Author’s Note: Although this article isn’t in my typical coverage area, some readers may find it interesting. More importantly, you may find it helpful.
As I was driving to work last summer, I noticed that the vision in my right eye was a little blurry. That’s not uncommon, due to the dry desert air in Arizona.
But that night at home, the blurriness persisted. I tested my eyes by covering up one and then the other. I quickly noticed that in addition to blurred vision, I had lost most of the color vision in my right eye. This was a definite red flag, so I booked an appointment with an optometrist the next day.
“There’s Something There”
The optometrist asked if I wanted to pay extra for retinal imaging. Normally, this sounds like an unnecessary extra which the insurance doesn’t cover, but given the circumstances, this time I agreed to pay the $30 charge.
The pictures revealed something in my eye. The optometrist said it could be bleeding, or he casually mentioned that it could be a tumor. He referred to it as a “freckle.” At that point I wasn’t too worried because I assumed if something was there, they could just remove it like a cataract.
The optometrist sent an emergency referral to an ophthalmologist. It took three weeks to get in for that appointment. There, they did more extensive testing on my eye and also took numerous pictures.
An Alarming Diagnosis
The ophthalmologist diagnosed me with a “large melanoma” inside my eye and sent an emergency referral to an ocular oncologist. She said this is a very specialized field, but she said I needed to see someone immediately. Her tone was grave.
I phoned my wife, who immediately investigated online. What she found was alarming. The survival rate for someone with a large melanoma in the eye is less than 50% over five years. We learned that the reason for the low survival rate is that ocular melanomas are notorious for metastasizing. Once the cancer escapes the eye, it becomes far more problematic to treat. (The actress Hellen Mirren’s stepson died from this).
Our whole world turned upside down in that moment. I started immediately thinking about things I thought I wouldn’t have to face for 30 more years.
A Better Prognosis, But a Scary Surgery
The next day I got in to see Dr. Aparna Ramasubramanian, one of the leading experts in the field of ocular oncology. She is based at Phoenix Children’s Hospital, but she sees patients (children and adults) from all over the U.S.
Dr. Ramasubramanian (“Dr. Rama”) ran several tests. Afterward, she sat me down and took a deep breath. She said “Sir, you have a melanoma.” My wife was crying. But then she said “It’s small. You caught it early because it is located in the center and interfered with your vision. For many people, they don’t catch them until it’s too late.” (The “large” diagnosis from the ophthalmologist had been in reference to the diameter, but Dr. Rama said it is thin, and that’s the diagnostic used to classify it as small, and highly treatable).
She explained that treatment of a small melanoma is over 90% effective. I told her I was getting ready to quit work and travel the world for my remaining days. She said “No, I am sorry about your travel plans. You are probably going to be fine. The odds of metastasis for a small tumor are very low.”
But the treatment sounded horrifying. They had to create a radiation plaque and sew it directly onto my eyeball. I had surgery to place it on, 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 this was either removal of my eye, or death.
A week later I had another surgery to remove the radiation plaque, and after a couple of days I was able to remove my patch. After a week of being covered up, my eye was very sensitive to light. In December I had one final surgery, where Dr. Rama used a laser on any remaining bits of tumor.
People have asked me how this could happen. I have several risk factors. Blue eyes and fair skin are especially susceptible. Excessive exposure to the sun is a risk. I have spent a lot of time in the sun. Welding is a risk factor, and I welded 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 pin down a definitive cause. She told me that these things just happen, although they are fortunately rare.
Dr. Rama performed the surgeries to place and remove the radiation plaque, as well as the follow-up laser surgery. The team also included a specialist in nuclear medicine, and a medical oncologist. I owe my life to them.
I have had multiple appointments to ensure that the cancer had not metastasized. These visits — which included bloodwork and a full body positron emission tomography (PET) scan — didn’t find any cancer outside of my eye.
However, I will require regular visits for the next several years just to confirm I am still clear. My medical oncologist said that I am probably cured.
If I hadn’t jumped on this quickly, the odds of it killing me would have risen substantially. That’s what would have happened in any case 100 years ago.
In conclusion, I would urge all optometrists to clearly explain the implications of getting retinal imaging done. I have been seeing optometrists for 30 years, and I don’t recall one ever telling me “This can detect cancers that are usually fatal if untreated.”
I have learned that most people have never even heard of ocular (more specifically, uveal) melanoma, and they don’t know how serious it can be. So, optometrists of the world — please take the extra 20 seconds to explain this. It would be good for your bottom line, and it would save lives.
For those who read this, I urge you to pay the extra fee every year to get images inside your eyes — even if your vision is fine. Dr. Rama said the eye is the second most common place for melanoma, but it’s dangerous because it’s only visible with a thorough eye exam.
I have lost some vision in my right eye, and that is permanent. But I still have about 50% use of the eye. The outcome could have been much worse.
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