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World-Class Retina Care. Community-Based Caring.

Ocular Cancer

Ocular cancer or cancer of the eye is a malignancy that starts and grows in the eye. A malignancy is a group of cells that are cancerous and can spread to other parts of the body. Ocular cancer is a rare disease, and only a small number of doctors in the United States treat it. We have four of those physicians here at Texas Retina Associates:

In addition, because ocular cancer can be an overwhelming diagnosis, Stephanie Colmenero, our dedicated Oncology Services Coordinator, serves as a personal resource to our patients and families, helping them navigate their medical journey.

What is Ocular Melanoma/Uveal Melanoma?

There are a variety of tumors that can exist in the eye. The eye cancer we treat most at Texas Retina Associates is uveal melanoma (also called ocular melanoma). It involves the iris, ciliary body, and/or choroid, which are collectively referred to as the uvea. These tumors develop in the pigmented cells within the uvea. These are the cells that give the eye its color. Uveal melanoma is a very rare disease, with only 2,000 – 3,000 cases per year in the United States.

Although rare, uveal melanoma (ocular melanoma) can be aggressive. It is a malignant tumor that can grow and spread to other parts of the body.

To address patients’ concerns about their ocular cancer metastasizing (spreading to other parts of the body), Texas Retina Associates provides the most advanced genetic analysis of ocular melanomas by performing fine needle aspiration biopsy at the time of treatment. This allows for more customized metastatic screening and a greater peace of mind.

Texas Retina Associates is also actively enrolling in the Collaborative Ocular Oncology Group 2 study led by William Harbour, MD, at Bascom Palmer Eye Institute. This study is ushering in the next level of genetic analysis and prognostication for ocular cancer.

Symptoms

Most uveal melanomas are identified in a dilated eye exam, and many patients do not have any symptoms. Some patients report experiencing:

  • Blurred or decreased vision
  • Floaters
  • Light flashes

Risk Factors

In most uveal/ocular melanoma, there is no family history. And unlike skin melanomas, it is not related to sun exposure. Uveal/ocular melanoma does occur more commonly in people with the following characteristics:

  • Caucasian (although it can occur in any race)
  • Light-colored eyes — blue or green
  • Age 55+

If uveal melanoma is caught early, the prognosis is better and the potential loss of vision is reduced. That is why it is important for everyone to get a dilated eye exam once a year. Dilation is critical because “no dilation” eye exams can miss detection of conditions like uveal/ocular melanoma.

Diagnosis

Uveal/ocular melanoma is diagnosed through a dilated eye exam. Your Texas Retina physician may perform additional tests to gather information about your specific condition. These can include:

Ultrasound


A small probe is placed on the surface of the eye and bounces sound waves through the eye. The pattern made by the reflection of the sound waves can help differentiate a benign tumor from an ocular melanoma.

Fluorescein Angiography


In this test, a small amount of vegetable-based dye is injected through a patient’s peripheral vein — usually in the arm or hand. The injected dye lights up the retina’s intricate vascular network, and a certified ophthalmic angiographer takes a series of detailed retinal photographs.

Treatment

The two primary treatment options for uveal melanoma are radiation therapy and enucleation (surgical removal of the eye).

1  |  Radiation Therapy


Radiation therapy is the most common treatment of uveal melanoma today. Every radiation therapy provided by Texas Retina Associates physicians is custom-designed to minimize the patient’s vision loss. The goal is to halt growth of the cancerous tumor cells with the least negative effects on the normal tissue surrounding them.

The most common radiation therapy used to treat uveal/ocular melanoma is called brachytherapy or plaque therapy. A small disc-shaped shield known as a plaque encases radioactive seeds on one side and is covered with a thin sheet of gold on the other. It is surgically attached to the outside surface of the eye, over the tumor. The gold protects the surrounding areas from radiation damage. The plaque is left in place for several days, allowing the radiation to treat the tumor. Once complete, it is then removed, and no radioactive material remains on or within the patient.

Proton beam therapy is another type of radiation sometimes used to treat uveal/ocular melanoma.

2  |  Enucleation


Enucleation is surgical removal of the eye and is another option to treat uveal/ocular melanoma. In this procedure, the eye is replaced with a ball implant which is sewn into position and attached to the patient’s eye muscles to allow movement. After healing for about six weeks, a specialist called an ocularist can fit the patient with an ocular prosthesis. This is a plastic contact lens painted to look like the patient’s other eye, and it rests on the ball implant. While the prosthetic eye improves cosmetic appearance, vision in that eye is lost and cannot be replaced. Enucleation is usually reserved for very large tumors that are not amenable to radiation therapy or tumors involving the optic nerve.


In addition to the information presented on this page, Texas Retina’s Rajiv Anand, MD, has published a great reference guide for uveal/ocular melanoma patients that is available on Amazon.

Care for Other Eye Cancers

At Texas Retina Associates, we also evaluate and treat a number of other ocular cancers and benign conditions which can convert to cancer (thus requiring lifelong monitoring), including:

  • Retinoblastoma
  • Choroidal nevus (benign)
  • Iris nevus (benign)
  • Congenital hypertrophy of the retinal pigment epithelium (benign)
  • Melanocytoma (benign)