Doctors turn to gamma knife to save man's eye, life
BY ERIKA ROSE
Times Correspondent | Monday, March 12, 2007
It all started with the simple annoyance of wearing glasses. If Steve Kirschner had not investigated the option of having a procedure to correct his vision, his life may have taken a much more dismal turn.
The 44-year-old engineer from Chesterton learned during an initial eye exam about a "freckle" on his retina. The doctor immediately referred him to a specialist who began to monitor the spot's size and shape closely. Sure enough, the spot grew and looked more and more suspicious.
The blue-eyed, fair-skinned Kirschner eventually was handed the grim and extremely rare diagnosis of choroidal melanoma, or cancer of the eye.
"This became very sobering for me," Kirschner says. "Up until then, I had been healthy and never sick and all of a sudden I was a cancer patient."
The doctors' appointments, exams and tests that followed were extensive. To his shock and surprise, doctors began talking to him about his "life expectancy." His treatment options were limited because of the location of the tumor -- close to the optic nerve. It was beginning to look as if his eye would have to be removed.
Radiation Oncologist Dr. Robert Woodburn and a team of professionals at The Methodist Hospitals offered a better option. The gamma knife procedure, though typically used for lesions of the brain, could be used to deliver 201 beams of radiation with pinpoint accuracy to eradicate Kirschner's tumor.
Woodburn calls the gamma knife, which isn't really a knife at all, "the most accurate radio surgery device there is" -- the gold standard for radio surgery.
Working with a team that included an invasive neuroradiologist, ophthalmologist, a physicist and neurosurgeon, Woodburn performed the procedure in May 2004, which proved to be a challenging task because of the difficult location of the tumor. They had to work quickly in the window of time his eye could be paralyzed.
The unconventional use of the gamma knife was a success.
Three years later, Kirschner's affected eye is often fatigued, and his vision is poor and unlikely to be corrected with lenses, but as he puts it, "it beats polishing a glass eye."
Most importantly, the cancer has not returned or spread elsewhere, which had been a concern. After five years, he will be considered cancer free.
Billie Childress, a registered nurse who works with the gamma knife patients, says ones like Kirschner have a whole life ahead of them thanks to the gamma knife, which she says is a wonderful alternative to having surgery or several weeks of radiation.
Kirschner agrees.
"I really felt like this was my savior," he says.
Choroidal melanoma
Steve Kirschner
Diagnosis: Choroidal melanoma
Definition: According to the National Cancer Institute, intraocular melanoma is a rare disease in which malignant (cancer) cells form in the tissues of the eye.
As in Kirschner's case, most intraocular cancers begin in the middle layer choroid, a layer of blood vessels that brings nutrients and oxygen to the eye.
Symptoms: According to the National Cancer Institute, there often are no early symptoms of intraocular melanoma, as in Kirschner's case. Symptoms that could occur include a dark spot on the iris, blurred vision, a change in the shape of the pupil and a change in vision. Age, sun exposure and having a fair complexion increases one's chances of getting intraocular melanoma. It was only through an eye exam that Kirschner's tumor was discovered.
Physicians/Treatment Team: Dr. Robert Woodburn, a radiation oncologist at The Methodist Hospitals. The entire team included Registered Nurse Billie Childress as well as a physicist, neuroradiologist, neurological surgeon and ophthalmologist.
Treatment: Woodburn says he would have used radioactive plaque bracytherapy, the typical treatment for intraocular tumors, but the location of Kirschner's tumor made that impossible -- the device would be bumping the optic nerve. In a case like this, removing the eye is usually the only option. But since Methodist Hospitals has a gamma knife, the most precise radio surgery device in the world, doctors decided to use this procedure -- typically used for brain lesions -- for Kirschner's eye, a challenging task. The procedure involves delivering 201 high-powered beams of radiation with pinpoint accuracy to the tumor while keeping the surrounding tissue intact.
What you should know: Because there were no symptoms to warn him he might have eye cancer, and because a routine eye exam is so quick and painless, Kirschner emphasizes that everyone should have their eyes examined with an experienced ophthalmologist. He also says the cancer likely was sun-related, so wearing sunglasses that wrap around, blocking out the sun on the sides as well, is a smart move, especially for those with light-colored eyes and skin.
"I think it happened to me for a reason," he says. "The reason is to tell people. The reason is to be a walking advertisement for telling people about skin cancer and taking care of your eyes."
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