Editorial
The importance of a team approach to research in
ophthalmology
What do Lance Armstrong
and Saku Koivu have in common? Let’s start with Armstrong. In
October 1996 the top-ranked cyclist in the world was forced off his
bike in excruciating pain. Tests revealed advanced testicular cancer
that had spread to his lungs and his brain. He underwent two operations
in the ensuing weeks: removal of the malignant testicle and then brain
surgery to remove the cancer that had spread upward. Five months later
he resumed riding and training. In 1998 he celebrated victory over cancer.
By 1999 he was back in top form, and he has gone on to win three more
Tour de France events.
Saku Koivu’s story is just as remarkable. In September 2001, while
on a flight back from Finland, the otherwise healthy Koivu suffered
abdominal pains and general discomfort. Tests revealed that the Montreal
Canadiens captain had non-Hodgkin’s (Burkitt’s) lymphoma.
Seven months later Koivu returned to the ice, to an unprecedented standing
ovation. He has been cancer-free since, and his performance on the ice
has been as spectacular as ever.
These two individuals have several things in common. They are both cancer
survivors who benefited immensely from recent advances in diagnosis
and treatment of their particular conditions. They both
benefited from a team approach to their diseases; the teams of specialists
included surgeons, oncologists, pathologists and nurses, to name a few.
Moreover, they both returned to professional athletics and have since
performed at the highest level.
On top of all this, they have both established charitable foundations
that sponsor research in the diagnosis and treatment of cancer. Having
gone through the process themselves, they are aware of how many different
specialists are involved in the diagnosis and treatment of each case.
They also know that it was only through years of research that the treatments
they benefited from were available to them.
In ophthalmology there are numerous examples of the importance of research
and the team approach in diagnosing and treating ocular conditions.
It is crucial that departments of ophthalmology and visual science continue
to support a collaborative approach to research, including intra- and
interdepartmental research programs. The ocular melanoma story is a
great example of proof that without a collaborative approach to research
it is not possible to achieve our goals.
Ophthalmologists and ocular pathologists learned about prognostic factors
in ocular melanoma, such as size of the tumour, cell type and extraocular
extension, during the first stage of researching this particular tumour.
More recently we have learned that it is virtually impossible to understand
the mechanisms in the development of ocular melanoma without understanding
the immunologic mechanisms involved. We came to this conclusion only
when we included on our research team immunologists, molecular biologists
and oncologists with a great deal of experience in the study of skin
melanoma. In fact, ophthalmologists and dermatologists dedicated to
the study of melanoma should share animal models, in-vivo and in-vitro
techniques, and imaging technology to discover the pathological mechanisms
involved in this lethal condition.
Ocular oncologists have come to the conclusion that the local treatment
of an ocular melanoma is far from sufficient to avoid spread of the
disease. Studies have proven that circulating malignant cells, the intra-
and extravascular matrix, and immunologic reactions need to be researched
in order for us to understand the establishment of liver metastasis,
which ultimately leads to the death of our patients.
Straatsma and colleagues (1) recently concluded
that “to increase long-term survival, there is a need to combine
ocular treatment of choroidal melanoma with measures to detect and treat
micrometastatic disease.”
The diagnosis and treatment of several ocular diseases, including melanoma,
should not be restricted to the ocular manifestations of those conditions.
Moreover, ophthalmology needs contributions from other departments and
programs — the team approach to research — to fulfil its
goals in the diagnosis and treatment of ocular diseases.
Miguel
N. Burnier, Jr., MD, PhD
Editor-in-Chief
Reference
- Straatsma
BR, Diener-West M, Caldwell R, Engstrom RE; Collaborative Ocular Melanoma
Study Group. Mortality after deferral of treatment or no treatment
for choroidal melanoma. Am J Ophthalmol 2003;136:47–54
|
