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When he joined the University of Tennessee Health Science Center in the mid 1990s, ophthalmologist Barrett Haik, MD, had a dream he hoped could be fulfilled in Memphis.
Haik wanted to develop a comprehensive eye clinic at St. Jude Children’s Research Hospital. The institution, devoted to clinical treatment and basic research of catastrophic pediatric diseases, provided just the setting he envisioned. He conceived of a clinic that would be devoted to the diagnosis and treatment of retinoblastoma, a tumor of the retina, along with eye infections and conditions that result from cancer, other serious pediatric illnesses and their treatments.
After talks with Hospital Director Arthur Nienhuis, MD, the idea for the Eye Tumor Clinic was born. It opened in the Patient Care Center in spring of 1996 and is staffed by at least seven physicians from University of Tennessee Health Science Center (UTHSC), who each work in the clinic part-time. The staff includes physicians who specialize in different areas: opportunistic eye diseases; post-transplant complications; tumors of the brain and optic nerve that affect the visual system; reconstructive surgery; and problems of the external eye, such as “dry eye.” Fletcher Goode, MD, who has volunteered his services at the hospital for more than 30 years, serves in the critical role of senior consultant.
“I don’t think any other cancer center in the country has the facilities, personnel and combined expertise that we have at St. Jude,” Haik says. Children affected with life-threatening and blinding eye cancers receive the most advanced clinical, surgical and supportive therapies.
Patients are treated as part of protocols or clinical studies. These studies use various combinations of radiation, chemotherapy, laser heat and freezing therapies to treat patients who have retinoblastoma in one or both eyes.
Retinoblastoma is a rare cancer, representing about 2 percent of childhood malignancies in the United States, but is much more common in developing countries. Findings made in retinoblastoma research could be applied to other cancers. It was the first cancer found to have a clear hereditary pattern and serves as the model for understanding the heredity and genetics of childhood cancer. About one-third of retinoblastoma patients suffer from the hereditary form, meaning their children will have a high likelihood of inheriting the disease.
Because of its genetic pattern, it is possible retinoblastoma could be cured by gene therapy – another reason St. Jude is an optimal institution to house a clinic for retinoblastoma. Clinical physicians work with world-renowned gene therapy experts such as Arthur Nienhuis, MD, hospital director; and Rupert Handgretinger, MD, and Brian Sorrentino, MD, Transplantation and Gene Therapy program leaders.
It will be years down the road before gene therapy will be used to treat retinoblastoma, Nienhuis says. But progress has already been made on this front. Scientists have already pinpointed that the heredity form of retinoblastoma occurs because these patients lack a certain gene. The idea of gene therapy would be to find a method to insert this gene into the patient's DNA or replace the protein into the gene. “If this approach is successful, one can transfer these findings to other cancers,” Haik says.
Despite its comparatively low incidence in the general population, retinoblastoma is nevertheless a complicated and devastating disease. “When we treat retinoblastoma, it regresses, but never completely disappears. The most important ophthalmic skill is determining whether the tumor is completely dead. Like any cancer, 99 percent is not good enough. It must be 100 percent,” says Haik.
To this end, the clinic is equipped with state-of-the-art examination and diagnostic equipment to aid ophthalmologists in their evaluation and long-term monitoring of the children.
There are many reasons why St. Jude is an excellent site for this clinic:
All these elements together make the clinic a unique facility for the diagnosis, treatment and ongoing care of children with retinoblastoma.
Updated 2004 from Corridors, April 1996