Patient's self advocacy for digital eye scan helps catch ocular melanoma early


When David began having problems seeing his computer screens at work, he decided it was time for glasses. At his eye exam, he decided to get a digital eye scan, which he understood to be a more precise image of the eye and surrounding tissue. Because the scan appeared to show a scratch, his optometrist recommended that he see a retinal specialist, who performed additional scans, injected dye and even did an ultrasound. When the doctor came in to review the results, the diagnosis was sobering: There was a mass on David’s eye.

David felt lucky to live fairly close to UW Medicine and Fred Hutchinson Cancer Center - Proton Therapy, where Dr. Andrew Stacey, one of the few ocular oncologists in the U.S., works. Dr. Stacey explained that there are a few types of masses found on eyes. The only way to tell if it is melanoma is to observe the mass and see if it gets bigger. They took measurements, and when David came back after two months, the tiny mass had grown slightly.

Initially, David wondered if removing the affected eye would be the best course of action. He was worried the cancer would metastasize to other parts of his body, especially his brain. “I was very concerned,” he says. “I figured I could live fine with one eye, but not with brain cancer. But I felt comfortable with Dr. Stacey’s expertise and recommendations for my care.”

Dr. Stacey outlined David’s treatment options. Ocular melanoma can’t be treated with chemotherapy, but there are two types of radiation that can be used: brachytherapy, which involves sewing radioactive seeds onto the eye, and proton therapy, which is an external beam of radiation targeted at the tumor. David chose proton therapy.

To prepare for proton therapy, small clips are sewn onto the patient’s eyeball, which help position the patient in just the right position precisely for every treatment session. While David was undergoing this procedure, he also had a biopsy done, which came back with good news.

“Dr. Stacey said I had won the genetic lottery,” says David. “The type of melanoma I had was the lowest-risk type and had a very small chance of recurring or metastasizing. Plus, it was extremely small, and he told me anything smaller than five to 10 millimeters has a very good control rate with proton therapy.” Next, Dr. Stacey referred David to Dr. Lia Halasz at Fred Hutch.

“Everyone at the center was super professional. From A to Z, everything was comforting and easygoing, everyone had great attitudes and explained things very well,” says David. “But I did feel like Hannibal Lecter in the mask with the ring around me.”

David in his ocular set up.

It’s been a year since his proton therapy. David now lives in Virginia and is finding a doctor to do his annual MRI, which checks for any potential metastasis, especially in the liver, which is a common area for secondary cancers in patients with ocular melanoma. Although he may eventually lose his vision in the affected eye because his tumor was right next to the optic nerve, for now David has a pinched view, like looking in a funhouse mirror. Things are a bit darker, and he can’t focus as well. But when he thinks about some of the patients he's met with other cancers, he feels lucky and hopeful for the future.

Today, David is back to working in instrumentation controls and electrical, which involves writing the programming that automates a power plant, creating the graphics that are used to interface with computers, cybersecurity and monitoring for environmental compliance.

In his spare time, David enjoys woodworking, camping, fishing, hiking and watching movies. He hopes to be able to continue his hobbies in spite of his vision problems, such as high-angle and confined-space search and rescue. His most memorable rescue involved lowering a worker off a 140-foot-tall power plant stack in a gurney. During the rescue, David rappelled down alongside the man, keeping him calm.

David rappels down a power plant wall.

David’s number-one recommendation for other patients is to get digital scans when getting your eye tests – he credits the tests with discovering his small, 1.2 mm-diameter tumor, which otherwise may not have been found so early.

David also recommends that anyone diagnosed with ocular melanoma join the Facebook Ocular Melanoma group. “Members share their stories and what to expect. They are very helpful,” he says.

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