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#EyeGetDilated: Dr. Alison Skalet

Guest blog post by Alison H. Skalet, MD, PhD, Ophthalmic Oncologist at Casey Eye Institute, Oregon Health & Science University. Dr. Skalet was the recipient of a 2018 MRF Career Development Award for her work in uveal melanoma.

#EyeGetDilated: An Eye Exam May Save Your Life

Dilated eye exams are an important part of routine medical care. While many people know that eye exams can detect problems that threaten vision like glaucoma and macular degeneration, and systemic problems like diabetes, most people are not aware that ophthalmologists can diagnose cancer through an eye exam. In fact, I often hear from patients, “Before my diagnosis, I didn’t know that eye cancer was a thing.” Unfortunately, it is. This is why campaigns like the Melanoma Research Foundation’s #EyeGetDilated campaign are so critical. An eye exam may save your life.

Ocular Melanoma

Ocular melanoma, also called uveal melanoma, is a rare but aggressive cancer. It develops inside of the eye but can spread to the liver and other organs throughout the body. When this occurs, there is currently no cure. For many patients there are no symptoms of ocular melanoma. This is particularly true for smaller tumors, which are associated with a better chance for survival. The most aggressive ocular melanomas develop in the back of the eye in tissues called the choroid and the ciliary body—areas that cannot be thoroughly examined without dilating the pupil. This is why routine dilated eye exams are so important. A dilated eye exam may be the only way to diagnose a life-threatening cancer before it is too late.

Who is at Risk?

Caucasians with light iris color are at highest risk for development of ocular melanoma, although ocular melanoma can affect patients of any race or ethnicity. Most patients are adults between 50 and 80 years of age at diagnosis, but even children may be affected.

The most common risk factor for development of an ocular melanoma is a pre-existing nevus, or mole, in the eye. About 8% of Caucasians have a choroidal nevus that puts them at higher risk for developing ocular melanoma. Patients with certain medical conditions, including ocular or oculodermal melanocytosis (hyperpigmentation of the white part of the eye and sometimes the skin around the eye), neurofibromatosis type 1 and dysplastic nevus syndrome are at higher risk for developing an ocular melanoma. In addition, some families have a predisposing gene mutation that increases the risk for ocular melanoma and can be inherited. If you have a personal or family history of cancers like renal cell carcinoma, mesothelioma or ocular melanoma, make sure to have your eyes checked.

Early Diagnosis with Eye Examination

In ocular melanoma, early diagnosis has the potential to save eyes and lives. While there are exceptions, patients treated for small ocular melanomas are more likely to survive than patients with larger tumors. In addition, patients with small tumors are less likely to require removal of the eye with enucleation surgery. They are often candidates for radiation treatment instead. Depending upon the location of the tumor, some patients with smaller ocular melanomas may retain good vision after treatment, although the majority of patients do experience some vision loss in the treated eye.

Often patients with small melanomas have no vision symptoms. Large melanomas in the eye may be associated with vision symptoms like blurry or distorted vision, flashing lights or curtains across the vision. This is caused by development of a retinal detachment due to leakiness of the tumor. Unfortunately for many patients, by the time symptoms develop tumor cells have already spread outside of the eye. In this situation, even after successful treatment of the melanoma in the eye, tumors may later develop in the liver, lungs, or elsewhere. When this happens patients do not survive, due to lack of effective treatments.

What Can You Do?

Here are some ways you can contribute as a patient, family member, or ally.

  • Get routine dilated eye exams: Remember ocular melanoma is rare, and most eye exams are reassuring, but this is one of the only ways we can catch this cancer early. A dilated eye exam with an ophthalmologist is the best way to detect ocular melanoma. Retinal photographs can be helpful, but do not allow doctors to see all of the areas in which tumors may grow. If a choroidal nevus is found, retinal photographs are important for documenting the appearance so it can be followed over time for growth or concerning change.
  • Spread the word: Ocular melanoma is rare and many people have never heard of it. Those in the know need to help spread the word among their family, friends and communities. Join campaigns like the MRF’s #EyeGetDilated and broad melanoma efforts like the Oregon Health & Science University (OHSU) War on Melanoma™ and #StartSeeingMelanoma.
  • Participate in research: Patients and family members can join research studies to improve understanding regarding ocular melanoma. Ask about opportunities at your treatment center and join nation-wide efforts like the OHSU War on Melanoma™ Community Registry. Patients, family members, and friends fighting all types of melanoma, including skin as well as ocular and other rare melanomas may register.
  • Contribute to research funding: Expert physicians and scientists are working hard to learn more about ocular melanoma, find new ways to predict and detect spread of disease and develop new treatments. Your research donations help support new and innovative science. Funds from the Melanoma Research Foundation currently support my work studying a newly discovered circulating melanoma cell type found in the blood. We are investigating whether these cells may be useful for early diagnosis of melanoma in the eye as well as early detection of spread of disease to the liver. In the future, we hope this work will lead to breakthroughs in ocular melanoma care that improve and extend lives.

The MRF and its CURE OM initiative is proud to support innovative researchers like Dr. Skalet in their pursuit of life-saving research and treatment advances. This is only possible because of the generosity of our supporters. Please consider a tax-deductible gift that could unlock the next research breakthrough: