Article Date: 3/1/2006

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