Background of Ocular Oncology
The Ocular Oncology Centre at the Royal Liverpool University Hospital was established in January 1993.
Bertil Damato became interested in ocular oncology in 1980, when he started working at the Tennent Institute of Ophthalmology in Glasgow under the leadership of Professor Wallace Foulds, whose pioneering surgery for ocular tumours had received world-wide acclaim.
In 1984, Professor Foulds was granted special funding from the Scottish Home and Health Department to establish an Ocular Oncology Service in Glasgow and he invited Dr Damato to join him in this work (note: in Scotland, eye specialists are 'Dr' whereas in England they are 'Mr').
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- Professor Wallace S Foulds CBE and Bertil Damato (1987)
In 1989, Professor Foulds retired and Dr Damato continued to run the oncology service. In 1993, Mr Damato moved to Liverpool which is more accessible to most patients, being located at the geographic centre of the British Isles. Liverpool is close to the Clatterbridge Centre for Oncology, which is the only unit in Britain with facilities for proton beam radiotherapy of ocular tumours.
The Liverpool Ocular Oncology Centre grew rapidly, with the number of new patients each year exceeding 550.
The Liverpool Ocular Oncology Centre has developed considerably over the years and the team now includes an oncology secretary, a specialist ocular oncology nurse, a health psychologist, a data manager, a photographer, a research scientist in ocular tumour biology, and a compliance officer. Close collaborative links have been established with pathologists, cyto-geneticists, radiotherapists, oncologists, radiologists and also a medical ethicist to provide a comprehensive service.
In 1997, the Ocular Oncology Centre was designated a 'Supra-Regional Service' by the National Specialist Commissioning Advisory Group (i.e., 'NSCAG') at the Department of Health in London. The purpose of this organization is to ensure that patients with rare conditions, such as ocular tumours, are given the highest possible standard of care by an experienced specialist team.
The Liverpool Ocular Oncology Centre offers an exceptionally wide range of treatments, which include:
- Plaque radiotherapy, placing a saucer-shaped applicator behind the eye for 3-7 days;
- Proton beam radiotherapy, directing a highly focused beam at the tumour using special equipment, located at Clatterbridge Centre for Oncology, on the Wirral Peninsula;
- Trans-scleral local resection, removing the tumour through a trap-door in the wall of the eye;
- Trans-retinal local resection, 'hoovering' the tumour through a hole in the retina;
- Trans-pupillary thermotherapy; sterilizing the tumour with a beam of infra-red laser;
- Photodynamic therapy, injecting a light sensitizer into a vein in the arm and then shining low-energy laser onto the back of the eye to activate the sensitizer as it passes through the tumour,
- Topical chemotherapy, using eyedrops to treat tumours on the surface of the eye, and
- Enucleation, removing the eye, which is the last resort, when other methods are unlikely to conserve the eye with useful vision.
These treatments are useful both for benign and malignant tumours. The wide choice of treatment enables us to design the optimal strategy for each patient, if necessary combining different methods to achieve the best possible results.
Special investigations include:
- Colour photography, for documenting tumour appearances;
- Fluorescein angiography, for investigating tumour circulation;
- Ocular ultrasonography; for measuring tumour dimensions and tissue consistency;
- Optical coherence tomography for assessing the layers of the retina;
- Tumour biopsy, performed either using a fine needle, or a 25-gauge vitreous cutter, ('vacuum cleaner') or through a trapdoor in the eye;
- Computerized tomography, for producing x-ray images of the eye;
- Magnetic resonance imaging, producing fine images of the eye with added information on tissue type; and
- Cytogenetic studies, for detecting DNA abnormalities in the tumour, which give an indication of tumour behaviour.
We have instituted several protocols to help patients understand their condition and its treatment. These include:
- Giving patients a series of guides and information leaflets;
- Giving all new patients an audio-cassette tape recording of their first consultation;
- Mailing patients a copy of the correspondence we send to the GP and ophthalmologist;
- Publishing a newsletter;
- Creating this website; and
- Providing a telephone helpline, run by our Specialist Ocular Oncology Nurse.
To maintain high standards we also:
- Prepare staff guidelines;
- Conduct patient satisfaction surveys and quality of life studies;
- Measure satisfaction of referring ophthalmologists;
- Conduct research;
- Encourage complaints; and
- Perform continuous outcomes assessments (ie, Audit).
