Ocular Oncology

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ophthowannabe1

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hi forum, I am interested in learning more about ocular oncology, and there isn't a ton of information on the inter webs.

What type of surgeries are added?
How saturated is the market?
Does it improve earning power?
Are there more work hours due to increased acuity of care?
Can an ocular oncologist still do anterior chamber (cats in particular)?
And any other interesting tidbits that you think a youngster should know.

Thanks!

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what year medical student are you?
have you done an ophthalmology rotation yet.
does your school have an ocular oncologist?
 
What type of surgeries are added?
- Mainly tumor biopsies and treatments which include laser, cryotherapy and plaque radiation therapy amongst others.

How saturated is the market?
- Not very. Intraocular tumors are rare and there are not many providers for this type of service across the country

Does it improve earning power?
- Not really. These are highly complex patients that require a lot of time to take care of. Though you might be able to bump up your referrals by providing this type of care, it is hard to build a productive practice of exclusively ocular oncology patients. Most ocular oncologist are affiliated with academic centers, though there are a small handful who are in private practice.

Are there more work hours due to increased acuity of care?
- These patients do not have increased acuity of care. Certainly not in comparison to other ocular emergencies. Work hours can be long in any field depending on your work habits, efficiency, and how you chose to run your practice.

Can an ocular oncologist still do anterior chamber (cats in particular)?
- Have not heard of one doing this. Most ocular oncologist are referred patients by general ophthalmologists. Not sure they would like you taking their cataracts. There may be regional situations where this would be possible but not common.
 
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How saturated is the market?
- Not very. Intraocular tumors are rare and there are not many providers for this type of service across the country

I would caution if you're thinking about this subspecialty that it is actually completely saturated. There's not really anywhere in the country you can set up shop and become an ocular oncologist...it's just too rare. Patients are better served going to a busy ocular oncologist who sees these cases everyday.
 
MstaKing10's post is excellent. I can add that ocular oncologists are few in number and due to low volume of cases the really well known ones attract people from all over the world. There is no way you could survive financially just seeing patients with eye malignancies in private practice. Because its so rare, patients are best served at large academic centers. The best example by far is the Shields practice at Wills. They are seriously a household name (or as close as there will be) in the field of ocular oncology. Other programs that come to mind, Jakobeic at MassEye (pathology), Mieler at UIC, Dr. Eagle (pathology). Prob most of the top programs have access to a large database of cases. I'm certainly no expert.

In terms of fellowships, that is easier. There aren't many ocular oncology fellowships but I think if you want one you can obtain it. Realize that many non-subspecialty trained docs can treat many eye malignancies. Peds ophtho or retina that treats peds are usually competent at assessing and managing retinoblastoma. Intraocular melanoma is treated mostly with plaque therapy these days and many non-subspecialty trained retina docs are comfortable treating small to medium size tumors (at least initially), or for large aggressive tumors referring to oculplastics. This goes for primary introcular lymphoma and other malignant B-cell tumors. Each needs co-management with oncology and pathology and this is useful for ensuring proper management for the patient. Many other malignant conditions (lacrimal tumors, metastatic disease) will be referred out after a diagnosis is made. I think the real challenge after diagnosis is who to consult, how to manage pretty toxic medications, and when to refer when treatment is either not-effective or the patient's condition worsens.
 
I don't know any peds or retina people that manage retinoblastoma. Sure you can diagnose it and get it to the right place and I'm sure there may be a few people out there that are comfortable managing. Very few (if any) peds or retina fellowships provide enough exposure to be in a position to properly take on this responsibility. Optimal therapy and surveillance are quite complex and require frequent EUAs/local re-treatment, a retcam to document EUAs and document lesion regression/stability, ability to provide intra-arterial chemo in select cases, ect. I think anyone that didn't do an ocular oncology fellowship and is not located at a major academic center is likely providing sub-optimal care.
 
I totally agree. I speak only from experience at a large academic referral center. The peds ophtho and retina docs at my institution receive the referrals you speak of and are comfortable managing it, usually in tandem. I certainly can't speak for folks in private practice which I agree prob aren't comfortable managing retinoblastoma.
 
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