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The importance of a team approach to research in ophthalmology
EDITORIAL
The importance of a team approach to research in ophthalmology "\"X Jhat do Lance Armstrong and Saku Koivu have in
VV common? Let's start with Armstrong. In October 1996 the top-ranked cyclist in the world was forced off his bike in excruciating pain. Tests revealed advanced testicular cancer that had spread to his lungs and his brain. He underwent two operations in the ensuing weeks: removal of the malignant testicle and then brain surgery to remove the cancer that had spread upward. Five months later he resumed riding and training. In 1998 he celebrated victory over cancer. By 1999 he was back in top form, and he has gone on to win three more Tour de France events. Saku Koivu's story is just as remarkable. In September 2001, while on a flight back from Finland, the otherwise healthy Koivu suffered abdominal pains and general discomfort. Tests revealed that the Montreal Canadiens captain had non-Hodgkin's (Burkitt's) lymphoma. Seven months later Koivu returned to the ice, to an unprecedented standing ovation. He has been cancer-free since, and his performance on the ice has been as spectacular as ever. These two individuals have several things in common. They are both cancer survivors who benefited immensely from recent advances in diagnosis and treatment of their particular conditions. They both benefited from a team approach to their diseases; the teams of specialists included surgeons, oncologists, pathologists and nurses, to name a few. Moreover, they both returned to professional athletics and have since performed at the highest level. On top of all this, they have both established charitable foundations that sponsor research in the diagnosis and treatment of cancer. Having gone through the process themselves, they are aware of how many different specialists are involved in the diagnosis and treatment of each case. They also know that it was only through years of research that the treatments they benefited from were available to them. In ophthalmology there are numerous examples of the importance of research and the team approach in diagnosing and treating ocular conditions. It is crucial that departments of ophthalmology and visual science Can J Ophthalmol 2003;38:45 I
Research in ophthalmology-Bumier
continue to support a collaborative approach to research, including intra- and interdepartmental research programs. The ocular melanoma story is a great example of proof that without a collaborative approach to research it is not possible to achieve our goals. Ophthalmologists and ocular pathologists learned about prognostic factors in ocular melanoma, such as size of the tumour, cell type and extraocular extension, during the first stage of researching this particular tumour. More recently we have learned that it is virtually impossible to understand the mechanisms in the development of ocular melanoma without understanding the immunologic mechanisms involved. We came to this conclusion only when we included on our research team immunologists, molecular biologists and oncologists with a great deal of experience in the study of skin melanoma. In fact, ophthalmologists and dermatologists dedicated to the study of melanoma should share animal models, in-vivo and in-vitro techniques, and imaging technology to discover the pathological mechanisms involved in this lethal condition. Ocular oncologists have come to the conclusion that the local treatment of an ocular melanoma is far from sufficient to avoid spread of the disease. Studies have proven that circulating malignant cells, the intra- and extravascular matrix, and immunologic reactions need to be researched in order for us to understand the establishment of liver metastasis, which ultimately leads to the death of our patients. Straatsma and colleagues 1 recently concluded that "to increase long-term survival, there is a need to combine ocular treatment of choroidal melanoma with measures to detect and treat micrometastatic disease." The diagnosis and treatment of several ocular diseases, including melanoma, should not be restricted to the ocular manifestations of those conditions. Moreover, ophthalmology needs contributions from other departments and programs - the team approach to research- to fulfil its goals in the diagnosis and treatment of ocular diseases.
Miguel N. Burnier, Jr., MD, PhD Editor-in-Chief REFERENCE
1. Straatsma BR, Diener-West M, Caldwell R, Engstrom RE; Collaborative Ocular Melanoma Study Group. Mortality after deferral of treatment or no treatment for choroidal melanoma. Am J Ophthalmo/2003;136:47-54 Fran.;;ais
a Ia page 453
451
The importance of a team approach to research in ophthalmology "\"X Jhat do Lance Armstrong and Saku Koivu have in
VV common? Let's start with Armstrong. In October 1996 the top-ranked cyclist in the world was forced off his bike in excruciating pain. Tests revealed advanced testicular cancer that had spread to his lungs and his brain. He underwent two operations in the ensuing weeks: removal of the malignant testicle and then brain surgery to remove the cancer that had spread upward. Five months later he resumed riding and training. In 1998 he celebrated victory over cancer. By 1999 he was back in top form, and he has gone on to win three more Tour de France events. Saku Koivu's story is just as remarkable. In September 2001, while on a flight back from Finland, the otherwise healthy Koivu suffered abdominal pains and general discomfort. Tests revealed that the Montreal Canadiens captain had non-Hodgkin's (Burkitt's) lymphoma. Seven months later Koivu returned to the ice, to an unprecedented standing ovation. He has been cancer-free since, and his performance on the ice has been as spectacular as ever. These two individuals have several things in common. They are both cancer survivors who benefited immensely from recent advances in diagnosis and treatment of their particular conditions. They both benefited from a team approach to their diseases; the teams of specialists included surgeons, oncologists, pathologists and nurses, to name a few. Moreover, they both returned to professional athletics and have since performed at the highest level. On top of all this, they have both established charitable foundations that sponsor research in the diagnosis and treatment of cancer. Having gone through the process themselves, they are aware of how many different specialists are involved in the diagnosis and treatment of each case. They also know that it was only through years of research that the treatments they benefited from were available to them. In ophthalmology there are numerous examples of the importance of research and the team approach in diagnosing and treating ocular conditions. It is crucial that departments of ophthalmology and visual science Can J Ophthalmol 2003;38:45 I
Research in ophthalmology-Bumier
continue to support a collaborative approach to research, including intra- and interdepartmental research programs. The ocular melanoma story is a great example of proof that without a collaborative approach to research it is not possible to achieve our goals. Ophthalmologists and ocular pathologists learned about prognostic factors in ocular melanoma, such as size of the tumour, cell type and extraocular extension, during the first stage of researching this particular tumour. More recently we have learned that it is virtually impossible to understand the mechanisms in the development of ocular melanoma without understanding the immunologic mechanisms involved. We came to this conclusion only when we included on our research team immunologists, molecular biologists and oncologists with a great deal of experience in the study of skin melanoma. In fact, ophthalmologists and dermatologists dedicated to the study of melanoma should share animal models, in-vivo and in-vitro techniques, and imaging technology to discover the pathological mechanisms involved in this lethal condition. Ocular oncologists have come to the conclusion that the local treatment of an ocular melanoma is far from sufficient to avoid spread of the disease. Studies have proven that circulating malignant cells, the intra- and extravascular matrix, and immunologic reactions need to be researched in order for us to understand the establishment of liver metastasis, which ultimately leads to the death of our patients. Straatsma and colleagues 1 recently concluded that "to increase long-term survival, there is a need to combine ocular treatment of choroidal melanoma with measures to detect and treat micrometastatic disease." The diagnosis and treatment of several ocular diseases, including melanoma, should not be restricted to the ocular manifestations of those conditions. Moreover, ophthalmology needs contributions from other departments and programs - the team approach to research- to fulfil its goals in the diagnosis and treatment of ocular diseases.
Miguel N. Burnier, Jr., MD, PhD Editor-in-Chief REFERENCE
1. Straatsma BR, Diener-West M, Caldwell R, Engstrom RE; Collaborative Ocular Melanoma Study Group. Mortality after deferral of treatment or no treatment for choroidal melanoma. Am J Ophthalmo/2003;136:47-54 Fran.;;ais
a Ia page 453
451