London - Kelly Luff was taking her children to the opticians for a check-up when it occurred to her to book herself in, too.
“My son wears glasses, so I’m often at the opticians, and I thought I’d get a check-up even though my vision has always been fine,” says Kelly, 35, who lives in Stevenage, Hertfordshire, with her partner Danny and their four children: Sam, Louie, Trixabelle and Buddy, who are aged five to 15.
“My last test had been several years before.”
That routine test changed Kelly’s life for ever.
“I’ve always had a tiny visible freckle on the iris in my left eye, and although it didn’t look any different to me, when the optometrist looked at it with a magnifying glass and a light, he said there was something there - a tumour.”
Kelly was told the growth had to be checked to see if it was benign or malignant and she was immediately referred to Moorfields Eye Hospital in London. Tests confirmed she had malignant melanoma of the eye: the freckle in her iris had turned cancerous.
“When we heard this, Danny and I just sat there in shock,” she says.
“We’d gone to the hospital feeling positive. I’d had that freckle all my life and just couldn’t believe this could be anything serious. Eye cancer isn’t something you hear about, so I had no idea what would happen next. I got home and looked online and that’s when I started to feel frightened.”
A malignant melanoma is something most people associate with skin cancer. In fact, a melanoma is defined as where the melanocytes, the cells that make pigment or colouring, become cancerous, and there are melanocytes in the eyes as well as the skin.
Melanoma of the eye is not as strongly associated with sunbathing as skin melanoma; it may be linked to UV light from the sun, but this has not been proven.
People with fair skin and blue or green eyes are more at risk - although it’s not known why - and the risk increases with age.
Having an eye mole or freckle, which are actually clusters of melanocyte cells, can also be a risk factor, explains Victoria Cohen, an oncologist and head of the eye cancer service at Moorfields.
“One in 20 of us has a mole inside the eye, although it may be at the back of the eye and not visible in the mirror,” she says.
“Just like in the skin, some of these moles are more likely to transform into cancer.”
Melanoma of the eye can cause visual disturbances such as a flickering light, blurred vision or a shadow in the vision if the tumour is located near the back of the eye. But, as in Kelly’s case, a third of patients have no symptoms.
“This is why we encourage people to go for a routine eye exam every two years to pick up this kind of problem,” says Cohen.
“The earlier melanoma is detected, the greater the chance of saving the vision and the eye.” Around 600 people are diagnosed with melanoma of the eye in the UK every year and the condition is most common among the over-50s. Cancer Research UK estimates that 84 percent of people diagnosed with early stage eye cancer will live at least five years after diagnosis.
“The success rate for eradicating the tumour is 90 percent,” says Ms Cohen. “We’re good at treating the eye, but the tumour can spread to other parts of the body, and that depends on the severity of the cancer. One of the factors is size at diagnosis.”
Kelly was diagnosed in January 2014 and soon afterwards underwent a targeted type of radiotherapy, known as plaque brachytherapy, where a small plate with radioactive powder on one side is placed directly on to the eyeball, like a contact lens.
This delivers a concentrated dose of radiotherapy on to the tumour. (If the tumour is large, the first option is usually surgery.) The plate, about the size of a penny, is made from lead and silver to stop the radioactive powder damaging the eyelid.
The patient must remain in a hospital room while they have the treatment, and visitors can stay only for a set period of time as a precaution because of the radiation that is released.
The treatment usually takes three to four days, depending on the size of the tumour, with the radioactive disc left on for the entire time.
“They sewed the plate on to my eyeball under general anaesthetic,” recalls Kelly. “When I came round, it was really painful. It was left on for four days and I took painkillers throughout. The whole thing was very strange.”
Six months later, tests showed the treatment had worked - the tumour had shrunk significantly. More tests six months on found the tumour had not disappeared completely, but had not grown.
“My doctors are happy,” says Kelly. “The important thing is that it doesn’t grow, because if it spreads it can go into your bloodstream and straight to your liver and then there’s very little they can do.”
The eye and the liver both have a very rich blood supply and so cancer can spread easily from one to another via the bloodstream.
It’s quite normal for the tumour not to go away completely, says Cohen: “It may remain there as a mass of dead cells for ever - but this does not affect vision.
“The first two years are critical. We continue to monitor patients for ten years. But usually, if there has been no recurrence for two years, it’s been successful.”
If the treatment fails to work, it may be tried again, or surgeons may use laser treatment or surgery to remove the tumour, and sometimes the eye.
“Treatments are custom-designed for the patient, depending on the size and location of the melanoma,” says Cohen.
Although the radiotherapy treatment is designed to preserve vision as much as possible, there can be side-effects, including cataracts and changes or loss of vision, because healthy cells in the retina can be damaged.
Kelly now wears glasses and has lost some of her peripheral vision.
She says: “The shape of my eye has changed slightly - it’s more narrow and looks like a lazy eye - and it gets very dry. I also see colours much more brightly than normal in that eye.
“It’s bearable because I know the treatment has killed the cancer. But it’s the stress of everything that’s been the hardest.
“I’m constantly having scans: every six months they scan my eye and I also have a dermatology check to see if any of the moles on my body look suspicious, and before those tests I always get a little anxious.”
Having eye melanoma is not linked to a raised risk of skin cancer, although there is a rare syndrome linking the two, says Ms Cohen. If it’s present, it tends to occur at an early age.
Kelly was studying for a psychology degree when she was diagnosed, but she decided to give it up because she was advised to avoid stress, which can lower immunity. She has recently started a job in a tea room.
“This is just a nice easy job that keeps me busy.”
Ash Shah, the optometrist who first spotted Kelly’s eye tumour, says it’s vital that people have regular eye checks.
“It’s not just about having your sight checked,” says Shah, a member of the College of Optometrists. “Eye tests also assess the health of the eye and can pick up health problems such as high cholesterol, high blood pressure and diabetes, as well as eye cancers and even brain tumours.”
Adults are recommended to have an eye check every two years, children under 16 every six months and people over 70 every year.
However, few of us follow this advice: a survey by Vision Express found that just over half of adults in the UK visit an optician only every five years, and eight percent have never had a sight test.
Kelly is now keen to raise awareness of this little-known type of cancer and to stress the importance of regular eye checks.
“I think people tend to only go to the optician if there’s a problem. But I had no symptoms at all. Who knows how long the tumour had been sitting there?
“I just hope that reading this will encourage more people to book an appointment.”
Daily Mail