Ophthalmic oncology

ALSO KNOWN AS: Cancer of the eyes

DEFINITION: Ophthalmic oncology is a medical specialty that deals with the diagnosis and treatment of eye cancers.

Subspecialties: Ophthalmic oncologists often specialize in one particular type of cancer, such as retinoblastoma or intraocular melanoma.

Cancers treated: Intraocular melanoma (sometimes called uveal melanoma), primary intraocular lymphoma, retinoblastoma, medulloepithelioma

Training and certification: Being an ophthalmic oncologist requires many years of specialized medical training. After receiving a medical degree from an accredited school, ophthalmic oncologists complete a residency program. This residency is usually in ophthalmology, although during this time, the individual will also often receive training in surgery and oncology.

After successfully completing a residency program, the individual can apply to be board-certified in ophthalmology. Board certification is a long and difficult process that requires at least one and one-half years to two years to complete. Candidates for board certification must apply to take the first test. Candidates whose applications are approved are allowed to take a five-hour written exam. Those candidates who pass are invited to take an extensive oral exam. Only after successful completion of all these steps is the candidate board certified. The individual must take extensive ongoing steps to retain board certification. Board certifications completed after 1992 must be renewed every ten years.

During and after the board certification process, most ophthalmic oncologists complete one or more additional fellowships or other training programs. These fellowships last one or more years and provide the doctor with additional training and expertise in the chosen field. Often, these fellowships are very specialized.

Ophthalmic oncologists often receive training during their residencies, fellowships, training programs, or at other times in research and clinical trials. Research is continuously being conducted to develop new methods, procedures, and drugs to help diagnose and treat cancers of the eye. Clinical trials are experiments designed to determine the effectiveness and safety of newly developed procedures, methods, drugs, and other treatments that have yet to be accepted into everyday practice. Their oncologist or other doctors may ask individuals with cancer if they wish to participate in a clinical trial. Clinical trials have varying possible risks and benefits, and deciding whether to participate should be discussed carefully with the cancer care team.

Services and procedures performed: Cancers of the eye are relatively rare. According to the American Cancer Society, about 3,320 people in the United States were likely to be newly diagnosed with primary eye cancer in 2024. Most of these eye cancers are intraocular melanomas. Many ophthalmic oncologists specialize in treating only one type of eye cancer or a specific kind of treatment.

Before ophthalmic oncologists can begin to treat eye cancer, they must determine whether it does exist and, if so, what type of cancer it is. A patient may be referred to an ophthalmic oncologist because of a suspicious finding during a routine vision screening or a visit to a primary care physician with symptoms that indicate a possible eye cancer.

To diagnose eye cancer, the ophthalmic oncologist will use a specialized tool called an ophthalmoscope that allows the doctor to look inside the patient’s eye. The ophthalmic oncologist will look for any abnormalities inside the eye, such as spots, discoloration of the pupil, or cloudiness of the gel inside the eye. The ophthalmic oncologist will also ask the patient about any signs or symptoms, such as pain, problems with vision, flashes of light or floating spots that are not there, or other abnormalities. The ophthalmic oncologist may also examine the eye to see if there are any problems, such as the eyeball moving abnormally, bulging, or seeming out of place.

In many cases, further diagnostic procedures are necessary. In some cases, a biopsy of the suspected tumor may be done, although this is often avoided if possible because performing a biopsy has some risk of damaging the eye. Technology such as an ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be performed to help the ophthalmic oncologist get a better picture of the eye. Additional scans or tests may be done to determine if the cancer has spread outside the eye.

Once the cancer has been diagnosed, the ophthalmic oncologist will work with the patient and the healthcare team to develop a treatment plan. The four main types of treatment for eye cancers are surgery, radiation therapy, laser therapy, and chemotherapy. New technologies and procedures are being developed, and different treatments are appropriate for different types and stages of eye cancer.

Surgery is often the treatment of choice for eye cancers. During the procedure, the ophthalmic oncologist removes the cancerous area. In some cases, vision out of the affected eye will still be possible after the surgery, and in others, it may be diminished or gone altogether. In very severe cases, the best option may be to remove the cancerous eye completely and replace it with a prosthetic.

Radiation therapy and chemotherapy are used to treat many forms of eye cancer. Radiation therapy is targeted as precisely as possible so that it affects as little of the healthy area of the eye as possible. Chemotherapy is not specifically targeted to an area of the eye, but instead, it is put into the blood intravenously or given by mouth. The chemotherapy drugs then travel in the bloodstream to the eye. Targeted therapy drugs and immunotherapies have undergone approval by the United States Food and Drug Administration in the twenty-first century and offer a new option for treatment. Further, gene therapy and anti-vascular endothelial growth factor, commonly known as anti-VEGF, continue to revolutionize the field of ophthalmological oncological treatments.

The fourth type of treatment that some ophthalmic oncologists use is laser therapy. The laser may use infrared light or a high-energy light beam to kill the cancer cells. One positive aspect of laser therapies is that lasers can be focused into a very thin beam of light that allows a high degree of accuracy, generally affecting fewer surrounding cells than other treatment methods.

After the cancer has been successfully treated, many patients return regularly to see their ophthalmic oncologist to check for any side effects and to ensure that the cancer has not returned.

Related specialties and subspecialties: Many doctors and other healthcare team members assist or work closely with an ophthalmic oncologist. An ophthalmologist is a doctor who specializes in the diagnosis and treatment of eye diseases and conditions. This can include things as diverse as eye surgery or prescribing corrective lenses. People need to visit an ophthalmologist regularly for vision screening and a general eye health checkup. During this kind of routine screening, many eye problems, including eye cancer, are first suspected or diagnosed.

Many other members of the allied health professions may be part of the cancer care team for someone with eye cancer. The specific individuals who will work with the ophthalmic oncologist will differ depending on the kind of cancer and the type of treatment. The team may include specialists in administering radiation or chemotherapy, nutritionists, medical technologists, and nurses specializing in the care and treatment of cancer patients. The ophthalmic oncologist may also be called on to be part of a larger oncology team involving oncologists specializing in cancer in other areas of the body if the cancer has metastasized from another area of the body to the eye. 

Bibliography

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Denniston, Alastair K. O., and Phillip I. Murray. Oxford Handbook of Ophthalmology. New York: Oxford UP, 2006.

Esmaeli, Bita. Ophthalmic Oncology. New York: Springer, 2012.

“Key Statistics for Eye Cancer - Ocular Melanoma Incidence.” American Cancer Society, 17 Jan. 2024, www.cancer.org/cancer/types/eye-cancer/about/key-statistics.html. Accessed 6 July 2024.

Shields, Jerry A., and Carol L. Shields. Intraocular Tumors: Atlas and Textbook, 2d ed., Philadelphia: Lippincott, 2008.

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Singh, Arun D., and Bertil Damato. Clinical Ophthalmic Oncology: Basic Principles and Diagnostic Techniques. New York: Springer, 2013.

“What's New in Eye Cancer Research?” American Cancer Society, 26 Jan. 2022, www.cancer.org/cancer/types/eye-cancer/about/new-research.html. Accessed 6 July 2024.