A few years ago, after examining two tiny lesions in the back of a 7-year-old girl’s eye, Miguel Materin, MD, asked the patient’s mother if there was a family history of colon cancer. As an ocular oncologist, he was trained to recognize familial adenomatous polyposis, a condition that can involve a combination of retinal lesions and multiple polyps in the colon that can lead to colon cancer. “Her mother turned pale,” he said. “I will never forget the look on her face.” It turned out both she and her mother had colon cancer at a young age.
According to Dr. Materin, the main difference between ophthalmology in general and ophthalmic oncology is that while the ophthalmologist’s first goal is to preserve vision, the oncologist’s primary concern is to save the patient’s life.
The most common primary intraocular cancer in adults, for example, is melanoma. “We know that melanoma of the eye is a systemic disease, not just an eye problem,” he said. He regularly collaborates with radiation oncologists, colleagues from the Yale Melanoma Program, medical oncologists, neurosurgeons, pediatric oncologists and colleagues in his own practice to treat patients.
To treat ocular melanoma, Dr. Materin usually relies on a combination of laser therapy and plaque brachytherapy, a radiation treatment in which he sutures a small disc-shaped plaque containing radioactive material to the surface of the eye over the tumor. After a few days, the plaque is removed and the patient can go home. At Yale, the standard of care for this disease also involves cytology analysis, cytogenetic analysis and culturing the lesion. The cytogenetic analysis reveals the genetic mutations involved in each tumor, which helps Dr. Materin and his colleagues determine the prognosis and how to keep the disease under control.
Yale is one of only a few institutions that culture melanoma tumors, allowing for whole genome sequencing. “It’s a huge investment for the future,” said Dr. Materin, who believes that one day ocular melanoma may be treated using radiation along with medications developed to control the enzymatic alterations caused by genetic mutations.
The most common childhood intraocular cancer is retinoblastoma. As an example, Dr. Materin has been treating a young patient since he was 5 months old, who was found to have tumors in both eyes more than a year ago. The survival rate for retinoblastoma is now 95 percent in developed countries, and like the majority of children with this disease, Dr. Materin’s patient is doing well.
Born and raised in Argentina, Dr. Materin became interested in ocular oncology while he was working there as a retina specialist. He came to the United States for a fellowship, returned to Argentina for less than two years, then came back and never left.
He is the only ocular oncologist at Yale who treats intraocular tumors, and his patients hail from across the state, region and even abroad. Yet he manages to see them all quickly—he’ll try to see babies within 24 hours—because he understands the anxiety the families go through. “The rule is that every new patient with an eye tumor should be seen in our oncology clinic within a week.” he said.
Name: Miguel A. Materin, MD
Title: Assistant professor of ophthalmology and visual science; director of ophthalmic oncology
Area of expertise: Ophthalmic oncology
Place of birth: Buenos Aires, Argentina
College: University of Buenos Aires
Med School: University of Buenos Aires
Training: Residency in ophthalmology at Santa Lucia Hospital, Buenos Aires; retina fellowship at Consultores Oftalmológicos, Buenos Aires; fellowship in ocular oncology at Wills Eye Hospital at Thomas Jefferson University
Family: Wife: Sonia; Children: Ari, 24, Jessica, 20, Tommy, 19, and Paula, 12
What is most challenging to you in academic medicine? These days to be a doctor in an academic medical center you need to both teach medical students and treat patients with serious conditions and also find a way to combine these two things.
What is most rewarding? In general, the patients I see feel they are strange because these diseases are so rare. So helping these patients is very rewarding. They feel comforted because we treat them like any other patient in any other specialty.
What do you like most about your practice? Sharing the happiness of my patients. For example, retinoblastoma in babies has a 95 percent cure rate. Many times we treat young babies less than 2 years old and see them every month. We’re so pleased to see them grow.
Personal interests or pastimes: Sharing time with my family, basketball
Last book read: ¿Que Les Paso? (What Happened to Them?) by Ernesto Tenembaum
What would you do to improve our clinical environment if you had a magic wand? I would eliminate bureaucracy—it decreases efficiency.