Advancing ocular oncology through the power of partnership

BY VICKI FRYE

Ocular Oncology is a distinct subspecialty of ophthalmology which focuses on the diagnosis and treatment of cancers that impact the eye, orbit (eye socket) and eyelids. The Division of Ocular Oncology was formally established at Duke Eye Center in Fall 2023 after more than 20 years of providing treatment for eye cancer. Under the leadership of Miguel Materin, MD, professor of ophthalmology and professor of radiation oncology, the Division of Ocular Oncology is dedicated to providing full time specialized care for children and adults battling benign and malignant tumors of the eye.

Originally part of the retina division, the demand for treatment has only increased over the past several years. Steadily expanding to more than 500 patients visiting Duke Eye Center each month for ocular oncology support, the need for a division solely devoted to eye cancer was clear.

“More than 90% of our patients are referred to us from other specialties within ophthalmology or from caregivers in other fields including melanoma, breast cancer, neuro-oncology, radiation oncology and pediatric oncology,” said Materin. “Our ocular oncology patients come from North Carolina, South Carolina, Virginia, Georgia, Tennessee and other states and countries. We also treat patients from other departments within Duke.”

Pioneering Treatments

In June 2023, Duke became one of only three treatment sites in the U.S. certified to utilize the novel high dose-rate (HDR) yttrium-90 (Y-90) brachytherapy procedure.

The Y-90 procedure, cleared by the Food and Drug Administration for episcleral brachytherapy of ocular tumors and benign growths, involves placing an applicator with a Yttrium-90 disc directly over the surface of eye for treatment. This approach effectively treats small lesions from a variety of conditions, including ocular surface tumors and posterior (intraocular) tumors. Remarkably, most procedures are completed in less than 10 minutes.

“We’re honored to have been chosen as one of the first centers in the country to offer this innovation in patient care,” said Materin. “Y-90 is an incredibly less-invasive procedure that replaces traditional therapy and will positively contribute to the evolution of ocular oncology on a national scale.”

“All brachytherapy is a team sport. None of this happens without a high degree of collaboration between the surgeon, the radiation oncologist, a dedicated physics team, as well as the nurses, surgical coordinators, recovery staff and assistants in the operating room.”

Junzo Chino, MD

In collaboration with the Department of Radiation Oncology at Duke, Junzo Chino, MD, associate professor of radiation oncology and director of brachytherapy, has worked with Materin to successfully perform the Y-90 procedure.

During the initial consult, the patient is evaluated to determine if they are a good fit for the Y-90 procedure. If so, using tumor measurements, the team calculates the time to the appropriate depth and then provides quality assurance during preplanning. In the operating room, Chino attaches the Y-90 disc to the wand, then ophthalmologist delivers the treatment to the patient. Physicists monitor the time as the source is applied. The procedure is over in a matter of minutes.

“All brachytherapy is a team sport,” said Chino.

“None of this happens without a high degree of collaboration between the surgeon, the radiation oncologist, a dedicated physics team, as well as the nurses, surgical coordinators, recovery staff and assistants in the operating room. Every role in this group is absolutely critical to ensure we’re on top of our game and each procedure is done as safely and effectively as possible.”

The collaborative team in ophthalmology and radiation oncology continue to pave the way for advancements that not only improve patient outcomes but also set new standards of excellence, positioning Duke as a pioneering force in the development of eye cancer treatments.

OR Team for Y-90 procedure. Materin, Chino, physics team, anesthesiology, and nursing staff.

Expanding Capabilities

In response to the growing need for ocular oncology care at Duke Eye Center, the division is host to a thriving training ground, including a one-year Ophthalmic Oncology and Pathology Fellowship program. The fellowship embraces a multidisciplinary approach to medical and surgical management of a wide range of ophthalmic cancers, along with a robust research component. Since 2017, six ocular oncology fellows have trained with Materin. These physicians have hailed from outside institutions around the globe.

Upon completion of the program, the most recent fellow, Arpita Maniar, MBBD, MD — also a skilled oculofacial plastic surgeon and ophthalmologist — became a full-time member of the Ocular Oncology division and is now working alongside Materin, as an attending physician and Duke faculty member. Together, the two are helping train ophthalmology residents, providing hands- on patient care and contributing to research. “The Duke Ocular Oncology fellowship was a tremendous opportunity for me to gain specialized skills and cultivate a deep knowledge of this rare field of cancer,” shared Maniar, associate professor of ophthalmology. “The support of the Duke Ophthalmology team and the collaboration with oncologists from other cancerrelated disciplines makes this fellowship impactful, and allows us to provide our patients with the highest level of care.”

Essential to the ability of the Ocular Oncology division to train the next generation of practitioners and deliver much-needed care to patients, is the cooperation and teamwork they enjoy with the Duke Cancer Center and other nationally-recognized treatment facilities. Together with renowned cancer specialists from areas such as pediatrics, neurosurgery, radiation oncology, breast cancer and others, they are able to provide the highest level of care to patients battling the spread of disease.