Eyeworld

Reporting from the WIO Summer Symposium, August 11–14, 2016, Williamsburg, Virginia Sponsored by EW MEETING REPORTER 124 September 2016 melanoma. She uses a mnemonic "To Find Small Ocular Melanoma Using Helpful Hints Daily." First, there would be thickness greater than 2 mm. You're also looking for fluid, symptoms, orange pigment, and a margin of less than or equal to 3 mm to disc. Ultrasound hollow, absent halo, and absent drusen are also signs. The lecture highlighted new therapies and ways to treat mela- noma, which Dr. Shields said is im- portant to do when the melanoma is especially tiny so you don't end up having to give bad news to these patients later on. There are new systemic ther- apies, like molecular pathway inhibi- tion and immune modulation, she said. Dr. Shields also highlighted a novel focal targeted treatment from Aura Biosciences (Boston). This new viral-like nanoparticle binds selec- tively to the tumor. It's coupled with a photosensitive drug to enhance the laser effect. This new nanoparti- cle has so far shown to be effective in rabbits, she said. Dr. Shields also mentioned the new Ocular Oncology Reading Center of America, a resource being launched in October 2016 where images can be uploaded if surgeons need help differentiating between a nevus and a melanoma. Editors' note: Dr. Shields has financial interests with Aura Biosciences. Practice management During the practice management session, topics like surviving the SGR fix bill, electronic medical records, marketing, patient satisfaction, and starting a new practice were dis- cussed. Tami Burke, Norfolk, Virginia, an American Society of Ophthal- mic Administrators (ASOA) speaker, discussed marketing, particularly sustainable marketing strategies. She stressed those strategies used at her workplace, Virginia Eye Consultants, where she is the director of market- ing and public relations. She said it's important to deter- mine the best tools and resources to Dr. Pappas also discussed formu- lating an alternative plan. Consid- er the pros and cons of making a move, she said. You can network and reach out to find alternative employment opportunities. Editors' note: The speakers have no financial interests related to their presentations. Memorial Lecture The Bernice Z. Brown Memorial Lecture was given by Carol Shields, MD, Philadelphia. Dr. Shields highlighted uveal melanomas in her lecture, particularly looking at millimeters, microns, DNA, and nanoparticles. In terms of millimeters, size matters, she said. Dr. Shields worked on a study looking at metastasis of uveal melanoma millimeter by millimeter in 8,033 consecutive eyes. Each millimeter increase in thickness adds 5% risk for metastasis at 10 years, she said. "The thinner the tumor, the bet- ter the prognosis," Dr. Shields said. If you don't know if it's a melanoma that you're dealing with, she recom- mended asking a retina colleague to take a look. Metastasis for melanoma is far more than size, she said. Some of it depends on mutations. Dr. Shields offered a tip for the way she identifies risk factors for Overcoming adversity Overcoming adversity was the topic of a panel discussion. It was mod- erated by Dr. Christmann and also featured Regine Pappas, MD, Mel- bourne, Florida, Susan MacDonald, MD, Burlington, Massachusetts, and Iris Kassem, MD, PhD, Milwaukee, Wisconsin. Dr. Pappas discussed some personal experiences in her presen- tation, particularly dealing with an overbearing boss and working in a less-than-ideal environment. Some of the challenges include unrealis- tic work scheduling, unwillingness to compromise, a micromanaging boss, lower pay, and inflexibility. Dr. Pappas, in the past, had a non-ne- gotiable schedule. She also dealt with a large number of patients and as a glaucoma specialist was then expected to deal with any additional patients with high pressure. She offered several strategies for coping. First, she recognized and confronted the problem. She then tried to develop a strategy to try to change the problems that she was facing. She also came up with strat- egies to negotiate and compromise and tried to give the administration at her practice possible solutions. However, in her case, a compromise was unreachable. If this happens, she said you ultimately need to develop an exit strategy. View videos from WIO 2016: EWrePlay.org Carol Shields, MD, discusses identifying and treating melanomas.

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