The eyes aren’t just windows to the soul for Chuck McCollum.
They’re part of a pathway that might have allowed cancer to spread from his left eye to the rest of his body, had a local doctor not recognized his rare condition and sent him to Philadelphia for treatment.
What’s more, the 66-year-old Stafford County man found out about the tumor when he had another problem with his eye—an issue that had nothing to do with the cancer—while he and his wife, Denise, were enjoying the best vacation of their lives.
Still, the episode eventually led the couple to Dr. T. Mark Johnson, a Fredericksburg ophthalmologist who spotted the growth on a part of the eye that’s difficult to see. Each year, there are only six to seven cases of ciliary body melanoma per million people in the United States, and some eye specialists may not encounter one in their lifetime, doctors told the McCollums.
“Without Dr. Johnson’s diagnosis, I’d hate to think where I’d be,” Chuck McCollum said.
In May, McCollum and his wife were cruising along Alaska’s Inside Passage, enjoying glorious weather and breathtaking views of the Pacific Northwest. They agreed it had been the trip of a lifetime—and the retired couple is well-traveled.
Neighbors joke that they’re gone so much, they vacation at home.
On the next-to-the-last day of the cruise, those on board set their sights on the Hubbard Glacier, a gigantic mass of ice more than 6 miles wide.
McCollum woke up and couldn’t see out of his left eye. Nothing was apparent on the outside, but he suspected bleeding inside.
The same thing had happened—in the same eye—six years earlier. Doctors said a spike in blood pressure probably had caused the first hemorrhage, which isn’t that unusual. McCollum worried that a detached retina might be responsible for the second.
“When that happens, it’s like a sheet falling over your eyes,” he said.
The cruise ended, and the McCollums visited a friend in Seward, Alaska, as planned. The friend took them to a local emergency room doctor, who referred McCollum to an ophthalmologist in Anchorage.
Both doctors did ultrasounds and saw no signs of a detached retina, or any other problems.
The couple had booked a trip to Denali National Park and asked if it was safe to continue. The ophthalmologist said it probably was—but that they should seek a specialist back home.
‘A RARE FORM’
On June 15, the McCollums saw Johnson in the Fredericksburg office of the Retina Group of Washington. He specializes in back-of-the-eye problems and detected a tumor, little more than ¼-inch long, on the ciliary body. It controls the shape of the lens and produces the clear fluid in the front of the eyeball.
Melanoma in that region of the eye, known as the uvea, is unusual enough, but only 10 percent of all uveal melanomas occur where McCollum’s did, the ophthalmologist said.
“It’s a rare form of a relatively rare condition,” Johnson said.
What’s more, cancer of the eye “is not what you die from,” McCollumn learned. “It’s when it metastasizes elsewhere” such as in the liver, lungs and skin.
The news made the couple stop thinking about their next vacation and start updating their wills.
“We were like gobsmacked,” he said.
“It was like walking out with a death sentence,” she added.
PLANTING RADIOACTIVE SEEDS
Johnson referred McCollum to Wills Eye Institute in Philadelphia. The couple made an appointment the first week in July and arrived early so they could enjoy Independence Day in the historic city.
Before then, they had to scramble to get all the screenings and tests—including seeing a cardiologist—done in a two-week period, but the couple rallied.
Both are familiar with procedures and treatments. They met in the Army Medical Services Corps; she served 30 years while he was in the reserves. Both were in administration, assisting those who provided care.
Away from his Army duty, McCollum worked for the U.S. Postal Service for 25 years before he retired.
At Wills, McCollum received plaque radiotherapy. Small radioactive seeds are attached within a gold or steel bowl called a plaque and placed on the tumor. The bowl has prongs like a small cap on a beer bottle.
The same type of therapy is used with breast and prostate cancer. It delivers radiation directly to the site with less damage to healthy tissue, according to the New York Eye Cancer Center website.
McCollum had the plaque placed on his eye on a Thursday, got bandaged and sent to a nearby hotel. The McCollums were told the seeds emit as much radiation as a microwave, but that could be dangerous for pregnant woman, so it’s best if patients stay isolated.
The following Monday, the plaque was removed during outpatient surgery, and the McCollums were good to go.
The treatment is 98 percent effective in controlling the eye tumor, the Wills website states. But because of the threat of cancer spreading elsewhere, McCollum will need to be checked twice a year.
‘A LUCKY EVENT’
McCollum was fortunate his eye bled when it did, even if it was while sightseeing more than 3,000 miles from home.
“This was a lucky event,” said Dr. Arman Mashayekhi, an ocular oncology specialist at Wills, who said the bleeding was a totally separate issue and not related to the tumor.
But had the bleeding not occurred, the tumor could have gone unnoticed for a long time, causing it to get bigger or spread elsewhere. The larger the tumor, the higher the dose of radiation delivered, which increases the risk of damage to the eye and subsequent vision loss, Mashayekhi said.
McCollum has been tested for cancer in other regions of his body and said every test has come back clean. Dr. Charles Maurer is his medical oncologist, and Maurer said he’s see a few cases of this type of eye melanoma But sadly, by the time patients reach his office, the cancer has metastasized elsewhere.
His case underscores the need for regular eye exams, Johnson said.
“You need your eyes to be dilated [and to be] checked for all medical issues, not just for a new pair of glasses,” he said.
“I second his opinion,” McCollum added. “It’s very important.”
While everyone values their vision, Johnson said few realize “how much your eyes tell you about everything else going on” in the body. They can give clues about diseases that affect the joints as well as diabetes and high blood pressure. People with high cholesterol can have lipid deposits show up as rings on the front of the eye.
“Blood vessels in the retina are the smallest in the human body that you can look at directly, so they tell you a lot about other vascular vessels in the heart, brain and kidney,” Johnson said. “They’re very important to how all systems work.”