From Humble Beginnings the Ocular Oncology Service has become a World-Class Center of Excellence

Carol L. Shields, M.D.

The Ocular Oncology Service at Wills Eye Institute celebrated its 35th birthday in 2009. The Service had modest beginnings as an offshoot of the Retina Service in a single examination room at the old Wills Eye Hospital on Spring Garden Street in 1974 with a single employee, Dr. Jerry Shields. Prior to that, Dr. Shields had been involved in directing diagnostic facilities on the Retina Service, working with fluorescein angiography , ultrasonography, radioactive phosphorus (p32) uptake tests and other modalities for the Retina Service patients and, because of his interest, this later evolved into an opportunity to specifically evaluate and treat patients with ocular tumors.

At first only 2-4 patients would be evaluated each day. Hospital admission would be performed on Sunday for inpatient testing of ocular melanoma patients and later treatment. At that time, accuracy in ophthalmologic diagnosis of intraocular tumors was limited so tests such as fluorescein angiography, ultrasonography and the 32P test were new and being explored. Most primary intraocular malignancies were managed with enucleation, but there was an exciting novel treatment for some ocular melanomas called plaque radiotherapy. This had been used in Europe and was being investigated at Wills Eye Hospital. At that time, examination notes were handwritten, letters were hand-typed by the physician, and charts were stored in a single orange crate. A second employee, Mrs. Mabel Bankes, joined the Service as a letter typist, patient assistant, and transcriptionist for the hand-written versions of the first edition of the Intraocular Tumor book. This was the inauguration of the Ocular Oncology Service.

During that time, there were only two other similar services worldwide, in New York City under the direction of Robert M. Ellsworth MD and in London with HB Stallard MD, FRCS. Over a period of two decades, these 3 key centers changed the global approach to ocular cancers, improved education for ophthalmologists, and greatly improved the therapy and prognosis for patients.

The Ocular Oncology Service at Wills Eye Institute gradually evolved into a world-class center for eye cancers. Dr. Carol Shields joined the Oncology Service in 1987 with expertise in retinoblastoma and melanoma management and extra fellowship training at Moorfields Eye Institute in orbital, conjunctival, and eyelid tumors. Under her direction 22 years ago, the Oncology Service was promptly organized for computerized retrieval of patient data and diagnostic coding to assist in clinical research. This has been the source for tremendous comprehensive data collection and reports on clinical features and therapies for a spectrum of ocular tumors. Residents, fellows, and medical students have benefited from this treasure of data organization, allowing for research projects to be completed efficiently. Some of the extraordinary analyzed data included 8033 patients with uveal melanoma (published in Archives of Ophthalmology 2009), 3422 patients with choroidal nevus (published in Ophthalmology 2009), and 1196 children with retinoblastoma (published in Pediatric Ophthalmology and Strabismus 2003). The Oncology Service has published over 1000 reports in peer-reviewed journals and the senior members have written 10 textbooks related to ocular oncology.

Currently, the Oncology Service provides care for patients with tumors of the conjunctiva, cornea, orbit, eyelid, and intraocular structures. The most common tumors include nevus, melanoma, squamous cell carcinoma, metastasis, hemangioma, and retinoblastoma. The Service occupies the 14th floor of the Institute and houses 17 examination rooms, a minor surgical suite, and offices for 6 full time fellowship-trained ocular oncologists. In addition to Dr. Jerry Shields and Dr. Carol Shields, the physician staff includes Dr. Arman Mashayekhi, Dr. Sara Lally, and Dr. Carlos Bianciotto. The staff is trained for all aspects of ocular oncology. Each week, this team of six, along with numerous clinical and research fellows, keeps an impressive schedule with daily clinic hours opening at 6:30 AM to accommodate the patient with all necessary examination, testing, and counseling performed in one day. On the average, this hardworking team evaluates 50 new patients or more weekly, many from the East Coast region as well as from distant locations in the United States and other countries. The Oncology Service has grown to become the busiest and the most respected eye cancer center in the USA.

The Service is attuned to new developments in imaging and therapy. High quality posterior segment and anterior segment optical coherence tomography, wide angle fundus photography, fluorescein and indocyanine angiography, autofluorescence, anterior segment ultrasound biomicroscopy and posterior segment ultrasonography are used daily. Custom-designed plaque radiotherapy, local tumor resection, and enucleation is employed for 15 to 20 patients with uveal melanoma weekly. Families with children affected with retinoblastoma fly in from all points in the USA and abroad to obtain care for their precious infant. Remarkable advances have been made in retinoblastoma management using standard intravenous chemotherapy, saving lives, eyes, and vision. The newest advance is the use of intra-arterial chemotherapy under the direction of Dr. Carol Shields (ocular oncology) and Dr. Robert Rosenwasser (neurosurgery) whereby catheterization of the femoral artery with a thin probe sent into the ophthalmic artery to deliver a tiny dose of chemotherapy has been used, minimizing systemic toxicities and saving advanced eyes from enucleation.

The Oncology Service welcomes medical students, residents, fellows, and visiting physicians. Each summer, nearly 25 medical students obtain experience in ophthalmic research via the ocular oncology team. Over 50 fellows have been trained in ocular oncology by the Oncology Service over the past 3 decades and maintain practices in their home countries of England, Ireland, Germany, Italy, Scotland, Belgium, Turkey, Egypt, Israel, Iran, India, China, Japan, Australia, Chile, Colombia, Venezuela, Costa Rica, Argentina, Brazil, Canada, Mexico, the Philippines, and others.

So from modest beginnings, the Ocular Oncology Service at Wills Eye Institute has grown from a single dusty room to a sparkling world-class center of excellence. The dedication and diligence of the entire staff of this team should be commended.