Author’s Note: Although this article is not in my typical area of coverage, it may be of interest to some readers. More importantly, it can help you.
When I was driving to work last summer, I noticed that my vision in my right eye was a little blurry. This is not unusual due to the dry desert air in Arizona.
But that night at home the blurriness persisted. I tested my eyes by covering one and then the other. I quickly noticed that I had lost most of my color vision in my right eye in addition to blurry vision. This was a definite red flag, so I made an appointment with an optometrist the next day.
The optometrist asked if I wanted to pay extra for retinal imaging. Normally this sounds like an unnecessary extra charge not covered by insurance, but given the circumstances I agreed to pay the $30 fee this time.
The images revealed something in my eye. The optometrist said it could be bleeding or casually mentioned it could be a tumor. He referred to it as a “freckle”. I wasn’t too worried at the time because I assumed that if there was something there, they could remove it like a cataract.
The optometrist sent an urgent referral to an eye doctor. It took three weeks to get an appointment. There they did more extensive testing on my eye and also took numerous pictures.
An alarming diagnosis
The ophthalmologist diagnosed a “large melanoma” in my eye and sent an urgent referral to an eye oncologist. She said it was a very specialized field but said I needed to see someone right away. Her tone was serious.
I called my wife who immediately investigated online. What she found was alarming. The five-year survival rate for someone with a large melanoma in the eye is less than 50%. We found that the reason for the low survival rate is that ocular melanomas are known to metastasize. Once the cancer escapes the eye, its treatment becomes much more problematic. (Actress Hellen Mirren’s stepson died from this).
Our whole world turned upside down at that moment. I immediately started thinking about things I thought I wouldn’t have to face for another 30 years.
Better prognosis but scary surgery
The next day I went to see it Dr. Aparna Ramasubramanian, one of the leading experts in the field of eye oncology. He is based at Phoenix Children’s Hospital, but sees patients (children and adults) from all over the US.
Dr. Ramasubramanian (“Dr. Rama”) performed several tests. She then sat me down and took a deep breath. She said, “Sir, you have melanoma.” My wife was crying. But then she said, “It’s small. You caught it early because it’s in the middle and obstructs your vision. A lot of people don’t catch them until it’s too late.” (The “large” diagnosis from the ophthalmologist was for diameter, but Dr. Rama said he is thin, and that is the diagnosis that classifies him as small and highly treatable).
She explained that the treatment of small melanoma is over 90% effective. I told her I was going to quit my job and spend the remaining days traveling the world. She said, “No, I’m sorry about your travel plans. You’ll probably be fine. The likelihood of a small tumor metastasizing is very low.”
But the treatment sounded scary. They had to create a radiation plaque and sew it directly onto my eyeball. I had surgery to place it where it had to stay for seven days during which the radiation would kill the tumor. It was a very uncomfortable seven days, isolated from everyone because of the radioactivity. But the alternative to that was either removing my eye or death.
A week later I had another surgery to remove the radiation plaque and after a few days I was able to remove the patch. After a week of covering my eye was very sensitive to light. I had my last surgery in December where Dr. Rama used the laser on the remaining part of the tumor.
People asked me how this could happen. I have several risk factors. Blue eyes and fair skin are particularly susceptible. Excessive sun exposure is a risk. I spent a lot of time in the sun. Welding is a risk factor and I used to weld when I was younger. When I was in graduate school, I worked with radioactive californium-252.
But Dr. Rama said that there is really no way to determine the definitive cause. She told me that these things just happen, although thankfully they are rare.
Dr. Rama performed surgeries to locate and remove the radiation plaque, as well as subsequent laser surgery. The team also included a nuclear medicine specialist and a medical oncologist. I owe them my life.
I have had several appointments to make sure the cancer has not metastasized. Those visits — which included blood tests and a full-body positron emission tomography (PET) scan — found no cancer outside of my eye.
However, I will require regular visits for the next few years to confirm that I am still clear. My oncology doctor said I was probably cured.
If I didn’t jump on it quickly, the odds of it killing me would increase substantially. That would have happened 100 years ago anyway.
In conclusion, I would urge all optometrists to clearly explain the implications of performing retinal imaging. I’ve been going to optometrists for 30 years and I don’t recall anyone ever saying to me, “This can detect cancers that are usually fatal if left untreated.”
I have found that most people have never even heard of ocular (specifically uveal) melanoma and do not know how serious it can be. So, optometrists of the world – please take an extra 20 seconds to explain this. It would be good for your bottom line and save lives.
For those of you reading this, I urge you to pay the extra fee every year to get the images into your eyes – even if your eyesight is fine. Dr. Rama said the eye is the second most common site for melanoma, but it is dangerous because it is only visible during a thorough eye exam.
I’ve lost some vision in my right eye, and it’s permanent. But I still have about 50% use of the eye. The result could have been much worse.