Last week I completed my third and hopefully final laser treatment on my right eye. I also completed my first post-diagnosis mets screening without a problem. Just like last time, the whole affair was brief and rather painless. After an ultrasound and some dilating and numbing eye drops, I sat down in a chair and stared straight ahead. You know how people often tell you never to stare straight into a laser pointer? Well...Anyhow, once again I opted to forego the local anesthesia--and it was fine, it hurt a tad more than last time, but probably on par with a dental cleaning. After four minutes of lasering I was done. I return to MSKCC for a checkup in April to assess whether a possible fourth lasering would need to be done to further break up scar tissue. My doctors were once again very, very positive and told me to "get on with life and put this behind me." It's important to take time to celebrate the victories and this feels pretty good.

After my initial radiation and laser treatments in May, yesterday I had a second laser treatment on my right eye. It was a brief affair. After an ultrasound, some retinal photos and some dilating and numbing eye drops, I sat down in a chair and stared straight ahead. Zap, zap, zap and it was done in a few minutes. I opted out of an injection of local anesthesia as it would have caused a black eye. To my amazement, I didn't feel a thing during the procedure. My eye did feel scratchy for a few hours and I had a slight headache after, but when I woke up this morning it was as if nothing was done. I go back in November (at the six month from initial treatment mark) for the third and final lasering. The doctors said everything looks great and my vision in my right eye is still very good to boot.

Today I met with my Imerman Angels buddy (who I'll use a pseudonym for), Bill, for the first time. Like me, Bill was diagnosed with his chorodial melanoma under the age of 40, which makes us unusual. Bill had his affected eye enucleated (removed) due to the tumor size so he didn't go through the same radiation treatment that I did, but nonetheless we shared very similar experiences. Both of our stories began with slight to moderate visual changes which just seemed annoying at first since we were both working very hard when this all took place. Fortunately for Bill, his optometrist spotted his tumor immediately and rang the alarm (and didn't bungle around like my original opthamologists in Chicago). I was surprised to learn from Bill that the enucleation process wasn't as terrible as I thought it might have been. In fact, he said he could have been back to work in just six days, but of course he took off longer as A) you never want to push your boundaries on these things and B) the psychological impact is immense and takes time to process. Much of our conversation then focused on the pyschological impact of our condition. Chorodial melanoma is a bit of an orphaned cancer at about a 6 per 1,000,000 incidence. Most people don't even know that cancers can occur in the eye. Public awareness is near zilch which complicates both realizing you have it and explaining you have it. In my case, I tell people I had it treated with radiation. In Bill's case, he says he had his eye removed. The general reaction is usually "So things are fine now?" or "So it's cured?" Unfortunately, as you, the educated reader, probably know, cancer isn't that simple. No one is every fully "cured." It's just that the longer you go without a recurrence or metastatic (spreading) occurrence, the further out you get on the bell curve toward it being unlikely that the cancer reappears locally or remotely. (Five and fifteen year marks are key for chorodial melanoma.) We both have also noted one other thing which is that people often ask a lot of questions about our vision and very few questions about the cancer. I don't think this is just people being polite or feeling uncomfortable. I think if it were another form of cancer the questions would center around the cancer. It's not that vision isn't important (it is--believe me, Bill and I are both very protective of our good eyes), it's just that, well, vision comes second to being alive. It was great meeting Bill and his story is inspiring to me. He's got a wife, a kid, a high-powered job and he's kicking cancer's butt. I thank Imerman Angels immensely for the opportunity to be paired with him. One other side note. I've noticied Imerman isn't really fully technologically enabled. I think it would be useful if all members could have a blog and Imerman became this powerful network of connected blogs. Imerman could also curate and feature the stories. If the blogs did well perhaps it could be like the TripAdvisor of cancer blogs where the content becomes highly ranked in Google and useful resources for anyone searching for a specific cancer-type. This could add a much needed human element and complement to all those Wikipedia and WebMD search results found by recently diagnosed patients and family members. (I am thinking my buddy Sachin's company Posterous.com would be a good match.)

I had my 1-month check up with one of my surgeons from MSK today and it went well! The doctors took an ultrasound and some retinal images and could see that tumor is responding how we wanted it to the radiation treatment; the tumor stopped growing and shrank from 2.7mm to 2.2mm in diameter. That's good. The goal isn't for it to disappear. It will probably go to 2.0mm in the long run. The radiation killed it and it is now turning into scar tissue and shrinking as that occurs. That means I am in the 97% of good outcomes for initial treatment and local remission which is good. The doctor also said my eye is healing "phenomenally" well and everything looks "perfect" thus far. The eye is still bright red from a burst vessel but that's OK and it is healing. My vision out of my right is still not perfect as I have a decent sized blind spot, some blurriness and some distortion. However it sounds like the blurriness and distortion may get better over the next six months, though things may get worse again in about 18 monts as the radiation has lasting effects on the retina. On the bright side though, it is absolutely amazing how well the brain is able to adaptively respond to eye trauma. My brain is actively taking the good feed from my left eye and stitching it together with the best parts of my vision from my right eye (mostly peripheral). I hardly notice the change except in certain circumstances. It goes to show how the brain can adapt, even long after childhood Ahh...yeah..so Mr. Kurzweil, I think it's going to be a lot longer before we reach the Singularity than you think. Our brains are way more bad ass computers than you can imagine until something like this actually happens to you.

Video from the 2009 walk. I just completed my first cancer walk with Sally. It was the 17th Annual Cancer Survivors' Celebration & Walk held by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. It was held in Grant Park Chicago, today June 6th, National Cancer Survivors Day. Sally commented how powerful it was to see folks of all ages and backgrounds at the event--cancer affects us all. It was a terrific event and the sun was shining making Chicago feel like the best city on earth. I also met the founders of Imerman Angels, which is a fantastic cancer support network that was founded in Chicago. I plan on becoming involved.

A recent photo of the author

THE FACTS.

I was recently diagnosed with a tumor, known as a choroidal melanoma, in the back of my right eye. The tumor likely started off as a benign nevus (a mole that is common in the back of the retina) but then started growing. Last week I underwent treatment at Memorial Sloan-Kettering Cancer Center (MSK) where radioactive seeds were placed on a small metal plaque and sutured onto the back of my eye for three days. The plaque was then removed in a second surgery and the tumor was also blasted with a laser. Everything went as planned. The tumor was large enough for treatment to be the recommended course, but small enough to be on the very earliest and smallest side that such treatments are used. I will follow up with the doctors in four weeks and also every six months. There was very little pain associated with the treatment. The outside of my right eye is black and blue in the corners of the eyelid and the eye itself is quite red. It looks like I got socked in the eye. I also have some blurry and double vision which should go away within a few weeks. Overall though, a miracle of science considering how good I feel. I have asked the doctors if any superpowers, including but not limited to monocular x-ray vision, might ensue. I haven't gotten a straight answer yet, but I have my suspicions.

HOW WAS THE TUMOR DETECTED?

I had started noticing increased floaters in my vision and then some flashing lights some months ago. I couldn't determine if the source of the symptoms was an eye, neurological or neuro-opthamological, given that the symptoms emanated from the exact center of my vision and the flashing lights appeared in the same spots even when I closed either eye. At first my doctors thought it was an ocular migraine, given my past medical history of migraines. Next, I went to an opthamologist, but they failed to see the tumor in a visual inspection of my eyes using glass lenses. To make a very long story short--after my insistence they eventually found the tumor after taking some photographs of my retinas and doing a computerized "visual field test" and noticing I was developing a blind spot in my right eye. That prompted other tests including an ultrasound of the eye which verified that the area of concern was malignant. (Biopsies are not performed. Ultrasound radio signatures are 98%+ accurate.) The floaters and flashing lights were caused by the tumor pushing up and detaching an area of the retina, which turned out to be a fortunate occurence. Many choroidal melanomas are asymptomatic and thus are not detected until it's late. All in, I am doing very well and looking to return to school just a few short weeks after formal treatment commenced. My fantastic doctors from MSK assure me that given the size and stage of my tumor, along with my relatively young age, my prognosis is extremely good. The probabilities are very, very much on my side. Nonetheless, it has been an intense and scary experience that quickly reminds one of what's important in life.

ADVICE.

It's amazing how many little things in life seem important until something potentially catastrophic slaps you in the face. All of a sudden you push everything off your calendar and spend your time with family and friends. Things that seemed so important and necessary reveal themselves as un*. Take a moment to evaluate your own life through this lens. You'd probably spend more time with your family and friends. Going through this process has radically changed my perceptions of healthcare. In the future, I will be writing about the insights I have gained from this experience. My immediate advice to you is, of course, to get your eyes examined once a year (and get photos of your retinas while you are at it--I wouldn't trust the lenses) and be your own advocate when it comes to your health. Doctors these days are often so jaded by other patients' hypochondriac complaints and internet-inspired patient paranoia that they dismiss real symptoms. If you are experiencing real and tangible symptoms that worry you, don't let up without exploring your options. It just might save your life. It probably saved mine.