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For Dr. Matthew Wilson, saving the lives of his eye-cancer patients while keeping the eye and preserving its vision are matters of priority — in that order.

Yet the increasing ability to do all three is changing the nature of ocular oncology, said Wilson, an ocular surgeon at Methodist University Hospital and associate professor of ophthalmology at the Hamilton Eye Institute at the University of Tennessee Health Science Center.

Trends toward targeted therapy are occurring in the treatment of eye cancer as in all forms of the disease, Wilson said.

“We are having better success at saving eyes,” he said. “I think you’re seeing a transition in cancer management, going from a ‘scorch-and-burn’ policy with traditional chemotherapy, to very-targeted molecules acting specifically on those cells.”

In the world of cancer, the treatment of eyes is a narrow niche. For Wilson, it began with his practice as an ophthalmologist, but he also had a long-term interest in cancer as “one of the ultimate challenges.”

“I realized I could merge the two together,” he said.

Toward that goal, Wilson’s training included three fellowships: in ophthalmic pathology at Emory University School of Medicine in Atlanta; in ocular oncology at Saint Bartholomew’s and Moorfields Eye hospitals in London; and in ophthalmic plastic and reconstructive surgery at the Casey Eye Institute in Portland, Ore.

Wilson holds a medical degree from Emory University School of Medicine in Atlanta, where he also completed an internship in the Department of Internal Medicine and a residency in oncology.

Prior to arriving in Memphis in 1999, he spent two years on the faculty of the University of Colorado. He is certified by the American Board of Ophthalmology.

With only a few centers in the nation dealing with eye cancer exclusively, Wilson’s patient base draws from across the Southeast — as far as eastern Tennessee, into Texas, including Alabama, Mississippi, Arkansas and much of Louisiana.

“It’s pretty specialized; there aren’t a lot of us,” Wilson said. “There are people who will treat the rare tumor here and there, but there are very few people who would say it’s 90 percent of their work. I’m pretty much immersed in it.”

A part of the reason that ocular oncologists are rare is that the diseases they treat are rare, as well.

Choroidal melanoma, Wilson’s treatment focus in adults, affects only about six out of every 1 million people in North America. It is a malignant melanoma of the choroid — the middle, vascular coat of the eye, between the sclera, the white outer coat of the eye, and the retina.

Retinoblastoma, his treatment focus in children, affects only about four out of every million under age 15 each year, according to the American Cancer Society. That translates into only about 300 cases per year in the United States, Wilson said.

Those two diseases make up the bulk of Wilson’s practice, alongside orbital tumors in both adults and children and cancers of the eyelid.

Among the most rewarding aspect of Wilson’s practice has been working alongside colleagues at St. Jude Children’s Research Hospital, where he serves as a surgeon in the ophthalmology division. There, he’s worked with Dr. Barrett Haik and Dr. Carlos Rodriguez-Galindo in developing a comprehensive retinoblastoma service, and collaborated with Michael Dyer, PhD, in exploring treatment options and developing new therapies.

He and colleagues continue to pursue the “holy grail” of retinoblastoma treatment — a drug to target the cancer that could be delivered across the porous sclera, the white part of the eye, in the same way other medications are commonly delivered.

In the treatment of choroidal melanoma, Wilson employs radiation plaque therapy. The plaque is a disc-shaped gold applicator about the size of a dime that holds radiation seeds the size of a grain of rice.

The device is surgically placed and sewn over the area of the eye that needs to be treated. It is left in place for several days to deliver the right dose of radiation and is then removed.

“Essentially, you’re taking your radioactive source and directly applying it to the cancer,” Wilson said.

While this form of treatment has proven highly effective for this form of cancer, he said, further research is focused on finding ways to keep the disease from spreading to the liver and other organs.

“The problem with choroidal melanoma is that it metastasizes early,” he said. “We are very effective in treating the eye, but damage has been done to the whole being.”

Splitting his time between patient care and research, Wilson keeps his days full. He spends three or four days each week in the operating room in addition to seeing patients in-clinic. The variety and challenge keep the work fresh.

“I’m lucky that I get to do what I do,” he said.

Outside of work, Wilson spends much of his time either cycling, running or swimming. An active triathlete, he competes in Iron Man and half-Iron Man events.



March 2008

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