Upfront
Keep Your Eye on the Prize
Jason S. Slakter, MD
A common criticism with modern society is that we too often seek �the quick
fix� to our problems. As clinicians, we constantly see patients who are pleading
for solutions to their sight-threatening disease, answers that we may or may not
be able to provide. I am no less guilty of exhibiting impatience with the
progress in medical research. Medical professionals have made great strides in
managing certain conditions, particularly in the area of age-related macular
degeneration. In other areas of our field, however, progress is not so apparent.
In the absence of obvious and immediate clinical �success,� are we to determine
that progress is not being made?
Perhaps the clearest answer to this question
can be found in looking at 2 of the key papers in this issue of Retinal
Physician focused on retinoblastoma and choroidal melanoma. Both of these
diseases have been the subject of intense study and research for decades, with
some of the best and brightest minds in ophthalmology focused on trying to
advance diagnosis and treatment. In the case of retinoblastoma, success and
progress are obvious. While only 5% of patients could expect to survive this
disease in 1869, the 5-year survival rate has increased to 95% with the same
percentage of patients retaining at least 1 eye throughout their lives. Research
is now focused on better screening and management of late-onset manifestations
of retinoblastoma in the form of secondary tumors.
Success in the management of choroidal melanoma may not be so obvious. Although overall survival statistics
have not changed, research has resulted in improvements in diagnosis and
treatment, as well as in a reduction in unnecessary enucleation for patients
with lesions simulating choroidal melanomas. We have gained a better
appreciation of risk factors for progression of suspicious nevi to melanoma,
allowing for earlier intervention and a potential effect on the survival of
these individuals. Finally, and perhaps most importantly, research has led to a
better understanding of the molecular nature of the tumors and their patterns of
growth and proliferation, which will ultimately lead to treatments that will
improve the survival in these individuals.
The Role of the Physician
As you read
the articles in this issue of Retinal Physician, keep these concepts of
�progress� and �success� in mind. As physicians, we must remain advocates for
solutions to our patients� problems and seek methods to improve their quality of
life. We can accomplish this by supporting ongoing and future clinical trials
for a variety of vitreoretinal conditions, education and encouragement of our
patients so they do not lose hope in the face of what may be a currently
untreatable situation, and through open and honest interaction and dialogue with
our colleagues.
Retinal Physician, Issue: March 2006