Hemangiomas are typically benign blood vessel tumors. Like the cherry-red spots sometimes seen on the skin, these tumors form within the eye, beneath the retina in the vascular choroid. Unfortunately, sometimes the choroidal hemangioma's blood vessels leak. This fluid collects on and around the tumor, beneath the retina, forming retinal cysts and retinal detachment. It is those “exudative” retinal detachments that can threaten or cause loss of vision. Doctors have tried to treat these leaking tumor blood vessels with laser, PDT-laser, and radiation. Of these, a single course of fractionated low dose radiation therapy has offered the most profound and durable cure. This podcast discusses clinical aspects related to the diagnosis, management, and treatment of choroidal hemangioma.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

Dr. Finger discusses the process of research and publication in ophthalmic oncology. This podcast reveals the foundational elements of peer-review publication, what screening is applied and how that research is relatively unavailable to the public. Clearly, there is a need to present "Real-World Outcomes" both for patients and less learned doctors. In addition, we need transparency on how the process works and the real meaning of published work. Learn about Doctors Reported Outcomes and Dr. Finger's online average outcome initiative.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

We must remember that our patients have very limited knowledge of their cancer, our methods of diagnosis and treatment options. Therefore, it is necessary for the eye cancer specialist to educate their patient for shared decision making. This podcast describes how

any eye cancer specialist can approach informed consent prior to treatment of choroidal melanoma. It includes information about assessing the patient, visual aids and counseling.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

Initial work up prior to surgery and subsequent surveillance after definitive local treatment varies from center to center. In this PodCast, Dr. Finger explains his methods of initial staging and subsequent surveillance for metastatic choroidal melanoma. Herein, we discuss the history of what was done by the Collaborative Ocular Melanoma Study, how socio-economic issues affect what might be available in the patient's health care system and how sensitive each type of examination is for detecting metastatic choroidal melanoma.

Some things are better done in groups. With rare tumors, multicenter, international collaboration has allowed the collection of HIPPA compliant, anonymized data on several rare eye tumors. This data has been or is in the process of being analyzed to answer questions that were not previously possible. Registries on choroidal melanoma, conjunctival melanoma and ocular adnexal lymphoma are described. Dr. Finger reports on their most important findings as well as those likely to be found (from this data) over the next couple of years.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

During these difficult times, it is important to protect our patients and our staff. Herein, is the March 16th, 2020 COVID19 update from The New York Eye Cancer Center. I describe the steps taken to ensure safety for patients during their eye examination as well as safety for our personnel working in their care. Make sure to listen to the local authorities, stay home, wash your hands and try not to touch your mouth and nose. Isolate and care for family members with upper respiratory tract infections. Shield your elderly from exposure and accept our best wishes for your continued good health.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

Patient education is the key to informed consent. At The New York Eye Cancer Center, we make every possible effort to show patients what is going on in, around and behind the eye. This means their eye photographs, intraocular images and radiographic scans (MRI and CT) are viewed on 55” ultra-high definition screens in each examination room. For example, patients and doctors see before and after treatment images. Dr. Finger uses the patient’s actual tumor images to explain likely results of treatment. Months to years later, when the patient says “I remember you showing me that!” is the best possible patient education response.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

Why have surgery if you don’t need it. Chemotherapy eye drops have been found to locally cure most patients with squamous carcinoma or melanoma of the conjunctiva.

During treatment, chemotherapy eye drops can cause irritation of the eye and eyelids or rarely flu-like symptoms, but Dr. Finger has found that most patients prefer to avoid surgery and anesthesia as well as experience less superficial scarring of the eye. Dr. Finger believes that most patients should have a try at these drops before risking surgery, don’t you?

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

Small choroidal tumors can be the hardest ones to distinguish. They often have not had the time to develop the most common distinguishing characteristics: Orange pigment, Subretinal Fluid and Thickness greater that 2 mm. However, Dr. Finger's mnemonic device MOST helps us remember them, where Melanoma = Orange pigment, Subretinal Fluid and Thickness > 2 mm.

There are other findings, but those are the most common and when seen together are diagnostic.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170

There exist 3 common types of eye-plaques used to destroy choroidal melanomas. They include: beta-emitters (ruthenium-106, Strontium-90) and seeded plaques iodine-125, palladium-103. The beta-emitters are popular in low socio-economic environments because they can be re-used for many patients. Iodine-125 gained its popularity as a treatment arm for the North American Collaborative Ocular Melanoma Study. The use of palladium-103 seeds in gold eye plaques was invented by Dr. Finger in 1991. Since that time, 6 North American Centers have adopted its use. Both the American Brachytherapy Society and the American Association of Physicists in Medicine have demonstrated advantages related to palladium-103.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170