Definition and Overview

An ocular oncology consultation, also known as an ophthalmic oncology consultation, is the first step in seeking medical treatment for all patients with eye tumours, regardless if they are cancerous or not. The goal of the consultation is to get a diagnosis and a list of possible treatment options.

Requesting for an ocular oncology consultation does not put the patient under any obligation to push through with any type of treatment suggested by the consulting physician. The patient is free to seek a second opinion should he has any doubts about the findings or treatment options presented.

Who Should Undergo and Expected Results

An ocular oncology consultation is strongly recommended for all patients who suspect that they might be suffering from eye cancer, which come in many forms, such as:

  • Eyelid tumors
  • Conjunctival tumors, some examples of which include melanoma or ocular surface squamous neoplasia
  • Anterior segment tumors
  • Iris tumors
  • Lymphoma of the eye
  • Metastatic lesions
  • Vascular eye lesions
  • Orbital nerve lesions
  • Optic nerve lesions
  • Melanocytoma
  • Nevus
  • Hemangioma
  • Osteoma
  • Granuloma and xanthogranuloma
  • Disciform degeneration
  • Congenital hypertrophy of retinal pigment epithelium
    Patients who experience the following symptoms will also benefit from such consultation:

  • Bulging in one eye

  • Blurred vision
  • Complete or partial vision loss
  • Seeing flashes of light
  • Seeing spots or floating objects (also known as floaters)
  • A dark spot on the iris
  • Misting of the eye lens (similar to a cataract)
  • Lumps on the surface of the eye, either on the conjunctiva or the cornea
  • Any physical changes in the appearance of the eye
    These symptoms can be brought to the attention of a regular eye doctor, who can refer the patient to an ocular oncologist if cancer of the eye is suspected. The eye doctor will make the referral based on the symptoms, and the oncologist will take over from there and order necessary tests.

At the end of an ocular oncology consultation, the patient may expect to receive a suspected diagnosis requiring further investigation or a confirmed diagnosis, which is followed by the doctor’s treatment recommendations.

How the Procedure Works

An ocular oncology consultation takes place at the clinic or office of an eye doctor or an ocular oncologist and usually takes an hour or so. It is normal for the oncologist to conduct some tests during the consultation if the necessary equipment is already available. Otherwise, he may request for the tests to be done separately and may call the patient in for a follow-up.

During the ocular oncology consultation, the doctor will ask about the patient’s:

  • History of ocular health
  • Medical history
  • Family history of cancer
  • Symptoms
    If more information is required to come up with a conclusive diagnosis, the consultation may lead to some tests, such as:

  • External eye examination

  • Ophthalmoscopic examination of the inside of the eye
  • Ultrasound or echography
  • Fluorescein angiography
  • Fine needle biopsy
  • CT scan
  • MRI scan
  • PET scan
  • Gonioscopy
  • Blood tests
  • Visual acuity assessment
  • Ocular pressure measurement
  • Pupillary and ocular motion assessment
  • Slit-lamp exam
    The consultation also gives the patient a chance to ask any questions, which may include the following:

  • What type of eye cancer is it?

  • Which part of the eye is affected?
  • What other symptoms may develop due to this condition?
  • What is the stage of cancer and what does this mean?
  • What are my treatment options and their possible side effects?
  • Is the consulting doctor experienced in treating this type of cancer?
    During the consultation, the ocular oncologist may also take the opportunity to provide a brief description of the patient’s treatment options to help him make a well-informed decision. These options may include:

  • Surgical tumor resection

  • Systemic chemotherapy
  • Radiation therapy
  • Plaque brachytherapy
  • Laser therapy

Possible Risks and Complications

An ocular oncology consultation is safe for all patients and plays an important role in helping a patient manage his eye cancer. All eye exams are also safe and cause very little discomfort.

Some of these tests use special equipment or medications to stimulate specific eye movement, such as pupil dilation. These tests are safe, although their effects may persist for several hours after the exam. Thus, they are advised to arrange for a ride home if they are scheduled for such exams.

Imaging scans also carry a very small risk due to the radiation used. However, as with all other imaging scans used to diagnose a medical condition, the dose of radiation in these tests are very minimal and are always carefully controlled by the doctor conducting the test. If the patient is pregnant or believed to be pregnant, the oncologist will perform an alternative eye test to obtain the necessary information.

Reference:

  • American Academy of Ophthalmology Preferred Practice Patterns Committee. Preferred Practice Pattern Guidelines. Comprehensive Adult Medical Eye Evaluation - 2010. Available at one.aao.org/preferred-practice-pattern/comprehensive-adult-medical-eye-evaluation--octobe. Accessed February 27, 2015.
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