal plaque position for any tumors that are near the 1.8 mm wide optic disc, an 8-mm slot was required to accommodate for the optic nerve sheath diameter, incorporate it into part of the plaque and thus move the plaque into ABS normal position.
Episode 5: Palladium-103 Plaque Radiation Therapy For Iris Melanoma
Vision-sparing plaque radiation can be used to destroy iris and iridociliary melanoma. The big advantage compared to surgical iris melanoma removal is that radiation doesn't require surgery that cuts into the eye to remove the tumor and margins.
Instead, a patch of radiation is sewn onto the cornea and white sclera after which the radiation extends through the eyewall and tumor. Compared to surgery, this form of radiation can treat a larger area, doesn't require removing normal iris and is less likely to cause loss of vision or loss of the eye. Though years later, radiation cataracts are common, no one has developed radiation retinopathy or optic neuropathy. Ask about Dr. Finger's Amniotic Membrane Buffer Technique to make radiation more comfortable.
Instead, a patch of radiation is sewn onto the cornea and white sclera after which the radiation extends through the eyewall and tumor. Compared to surgery, this form of radiation can treat a larger area, doesn't require removing normal iris and is less likely to cause loss of vision or loss of the eye. Though years later, radiation cataracts are common, no one has developed radiation retinopathy or optic neuropathy. Ask about Dr. Finger's Amniotic Membrane Buffer Technique to make radiation more comfortable.
Episode 6: Palladium-103 Plaque Radiation Therapy For Chorodial Melanoma
Learn about why not all eye plaques used for treatment of choroidal melanoma and other intraocular tumors are not equal. Dr. Finger started using palladium-103 seed sources in eye plaques back in 1991. He recognized that palladium-103 would provide more radiation to choroidal melanomas while reaching fewer normal vital intraocular structures compared to iodine-125 seeds. This difference has translated into better local cancer destruction and better vision retention for his patients.
Episode 7: Which Type of Plaque is Better?
There exist 3 common types of eye-plaques used to destroy choroidal melanomas. They include: beta-emitters (ruthenium-106, Strontium-90) and seeded plaques iodine-125, palladium-103. The beta-emitters are popular in low socio-economic environments because they can be re-used for many patients. Iodine-125 gained its popularity as a treatment arm for the North American Collaborative Ocular Melanoma Study. The use of palladium-103 seeds in gold eye plaques was invented by Dr. Finger in 1991. Since that time, 6 North American Centers have adopted its use. Both the American Brachytherapy Society and the American Association of Physicists in Medicine have demonstrated advantages related to palladium-103.
Episode 8: MOST - Finger's Chorodial Melanoma Mnemonic
Small choroidal tumors can be the hardest ones to distinguish. They often have not had the time to develop the most common distinguishing characteristics: Orange pigment, Subretinal Fluid and Thickness greater that 2 mm. However, Dr. Finger's mnemonic device MOST helps us remember them, where Melanoma = Orange pigment, Subretinal Fluid and Thickness > 2 mm.
There are other findings, but those are the most common and when seen together are diagnostic.
There are other findings, but those are the most common and when seen together are diagnostic.
Episode 9: Chemotherapy Eye Drops for Conjunctival and Corneal Cancers
Why have surgery if you don’t need it. Chemotherapy eye drops have been found to locally cure most patients with squamous carcinoma or melanoma of the conjunctiva.
During treatment, chemotherapy eye drops can cause irritation of the eye and eyelids or rarely flu-like symptoms, but Dr. Finger has found that most patients prefer to avoid surgery and anesthesia as well as experience less superficial scarring of the eye. Dr. Finger believes that most patients should have a try at these drops before risking surgery, don’t you?
During treatment, chemotherapy eye drops can cause irritation of the eye and eyelids or rarely flu-like symptoms, but Dr. Finger has found that most patients prefer to avoid surgery and anesthesia as well as experience less superficial scarring of the eye. Dr. Finger believes that most patients should have a try at these drops before risking surgery, don’t you?
Episode 10: Seeing Your Tumor - Office Visual Aids
Patient education is the key to informed consent. At The New York Eye Cancer Center, we make every possible effort to show patients what is going on in, around and behind the eye. This means their eye photographs, intraocular images and radiographic scans (MRI and CT) are viewed on 55” ultra-high definition screens in each examination room. For example, patients and doctors see before and after treatment images. Dr. Finger uses the patient’s actual tumor images to explain likely results of treatment. Months to years later, when the patient says “I remember you showing me that!” is the best possible patient education response.
