Early detection of eye cancer critical for successful treatment

This story first appeared in Healthy You - January 2025, The Gazette’s quarterly health publication.

Beyond the eyeglasses she wore for computer work in her job as an accountant, Jen O’Halloran had no problem with her eyes when she went for an annual eye exam in March 2021.

“I had great vision at the time,” O’Halloran recalled recently. “I didn’t have any reason for worry or concern. She did that scan where they look at the back of your eye, at the optic nerve, and she saw a freckle. They can be really common, but sometimes they can be concerning. It appeared to be raised, which raises alarms for a tumor.”

O’Halloran’s optometrist first referred her to a retinal specialist for a closer look at her right eye.

“He almost positively thought it was eye melanoma,” she said. “He told me there’s few places in the country that address eye melanoma.”

Cancers of the eye are exceedingly rare, and only a rare handful of cancer clinics in the nation are equipped to deal with them. Fortunately for O’Halloran, one of them is the University of Iowa’s Holden Comprehensive Cancer Center.

“That was huge, to know two hours away there’s a place we could get to, have my appointment, and come home the same day,” said O’Halloran, 50, of Des Moines.

O’Halloran’s experience is typical of patients at the university, according to Dr. Asad Javed, Holden Center oncologist specializing in ocular cancer.

“There’s two ways patients get diagnoses,” Javed said. “One is during the routine eye exam they will find a growth on the inner surface of the eye. Or patients may present with vision changes. They’ll see slowly deteriorating vision in one eye.”

Those symptoms may include the occurrence of shadows, flashes of light, or “floaters,” the wiggly lines across one’s field of vision. Patients may also detect a growing dark patch on the eye or lump on the eyelid, or simple irritation. These symptoms can also be caused by minor eye conditions and are not necessarily a sign of cancer.

Cancers of the eye include several types that begin in the eyeball and the structures surrounding it. While relatively uncommon, an intraocular melanoma like O’Halloran’s is the most common cancer affecting the eye.

“In the world of melanoma, it’s the second most common after skin melanoma,” Javed said. “More than 90 percent of the cases will be skin melanoma.”

A melanoma in the eye differs significantly from the more common melanoma that can develop into skin cancer.

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“Even though they begin from the same type of cell, they have different mutations, different characteristics,” Javed said. “The treatments that work for skin melanoma don’t work for eye melanoma, and that’s why we have these specialized treatments.”

About two weeks after her consultation with the retinal specialist, O’Halloran was referred to Holden and ophthalmologist Dr. Elaine Binkley.

“Eye melanoma’s tricky, because you can’t biopsy it like most cancers,” Binkley said.

“Because the tumor is so small and it’s in such a sensitive area of the eye, you don’t need a biopsy,” Javed said.

Instead, Binkley used an ultrasound scan of O’Halloran’s retina.

“That’s basically how they confirm it,” O’Halloran said. “She took some more pictures and confirmed it was melanoma.”

Once confirmed, the diagnosis left O’Halloran with three basic options:

The tumor was fairly close to the macula, the small area within the retina that processes central vision, color and fine detail. To protect the macula, Binkley and her staff placed a radioactive patch over O’Halloran’s eye for five days.

“The type of radiation that is offered to the patient is highly localized,” Javed said. “You’re not radiating the whole eye; you’re radiating the part of the eye that has the tumor.”

The process required hospitalization for five days at the University of Iowa Hospitals.

“My husband could come up once a day and stay a few hours a certain distance from me, because I was considered radioactive,” she said. “I can’t say enough things about Dr. Binkley and her care and her team. She’s amazing, just so talented and a great communicator.”

O’Halloran also received injections to stimulate blood flow in the eye to maintain its sight. Her eye has responded to the treatment but will require enhanced monitoring. With another clean exam, she expects to go from twice-yearly monitoring to annual visits.

“They run some different scans and they do some eye ultrasounds,” she said. “Dr. Binkley has been very positive. She says I’ve been doing better than most at this juncture.”

“With a lot of cancers, follow-up is typically done for five years,” Javed said. “In the case of eye melanoma, it’s more long-term or even lifetime. Patients need to be seen and follow up with over much longer time periods.”

That’s to ensure the tumor doesn’t metastasize, or spread elsewhere in the body.

“The tumor is dead,” O’Halloran said. “The radiation did its job, so the tumor is just a lump of dead cells. But here’s that risk of a rogue cell — did it travel in my body?”

O’Halloran continues to undergo regular MRIs of her liver, where such spread would first become apparent.

“I’ve been fortunate,” she said. “Everything has been clear to date, and it hasn’t spread.”

Eye cancer’s rarity makes it difficult to identify risk factors. Most ocular melanoma occurs in people over age 50, and race, light complexions and eye color may be a factor.

“Ninety-nine percent of ocular melanomas happen in patients of Caucasian descent,” Javed said. “There is an association with light eye color. The incidence of eye melanoma increases as you go up north. The higher up in latitude you go, the higher the incidence.”

Javed said medical literature shows an increased incidence of ocular cancers among professional welders, “but other than that, as far as environmental factors are concerned, there’s no clear established link.”

A family history of cancer or eye problems may be an indicator, but didn’t apply in O’Halloran’s case.

“They don’t have a lot of data on what causes it,” she said. “I have blond hair and blue eyes and a fair complexion, but they’re not really sure if it’s caused by sun exposure. The ‘why’ really still isn’t answered and never will be, probably.”

O’Halloran expects the central vision in the affected eye will continue to deteriorate.

“I can still see fairly well, but eventually it will become peripheral only,” she said.

As with any cancer, early detection is critical to successful treatment. Her husband and two of their four children wear glasses, so the entire family goes for an annual eye exam with the added retinal scan.

“The sooner you have that information, the more you can do with it, as scary as it was at the time,” she said. “Now I have my follow-up appointments, and I can just live. This was so random and so scary at the time — it still is.”