Latest / The Eye Believe Podcast / "Brachytherapy vs. Proton Therapy for Ocular Melanoma: Dr Tara McCannel

Transcript

"Brachytherapy vs. Proton Therapy for Ocular Melanoma: Dr Tara McCannel · The Eye Believe Podcast

• 0:00
  Hey
• 0:00
  everyone
• 0:00
  I am
• 0:01
  Megan
• 0:01
  with
• 0:01
  the eye
• 0:02
  believe
• 0:02
  podcast
• 0:03
  with
• 0:03
  a cure
• 0:03
  in site.
• 0:04
  And
• 0:04
  we have
• 0:04
  a fabulous
• 0:05
  guest
• 0:05
  today.
• 0:05
  We have
• 0:06
  Tara
• 0:06
  McCannel.
• 0:07
  Hi Tara.
• 0:07
  Thanks
• 0:07
  for
• 0:07
  being here.
• 0:09
  Thank you
• 0:09
  so much,
• 0:09
  Megan.
• 0:10
  It's
• 0:10
  a real
• 0:11
  honor
• 0:11
  to be
• 0:11
  part of
• 0:12
  the cure
• 0:12
  in sight
• 0:13
  and
• 0:13
  to share
• 0:14
  what
• 0:14
  I know
• 0:14
  with you.
• 0:16
  We are so excited
• 0:17
  to have
• 0:17
  you share
• 0:17
  what
• 0:18
  you know
• 0:18
  with us.
• 0:21
  So I can
• 0:21
  just
• 0:22
  start.
• 0:22
  I'll just
• 0:23
  jump in
• 0:23
  and just
• 0:24
  introduce myself
• 0:25
  and
• 0:26
  you know
• 0:26
  where I
• 0:27
  come
• 0:27
  from.
• 0:27
  So I'm
• 0:28
  a professor
• 0:29
  of
• 0:29
  ophthalmology
• 0:30
  at the
• 0:30
  University
• 0:31
  of
• 0:31
  California,
• 0:32
  Los
• 0:32
  Angeles,
• 0:32
  at the
• 0:33
  stein eye
• 0:33
  Institute,
• 0:34
  and I'm
• 0:35
  the
• 0:35
  director
• 0:35
  of ocular
• 0:36
  oncology
• 0:37
  and
• 0:38
  excited
• 0:38
  that this
• 0:39
  is
• 0:39
  actually
• 0:39
  my 20th
• 0:40
  year at
• 0:41
  UCLA.
• 0:42
  And,
• 0:43
  I've
• 0:43
  really
• 0:44
  learned
• 0:44
  so much
• 0:45
  about
• 0:46
  what's
• 0:46
  involved
• 0:47
  in
• 0:47
  helping
• 0:48
  people
• 0:48
  who are
• 0:49
  diagnosed
• 0:49
  with
• 0:50
  ocular
• 0:50
  melanoma,
• 0:51
  both in
• 0:51
  treatments,
• 0:52
  but also,
• 0:53
  helping
• 0:53
  to
• 0:54
  disseminate
• 0:54
  information,
• 0:56
  and sort
• 0:56
  of really
• 0:57
  focusing
• 0:57
  a lot
• 0:57
  of our
• 0:58
  academic
• 0:58
  research
• 0:59
  on how
• 1:00
  the more
• 1:01
  you know
• 1:02
  about
• 1:02
  what
• 1:03
  the ocular
• 1:03
  melanoma
• 1:04
  is, why
• 1:05
  you're
• 1:05
  getting
• 1:05
  treated
• 1:06
  a certain
• 1:06
  way,
• 1:07
  and
• 1:08
  better
• 1:08
  understanding
• 1:09
  of the
• 1:09
  cancer
• 1:10
  really
• 1:10
  helps
• 1:11
  people to
• 1:11
  do
• 1:11
  better.
• 1:11
  So I'm
• 1:12
  hoping to
• 1:13
  help
• 1:13
  further
• 1:13
  that
• 1:14
  goal.
• 1:15
  and I
• 1:15
  think
• 1:15
  what
• 1:16
  a cure
• 1:16
  in sight
• 1:17
  does is
• 1:17
  really
• 1:17
  fantastic
• 1:18
  because
• 1:18
  it brings
• 1:19
  all this
• 1:19
  information
• 1:20
  together
• 1:21
  for
• 1:21
  patients.
• 1:23
  So I
• 1:24
  wanted to
• 1:25
  speak
• 1:25
  about,
• 1:26
  what's
• 1:27
  involved
• 1:27
  in
• 1:28
  brachytherapy
• 1:29
  surgery
• 1:30
  and also
• 1:31
  just
• 1:32
  other
• 1:32
  surgery
• 1:33
  and
• 1:33
  procedures
• 1:34
  that can
• 1:34
  happen to
• 1:35
  the eye.
• 1:35
  And,
• 1:35
  Megan,
• 1:36
  please
• 1:37
  interrupt
• 1:37
  me.
• 1:38
  just
• 1:38
  jump in
• 1:38
  if
• 1:39
  there's
• 1:39
  something
• 1:39
  that you
• 1:40
  need me
• 1:41
  to help
• 1:41
  explain
• 1:42
  further,
• 1:42
  I'd
• 1:43
  be more
• 1:43
  than
• 1:43
  happy to
• 1:43
  do that.
• 1:44
  So,
• 1:44
  you know,
• 1:45
  I want
• 1:45
  to.
• 1:45
  We want to
• 1:46
  have this
• 1:46
  as casual
• 1:47
  and easy
• 1:48
  to
• 1:48
  understand
• 1:49
  as
• 1:49
  possible.
• 1:50
  When
• 1:50
  a person
• 1:51
  gets
• 1:51
  treated
• 1:52
  for
• 1:52
  ocular
• 1:52
  melanoma,
• 1:53
  there are
• 1:53
  really
• 1:54
  two major
• 1:56
  categories
• 1:56
  of
• 1:56
  treatment.
• 1:57
  As
• 1:58
  most of
• 1:58
  you know.
• 1:59
  One is
• 2:00
  removal
• 2:00
  of the eye
• 2:01
  or what
• 2:02
  we call
• 2:02
  a
• 2:02
  enucleation,
• 2:04
  and
• 2:04
  the other
• 2:05
  is some
• 2:06
  sort of
• 2:06
  treatment
• 2:06
  to
• 2:06
  the eye
• 2:07
  that saves
• 2:08
  the eye
• 2:08
  and can
• 2:08
  save
• 2:09
  some of
• 2:09
  the
• 2:09
  vision.
• 2:10
  And I'm
• 2:11
  really
• 2:11
  pleased
• 2:12
  that it's
• 2:13
  actually
• 2:13
  becoming
• 2:14
  less
• 2:14
  common
• 2:15
  now for
• 2:15
  patients
• 2:16
  to
• 2:16
  need
• 2:17
  to have
• 2:17
  a
• 2:17
  enucleation,
• 2:18
  because
• 2:18
  we are
• 2:19
  finding
• 2:19
  ocular
• 2:20
  melanoma
• 2:20
  much
• 2:21
  earlier
• 2:22
  than we
• 2:22
  had been,
• 2:23
  even
• 2:24
  when I
• 2:24
  started
• 2:25
  practicing.
• 2:25
  it's it's
• 2:26
  really
• 2:27
  uncommon
• 2:27
  to have
• 2:28
  a person
• 2:28
  whose
• 2:29
  cancer
• 2:29
  has
• 2:29
  gotten
• 2:30
  so
• 2:30
  advanced
• 2:30
  in
• 2:30
  the eye
• 2:31
  that we
• 2:31
  don't
• 2:31
  have
• 2:31
  a lot of options.
• 2:33
  So
• 2:33
  I think,
• 2:34
  you know,
• 2:34
  early
• 2:34
  detection,
• 2:35
  getting
• 2:36
  ocular,
• 2:36
  getting
• 2:37
  just eye
• 2:38
  exams
• 2:38
  where
• 2:39
  you're
• 2:39
  dilated
• 2:40
  and
• 2:40
  you're
• 2:40
  checked.
• 2:41
  and
• 2:41
  also a
• 2:42
  lot of times
• 2:43
  now
• 2:43
  when you
• 2:44
  go to
• 2:44
  a
• 2:44
  health
• 2:45
  care
• 2:45
  officer
• 2:46
  and
• 2:46
  an eye
• 2:47
  care
• 2:47
  provider,
• 2:47
  you
• 2:47
  get these
• 2:48
  photos
• 2:48
  that are
• 2:48
  done.
• 2:49
  And those
• 2:50
  have been
• 2:50
  a really
• 2:50
  excellent
• 2:51
  screening
• 2:51
  tool and
• 2:52
  allow us
• 2:53
  to find
• 2:54
  melanoma,
• 2:54
  the eye
• 2:54
  when it's
• 2:55
  very
• 2:55
  small.
• 2:55
  So
• 2:56
  fortunately,
• 2:57
  it's a,
• 2:57
  it's a
• 2:58
  smaller
• 2:58
  percent
• 2:59
  of
• 2:59
  the people
• 3:00
  who have
• 3:00
  ocular
• 3:00
  melanoma
• 3:01
  that need
• 3:01
  to have
• 3:02
  the
• 3:02
  enucleation.
• 3:04
  And then
• 3:04
  when
• 3:05
  we're
• 3:05
  able to
• 3:05
  save the eye,
• 3:06
  which is
• 3:06
  in
• 3:07
  most of
• 3:07
  the cases,
• 3:08
  we
• 3:09
  the most
• 3:09
  common
• 3:09
  way to
• 3:10
  treat
• 3:10
  ocular
• 3:10
  melanoma
• 3:11
  is using
• 3:11
  some type
• 3:12
  of radiation.
• 3:13
  because
• 3:13
  the radiation
• 3:14
  destroys
• 3:15
  the
• 3:15
  cancer,
• 3:16
  excellently,
• 3:17
  without a doubt.
• 3:18
  I think
• 3:18
  that's
• 3:18
  the one thing
• 3:19
  that
• 3:19
  we're
• 3:19
  very
• 3:20
  certain
• 3:20
  about
• 3:20
  with
• 3:20
  ocular
• 3:21
  melanoma
• 3:21
  is that
• 3:22
  radiation
• 3:23
  will kill
• 3:23
  it.
• 3:24
  And
• 3:25
  there's
• 3:25
  a few
• 3:26
  different
• 3:26
  types
• 3:26
  of
• 3:26
  radiation.
• 3:27
  But
• 3:28
  the most
• 3:28
  common
• 3:29
  type of
• 3:30
  radiation
• 3:30
  treatment
• 3:30
  is when
• 3:31
  people
• 3:31
  have
• 3:32
  what's
• 3:32
  called
• 3:33
  brachytherapy
• 3:34
  plaque
• 3:34
  or when
• 3:35
  they're
• 3:35
  seeds
• 3:35
  of
• 3:35
  radiation
• 3:36
  in a carrier,
• 3:37
  which is
• 3:38
  like this
• 3:38
  disc that
• 3:38
  gets
• 3:39
  placed
• 3:39
  on the
• 3:39
  outside
• 3:40
  of
• 3:40
  the eye
• 3:40
  behind
• 3:41
  where
• 3:41
  the tumor
• 3:42
  is.
• 3:42
  That's
• 3:42
  the most
• 3:43
  common
• 3:43
  way that
• 3:44
  radiation
• 3:44
  is, is
• 3:45
  given,
• 3:46
  a second
• 3:46
  way that
• 3:47
  radiation
• 3:47
  is given
• 3:48
  is what
• 3:48
  we call
• 3:49
  proton
• 3:49
  beam
• 3:50
  therapy.
• 3:50
  And
• 3:51
  there are
• 3:51
  far fewer
• 3:52
  centers
• 3:53
  that
• 3:53
  offer
• 3:53
  this
• 3:53
  treatment.
• 3:54
  But
• 3:54
  it involves
• 3:55
  radiation,
• 3:55
  so can be
• 3:57
  also
• 3:57
  successful
• 3:58
  at
• 3:58
  treating
• 3:58
  the
• 3:58
  melanoma.
• 4:00
  in terms
• 4:00
  of just
• 4:00
  talking
• 4:01
  about
• 4:01
  what
• 4:01
  happens
• 4:02
  in these
• 4:02
  surgeries.
• 4:03
  I want to
• 4:03
  talk
• 4:04
  about,
• 4:04
  you know,
• 4:04
  in terms
• 4:05
  of
• 4:05
  enucleation.
• 4:06
  if
• 4:06
  a person
• 4:07
  needs to
• 4:07
  have
• 4:07
  enucleation,
• 4:08
  this can
• 4:08
  definitely
• 4:09
  be very
• 4:10
  traumatic
• 4:10
  because
• 4:11
  you're
• 4:11
  like,
• 4:12
  you're
• 4:12
  losing
• 4:12
  an organ.
• 4:13
  It's like
• 4:14
  losing
• 4:14
  a limb.
• 4:15
  And it's
• 4:16
  the
• 4:17
  difficult
• 4:17
  the most.
• 4:17
  The
• 4:18
  difficult
• 4:18
  thing
• 4:18
  about it
• 4:19
  is
• 4:19
  sort of
• 4:19
  getting
• 4:19
  over
• 4:20
  the shock
• 4:20
  of
• 4:21
  having to
• 4:22
  go
• 4:22
  through
• 4:22
  this
• 4:22
  where
• 4:22
  your eye
• 4:23
  is
• 4:23
  taken
• 4:23
  out.
• 4:24
  however,
• 4:25
  I think
• 4:26
  it's
• 4:26
  important
• 4:26
  to
• 4:26
  understand
• 4:27
  that if
• 4:29
  the enucleation
• 4:29
  is
• 4:29
  required
• 4:30
  because
• 4:31
  everything
• 4:32
  is too
• 4:32
  big,
• 4:33
  there's not
• 4:33
  much
• 4:33
  vision
• 4:34
  in the eye
• 4:34
  and
• 4:35
  there's
• 4:35
  not
• 4:35
  really
• 4:35
  anything else
• 4:36
  we can
• 4:36
  do.
• 4:37
  it is
• 4:38
  far more
• 4:38
  straightforward
• 4:39
  and kind
• 4:40
  of makes
• 4:41
  a lot
• 4:41
  more
• 4:41
  sense
• 4:41
  than
• 4:42
  really
• 4:42
  doing
• 4:42
  everything
• 4:43
  possible
• 4:44
  to try
• 4:44
  to save
• 4:44
  the eye,
• 4:45
  to try
• 4:45
  to radiate
• 4:46
  and then
• 4:47
  see if
• 4:47
  we can
• 4:47
  keep
• 4:48
  anything.
• 4:49
  Because
• 4:50
  enucleation
• 4:50
  is a very
• 4:51
  simple
• 4:52
  surgery.
• 4:53
  You have
• 4:53
  an operation
• 4:54
  that's
• 4:55
  about an hour.
• 4:56
  they
• 4:57
  they're able
• 4:57
  to
• 4:58
  replace
• 4:58
  the globe,
• 4:59
  which is
• 5:00
  the eyeball
• 5:01
  with
• 5:01
  like a
• 5:01
  silicone
• 5:02
  ball
• 5:02
  that fills
• 5:03
  the space.
• 5:03
  After
• 5:04
  a couple
• 5:04
  weeks of
• 5:05
  healing,
• 5:06
  you can get
• 5:06
  fitted
• 5:06
  with the
• 5:07
  prosthesis
• 5:08
  that
• 5:08
  looks
• 5:09
  incredibly
• 5:10
  lifelike.
• 5:12
  and we
• 5:12
  call this
• 5:12
  sort
• 5:12
  of the
• 5:13
  artificial
• 5:13
  eye.
• 5:14
  But
• 5:14
  really,
• 5:14
  it's
• 5:14
  like a
• 5:15
  jumbo
• 5:15
  contact
• 5:15
  lens that
• 5:16
  goes in
• 5:16
  place,
• 5:17
  and
• 5:18
  it's very
• 5:18
  low
• 5:18
  maintenance.
• 5:19
  We have
• 5:20
  this idea
• 5:20
  that
• 5:21
  if you
• 5:21
  have
• 5:21
  to have a
• 5:21
  fake eye,
• 5:22
  you have to
• 5:23
  take it
• 5:23
  out
• 5:23
  every night
• 5:24
  and
• 5:24
  put it
• 5:24
  by your
• 5:25
  bedside
• 5:25
  table.
• 5:26
  And I
• 5:26
  don't
• 5:26
  know
• 5:27
  where
• 5:27
  this
• 5:27
  notion
• 5:27
  came
• 5:28
  from,
• 5:28
  but
• 5:28
  everybody
• 5:28
  assumes
• 5:29
  that
• 5:29
  that's
• 5:29
  what
• 5:30
  what's
• 5:30
  involved.
• 5:31
  But
• 5:31
  really
• 5:32
  it's very
• 5:33
  low
• 5:33
  maintenance.
• 5:34
  You might
• 5:34
  only have
• 5:35
  it
• 5:35
  removed
• 5:36
  a couple
• 5:36
  times
• 5:37
  a year
• 5:37
  for
• 5:37
  polishing
• 5:38
  and fitting,
• 5:39
  and then
• 5:39
  you just
• 5:40
  leave it
• 5:40
  in there
• 5:41
  and carry
• 5:41
  on.
• 5:42
  And I've
• 5:43
  just been
• 5:43
  impressed
• 5:44
  with the
• 5:44
  artistry
• 5:45
  of the
• 5:45
  Ocularist
• 5:46
  who
• 5:47
  actually
• 5:47
  build
• 5:47
  and
• 5:47
  create
• 5:48
  these
• 5:48
  prosthesis
• 5:49
  And I
• 5:50
  have been
• 5:50
  at the
• 5:51
  microscope
• 5:51
  in the exam
• 5:52
  room and
• 5:52
  looking
• 5:52
  at the
• 5:53
  artificial
• 5:53
  eye
• 5:54
  thinking,
• 5:54
  whoops,
• 5:54
  this is the wrong eye
• 5:56
  because
• 5:56
  it's so
• 5:57
  good.
• 5:57
  And until
• 5:57
  you see
• 5:58
  it under
• 5:58
  close
• 5:59
  magnification,
• 5:59
  you can tell
• 6:00
  that it's
• 6:01
  not
• 6:01
  really
• 6:02
  the
• 6:02
  real thing.
• 6:03
  So very
• 6:04
  straightforward.
• 6:05
  And
• 6:05
  sometimes
• 6:05
  when
• 6:05
  people
• 6:06
  are
• 6:06
  diagnosed
• 6:06
  with a
• 6:07
  really
• 6:07
  large
• 6:08
  ocular
• 6:08
  melanoma,
• 6:09
  there can also
• 6:10
  be pain
• 6:11
  associated
• 6:12
  with it.
• 6:12
  And once
• 6:13
  the eyes
• 6:14
  removed,
• 6:14
  all that
• 6:15
  pain and
• 6:15
  discomfort
• 6:16
  immediately
• 6:17
  goes away.
• 6:18
  And so
• 6:19
  it allows
• 6:19
  you
• 6:19
  to just
• 6:20
  carry on
• 6:20
  and not
• 6:21
  have this
• 6:21
  drag
• 6:22
  on your eye.
• 6:23
  And
• 6:23
  I know
• 6:24
  that
• 6:24
  sometimes
• 6:24
  when
• 6:25
  people
• 6:25
  have a
• 6:25
  very
• 6:26
  large
• 6:26
  melanoma
• 6:26
  that is
• 6:27
  treated
• 6:27
  with
• 6:27
  radiation
• 6:28
  in an
• 6:28
  attempt
• 6:29
  to save
• 6:29
  the eye,
• 6:29
  sometimes
• 6:30
  there
• 6:30
  can be
• 6:30
  this
• 6:31
  prolonged
• 6:31
  period of
• 6:32
  a lot
• 6:33
  of
• 6:33
  discomfort
• 6:34
  because
• 6:34
  there's
• 6:34
  so much
• 6:35
  tissue
• 6:35
  that was
• 6:36
  damaged
• 6:36
  with the
• 6:36
  radiation
• 6:37
  treatment
• 6:38
  because
• 6:38
  things
• 6:38
  were
• 6:38
  so big
• 6:39
  and
• 6:39
  there can be
• 6:40
  sort of
• 6:40
  this
• 6:40
  ongoing,
• 6:41
  painful
• 6:42
  period
• 6:43
  until the
• 6:44
  person
• 6:44
  may
• 6:44
  eventually
• 6:45
  need
• 6:45
  enucleation.
• 6:46
  So
• 6:46
  I think
• 6:47
  if it's
• 6:47
  recommended
• 6:48
  that
• 6:48
  enucleation
• 6:49
  is
• 6:49
  the best
• 6:50
  hope
• 6:51
  for
• 6:52
  getting
• 6:52
  through
• 6:52
  this,
• 6:52
  and
• 6:53
  treatment
• 6:53
  it is
• 6:53
  a very
• 6:54
  straightforward
• 6:55
  procedure,
• 6:55
  and
• 6:56
  a lot of
• 6:57
  it is
• 6:57
  just
• 6:57
  understanding
• 6:58
  what's
• 6:58
  involved.
• 7:00
  you're
• 7:00
  100%
• 7:01
  right.
• 7:01
  Some of the prosthetics
• 7:03
  look so
• 7:03
  good,
• 7:04
  you
• 7:04
  really
• 7:04
  cannot
• 7:05
  tell.
• 7:06
  And, it's
• 7:07
  just it's
• 7:07
  really,
• 7:08
  really
• 7:08
  impressive.
• 7:11
  Yeah.
• 7:11
  I don't
• 7:11
  know how
• 7:12
  they,
• 7:13
  the ocularist
• 7:14
  do
• 7:14
  the work
• 7:14
  they do,
• 7:15
  but,
• 7:16
  you know,
• 7:16
  basically
• 7:16
  they take
• 7:17
  a lot
• 7:17
  of photos
• 7:17
  of your
• 7:18
  other
• 7:18
  eye, and
• 7:19
  just
• 7:20
  create
• 7:20
  this, and
• 7:21
  it's
• 7:21
  just,
• 7:21
  it's very
• 7:22
  difficult
• 7:23
  to tell,
• 7:23
  if
• 7:24
  this is
• 7:24
  your eye
• 7:25
  or not,
• 7:25
  and
• 7:25
  people
• 7:25
  don't
• 7:26
  have to
• 7:26
  walk
• 7:26
  around
• 7:27
  wearing
• 7:27
  a black
• 7:28
  patch
• 7:28
  for
• 7:28
  the rest
• 7:29
  of their
• 7:29
  life,
• 7:29
  I think
• 7:30
  that's
• 7:30
  another
• 7:31
  image
• 7:32
  that
• 7:32
  comes
• 7:32
  to mind.
• 7:33
  we have
• 7:33
  really
• 7:33
  great
• 7:34
  ways
• 7:34
  of
• 7:35
  helping
• 7:36
  make
• 7:36
  people
• 7:37
  look,
• 7:37
  as they
• 7:38
  should,
• 7:38
  you know,
• 7:38
  as normal
• 7:39
  as
• 7:39
  possible
• 7:40
  after
• 7:40
  this
• 7:40
  sort of a
• 7:41
  sort of
• 7:41
  a
• 7:41
  procedure.
• 7:43
  the fact
• 7:43
  that they
• 7:43
  can
• 7:44
  match it
• 7:44
  to your
• 7:44
  other
• 7:44
  eye, it's
• 7:46
  really
• 7:46
  just it
• 7:47
  blows
• 7:47
  your mind
• 7:48
  how
• 7:48
  the artistry
• 7:49
  and the
• 7:50
  talent
• 7:50
  that
• 7:50
  goes into
• 7:51
  creating that.
• 7:51
  But
• 7:51
  they really
• 7:52
  are
• 7:52
  beautiful.
• 7:53
  Yeah.
• 7:54
  I think
• 7:54
  that's a
• 7:54
  that's a
• 7:55
  lovely
• 7:55
  word.
• 7:55
  They're
• 7:56
  beautiful.
• 7:56
  It's
• 7:56
  a beautiful
• 7:57
  work
• 7:57
  of art.
• 7:57
  Like
• 7:57
  the other day
• 7:58
  I had,
• 7:59
  I was,
• 7:59
  I was
• 7:59
  looking,
• 8:00
  I was taking,
• 8:01
  someone's
• 8:01
  prosthesis
• 8:02
  and I was
• 8:02
  looking at it
• 8:03
  and
• 8:03
  you know,
• 8:03
  I when
• 8:04
  I take about
• 8:04
  I always
• 8:04
  like,
• 8:05
  wash
• 8:05
  it first
• 8:05
  and then
• 8:06
  I'm
• 8:06
  looking
• 8:06
  at this
• 8:06
  thing,
• 8:07
  I'm like,
• 8:07
  this is like
• 8:08
  I'm
• 8:08
  holding
• 8:08
  an eye
• 8:09
  in my
• 8:09
  hand.
• 8:10
  It's it's
• 8:11
  really
• 8:11
  amazing.
• 8:12
  So,
• 8:12
  so really
• 8:13
  excellent
• 8:13
  work.
• 8:14
  and some
• 8:14
  people
• 8:15
  need
• 8:15
  enucleation
• 8:16
  from the beginning,
• 8:17
  but
• 8:17
  sometimes
• 8:18
  people
• 8:19
  after
• 8:19
  treatment
• 8:20
  and
• 8:20
  the eye
• 8:20
  is not
• 8:21
  doing
• 8:21
  very
• 8:21
  well.
• 8:22
  As
• 8:22
  I
• 8:22
  mentioned,
• 8:22
  sometimes
• 8:23
  it can
• 8:23
  be
• 8:23
  painful
• 8:24
  and not
• 8:24
  really
• 8:24
  giving
• 8:25
  vision
• 8:25
  back.
• 8:26
  if I sort of
• 8:26
  think
• 8:27
  that,
• 8:27
  you know,
• 8:27
  maybe
• 8:27
  in the
• 8:28
  not too
• 8:28
  distant
• 8:28
  future
• 8:29
  we might be
• 8:29
  talking
• 8:30
  about
• 8:30
  this.
• 8:30
  I try to
• 8:31
  bring it
• 8:31
  up early
• 8:32
  and just
• 8:32
  keep
• 8:33
  talking about it
• 8:33
  so that
• 8:34
  people
• 8:34
  can start
• 8:35
  thinking
• 8:36
  about
• 8:36
  this
• 8:37
  possibility
• 8:38
  and, and
• 8:39
  really
• 8:39
  adjusting
• 8:40
  to it
• 8:40
  a little bit
• 8:41
  because
• 8:41
  it's it's
• 8:41
  definitely
• 8:42
  it can be
• 8:42
  a shock
• 8:43
  if
• 8:43
  someone
• 8:43
  if
• 8:44
  you've
• 8:44
  come to
• 8:44
  an appointment
• 8:45
  and
• 8:45
  you're
• 8:46
  told that
• 8:46
  you have
• 8:46
  to have
• 8:46
  the eye
• 8:47
  removed.
• 8:47
  So,
• 8:48
  you know,
• 8:48
  just just
• 8:49
  understanding
• 8:50
  as much
• 8:50
  about it
• 8:51
  as
• 8:51
  possible
• 8:51
  can really
• 8:52
  make it a
• 8:53
  more easy
• 8:54
  transition.
• 8:55
  if you
• 8:55
  actually
• 8:56
  need to
• 8:56
  have it.
• 8:58
  I want to
• 8:59
  talk a
• 8:59
  bit about
• 9:00
  what
• 9:00
  happens
• 9:00
  in
• 9:01
  brachytherapy
• 9:01
  eye
• 9:01
  surgery,
• 9:02
  and
• 9:02
  certainly
• 9:03
  people
• 9:03
  who have
• 9:04
  already
• 9:05
  had the
• 9:05
  treatment
• 9:06
  may,
• 9:06
  you know,
• 9:07
  be
• 9:07
  already.
• 9:07
  Well
• 9:07
  beyond
• 9:08
  this.
• 9:08
  But for
• 9:08
  people
• 9:09
  who
• 9:09
  this is
• 9:09
  new for,
• 9:10
  but also
• 9:11
  people
• 9:11
  who
• 9:11
  have had
• 9:12
  the treatment
• 9:12
  and maybe
• 9:13
  didn't
• 9:13
  quite
• 9:13
  understand
• 9:14
  what happened,
• 9:15
  I think
• 9:16
  it's
• 9:16
  helpful
• 9:16
  to
• 9:16
  kind of
• 9:17
  go over
• 9:17
  what
• 9:18
  happens
• 9:18
  in
• 9:18
  surgery.
• 9:19
  So I'm
• 9:19
  going to
• 9:19
  I'm going
• 9:20
  to talk
• 9:20
  about
• 9:20
  break
• 9:21
  the
• 9:21
  brachytherapy
• 9:22
  plaque
• 9:22
  because
• 9:22
  that's
• 9:23
  the most
• 9:23
  common.
• 9:23
  And then
• 9:24
  also a
• 9:24
  little bit
• 9:25
  about
• 9:25
  proton
• 9:25
  beam
• 9:26
  after.
• 9:27
  So
• 9:28
  one of
• 9:28
  the
• 9:28
  things
• 9:29
  that
• 9:29
  doesn't
• 9:29
  happen is
• 9:30
  the eye
• 9:31
  gets
• 9:31
  taken out
• 9:32
  and
• 9:32
  put on
• 9:33
  a surgical table.
• 9:34
  And then
• 9:34
  we do
• 9:35
  surgery
• 9:35
  and
• 9:35
  then put
• 9:36
  the eye
• 9:36
  back so
• 9:37
  the eye
• 9:37
  stays in
• 9:38
  the head
• 9:39
  the whole time.
• 9:40
  This
• 9:40
  is it's
• 9:41
  really
• 9:41
  possible
• 9:41
  to do
• 9:42
  this type
• 9:42
  of
• 9:42
  surgery
• 9:43
  because
• 9:43
  of
• 9:44
  isolating
• 9:45
  the
• 9:45
  muscles
• 9:45
  and
• 9:45
  really
• 9:46
  getting
• 9:46
  a lot
• 9:46
  of
• 9:46
  exposure
• 9:47
  during
• 9:47
  surgery.
• 9:48
  And
• 9:48
  when people
• 9:49
  have
• 9:49
  brachytherapy
• 9:50
  plaque
• 9:50
  surgery,
• 9:50
  we use
• 9:51
  we use
• 9:51
  anesthesia.
• 9:53
  I think
• 9:53
  some
• 9:54
  centers
• 9:54
  will do
• 9:54
  general
• 9:55
  anesthesia.
• 9:56
  I know
• 9:56
  our center.
• 9:57
  I like to use
• 9:58
  a lot of
• 9:58
  local
• 9:58
  anesthesia.
• 9:59
  I try
• 9:59
  to avoid
• 9:59
  generals
• 10:00
  unless
• 10:01
  people
• 10:01
  are
• 10:01
  really young
• 10:02
  or just
• 10:02
  totally
• 10:02
  can't
• 10:02
  tolerate
• 10:03
  it.
• 10:04
  but
• 10:04
  either
• 10:04
  way,
• 10:05
  the
• 10:05
  person is
• 10:05
  very
• 10:05
  comfortable,
• 10:07
  and
• 10:07
  the surgery
• 10:08
  can last,
• 10:09
  it's
• 10:09
  different
• 10:09
  at
• 10:09
  every place.
• 10:10
  But
• 10:10
  can be
• 10:10
  is
• 10:11
  as short
• 10:12
  as 30
• 10:12
  minutes
• 10:13
  to
• 10:13
  sometimes
• 10:14
  an hour,
• 10:14
  an hour
• 10:14
  and a
• 10:14
  half,
• 10:15
  depending
• 10:15
  on
• 10:16
  everything
• 10:16
  that's
• 10:16
  happening,
• 10:17
  depending
• 10:17
  on,
• 10:18
  the
• 10:18
  complexity
• 10:19
  of the surgery.
• 10:20
  But
• 10:20
  when you
• 10:20
  come to
• 10:21
  surgery,
• 10:21
  it's
• 10:22
  usually
• 10:23
  in most
• 10:23
  places.
• 10:23
  Now it's
• 10:24
  all outpatient.
• 10:25
  I think
• 10:26
  that
• 10:26
  the last
• 10:27
  I heard
• 10:27
  the centers,
• 10:28
  it used
• 10:28
  to be
• 10:28
  inpatient,
• 10:29
  meaning
• 10:29
  staying
• 10:30
  in the
• 10:30
  hospital
• 10:31
  have
• 10:31
  switched.
• 10:32
  And so,
• 10:32
  most of
• 10:33
  the time
• 10:33
  this is
• 10:34
  an
• 10:34
  outpatient
• 10:34
  procedure.
• 10:35
  So,
• 10:36
  you don't
• 10:36
  have
• 10:36
  to stay
• 10:37
  in the hospital.
• 10:38
  And
• 10:38
  what happens
• 10:39
  in
• 10:39
  the surgery
• 10:40
  is that
• 10:40
  the
• 10:40
  plaque,
• 10:41
  which is
• 10:42
  customized
• 10:43
  and built
• 10:43
  to the
• 10:44
  specifications
• 10:46
  of the
• 10:46
  individual
• 10:47
  melanoma,
• 10:48
  the plaque
• 10:48
  is placed
• 10:49
  on the
• 10:50
  eye on
• 10:50
  the
• 10:50
  outside
• 10:51
  of the eye,
• 10:53
  and we
• 10:53
  get
• 10:53
  to the
• 10:53
  outside
• 10:54
  of the eye
• 10:55
  by
• 10:55
  opening
• 10:56
  up the
• 10:56
  superficial
• 10:57
  tissues.
• 10:58
  So
• 10:58
  we call
• 10:58
  that the
• 10:58
  conjunctiva,
• 10:59
  the
• 10:59
  and the,
• 11:00
  which is
• 11:00
  sort
• 11:00
  of the
• 11:01
  superficial
• 11:01
  tissue
• 11:01
  overlying
• 11:02
  the white
• 11:02
  part of
• 11:03
  the eye.
• 11:04
  And the
• 11:04
  muscles
• 11:05
  of
• 11:05
  the eye.
• 11:05
  There's
• 11:06
  four main
• 11:06
  muscles
• 11:07
  that we
• 11:08
  look for.
• 11:08
  And
• 11:09
  they're
• 11:09
  really
• 11:09
  ones,
• 11:11
  that help
• 11:11
  the eye
• 11:11
  look up,
• 11:12
  look down
• 11:12
  and look
• 11:12
  right to
• 11:13
  look
• 11:13
  left.
• 11:13
  And so
• 11:14
  each of
• 11:14
  those
• 11:15
  four
• 11:15
  muscles
• 11:15
  is
• 11:16
  identified
• 11:17
  at
• 11:17
  the time
• 11:17
  of surgery.
• 11:18
  And
• 11:18
  we put
• 11:18
  a suture
• 11:20
  around
• 11:20
  those muscles
• 11:21
  so that
• 11:21
  we can
• 11:21
  turn
• 11:22
  the eye.
• 11:22
  And you
• 11:22
  can turn
• 11:23
  the eye
• 11:23
  way over
• 11:24
  so that
• 11:25
  you can
• 11:25
  get
• 11:25
  to the
• 11:25
  very
• 11:25
  back.
• 11:26
  So it's
• 11:26
  possible
• 11:27
  to put
• 11:28
  the
• 11:28
  breaking
• 11:28
  for
• 11:28
  if you're
• 11:29
  the
• 11:29
  melanomas
• 11:30
  at
• 11:30
  the close
• 11:31
  to the
• 11:31
  macula
• 11:32
  or very
• 11:32
  posterior,
• 11:33
  we call
• 11:34
  that,
• 11:34
  we can
• 11:35
  turn
• 11:35
  the eye
• 11:36
  and
• 11:36
  expose
• 11:37
  that area
• 11:37
  very well
• 11:38
  with just
• 11:39
  using our
• 11:39
  strings
• 11:40
  and
• 11:40
  instruments
• 11:41
  to help
• 11:41
  spread
• 11:41
  the
• 11:42
  tissues
• 11:42
  to get
• 11:42
  right
• 11:43
  where we
• 11:43
  needed
• 11:43
  to be.
• 11:44
  and
• 11:45
  because
• 11:45
  people
• 11:46
  are have
• 11:46
  anesthesia,
• 11:47
  you're
• 11:47
  really
• 11:47
  not
• 11:48
  feeling
• 11:48
  any of
• 11:49
  this
• 11:49
  movement
• 11:50
  around
• 11:50
  the eye.
• 11:51
  when we do
• 11:52
  local
• 11:52
  anesthesia,
• 11:53
  when a
• 11:53
  person
• 11:53
  is
• 11:54
  sort of
• 11:54
  in
• 11:54
  twilight,
• 11:55
  we add
• 11:55
  additional
• 11:56
  anesthesia
• 11:56
  around
• 11:57
  the eyes.
• 11:57
  So
• 11:58
  the eyes
• 11:58
  bathed
• 11:59
  in, in
• 12:00
  sort of
• 12:01
  xylocaine
• 12:01
  type
• 12:02
  solutions,
• 12:02
  which
• 12:03
  really
• 12:03
  numbs
• 12:03
  everything,
• 12:04
  you can
• 12:05
  also be
• 12:05
  sort of
• 12:05
  semi awake
• 12:06
  and you
• 12:06
  might
• 12:07
  hear
• 12:07
  people
• 12:07
  talking
• 12:08
  or
• 12:08
  sometimes
• 12:08
  our patients
• 12:09
  kind
• 12:09
  of talk
• 12:09
  along
• 12:10
  with us,
• 12:10
  but
• 12:10
  whatever
• 12:11
  works.
• 12:12
  So
• 12:12
  once we
• 12:13
  find the
• 12:13
  muscles,
• 12:14
  we can
• 12:14
  turn
• 12:14
  the eye
• 12:15
  and then
• 12:15
  in order
• 12:16
  to find
• 12:17
  where
• 12:17
  that
• 12:18
  melanoma
• 12:18
  is,
• 12:19
  there's a
• 12:20
  couple
• 12:20
  ways,
• 12:21
  and
• 12:21
  we use
• 12:21
  a bit of
• 12:21
  both,
• 12:22
  but
• 12:22
  you can
• 12:23
  do
• 12:23
  something
• 12:23
  called
• 12:24
  trans
• 12:24
  illumination,
• 12:25
  which is
• 12:25
  getting
• 12:26
  a really
• 12:26
  strong
• 12:26
  light
• 12:27
  and
• 12:27
  shining
• 12:28
  it
• 12:28
  through
• 12:28
  the
• 12:28
  dilated
• 12:29
  pupil,
• 12:29
  just like you,
• 12:30
  like if
• 12:31
  you
• 12:31
  imagine
• 12:31
  a pumpkin
• 12:32
  like
• 12:32
  a jack
• 12:33
  o
• 12:33
  lantern.
• 12:34
  if you put
• 12:35
  a candle
• 12:35
  inside,
• 12:36
  if
• 12:36
  there's
• 12:36
  something
• 12:36
  dark on
• 12:37
  the wall
• 12:38
  of the
• 12:38
  of the
• 12:39
  pumpkin,
• 12:39
  it will be black
• 12:40
  and
• 12:40
  it will
• 12:41
  block
• 12:41
  light.
• 12:42
  So
• 12:42
  a
• 12:42
  melanoma
• 12:43
  does
• 12:43
  the same
• 12:44
  sort
• 12:44
  of thing.
• 12:44
  So if
• 12:45
  you shine
• 12:45
  a light
• 12:46
  and you,
• 12:46
  you
• 12:47
  expose
• 12:47
  the wall
• 12:48
  of the eye
• 12:48
  with the
• 12:49
  light
• 12:49
  glowing
• 12:49
  through
• 12:50
  it,
• 12:50
  you can see
• 12:51
  this dark
• 12:52
  area
• 12:52
  where the
• 12:53
  melanoma
• 12:53
  is.
• 12:54
  sometimes
• 12:55
  melanomas
• 12:55
  are
• 12:56
  very tiny
• 12:57
  and
• 12:57
  sometimes
• 12:58
  they
• 12:58
  don't
• 12:58
  have
• 12:58
  a lot
• 12:58
  of pigment.
• 12:59
  So this,
• 13:00
  this way
• 13:01
  of, of
• 13:01
  using
• 13:01
  trans
• 13:02
  illumination,
• 13:03
  it
• 13:03
  doesn't
• 13:04
  always work.
• 13:04
  So what
• 13:05
  I always
• 13:05
  find is
• 13:06
  helpful
• 13:06
  together
• 13:07
  with
• 13:07
  trans
• 13:07
  illumination
• 13:08
  is also
• 13:08
  to, to
• 13:09
  actually
• 13:09
  look.
• 13:10
  So we put
• 13:11
  on the
• 13:11
  indirect
• 13:12
  ophthalscope
• 13:13
  which is
• 13:13
  sort of
• 13:13
  that
• 13:13
  miner's
• 13:14
  light
• 13:15
  that
• 13:15
  we use
• 13:15
  with a lens.
• 13:16
  And
• 13:16
  you can
• 13:16
  actually
• 13:16
  see where
• 13:17
  the
• 13:18
  melanoma
• 13:18
  is and
• 13:19
  you can
• 13:19
  use a
• 13:19
  little,
• 13:20
  what
• 13:20
  we call
• 13:20
  a little
• 13:20
  depressor
• 13:21
  on the
• 13:21
  outside
• 13:22
  of
• 13:22
  the eye
• 13:22
  to see
• 13:23
  and mark
• 13:23
  where
• 13:23
  the very
• 13:24
  edge of
• 13:24
  it
• 13:24
  starts.
• 13:25
  And
• 13:25
  so
• 13:25
  then you
• 13:25
  can mark
• 13:26
  that
• 13:26
  on the eye
• 13:26
  wall.
• 13:27
  And
• 13:27
  usually
• 13:28
  if you do
• 13:28
  that
• 13:29
  together
• 13:29
  with the
• 13:30
  trans
• 13:30
  illumination,
• 13:31
  you're
• 13:32
  most of
• 13:32
  the time
• 13:33
  you're
• 13:33
  there.
• 13:33
  But I'm
• 13:34
  always
• 13:34
  surprised
• 13:35
  that
• 13:36
  sometimes
• 13:36
  the trans
• 13:37
  illumination
• 13:37
  isn't
• 13:38
  exactly
• 13:38
  accurate
• 13:39
  or eye
• 13:40
  mark
• 13:40
  at all.
• 13:41
  And
• 13:41
  it looks
• 13:42
  and it
• 13:42
  looks
• 13:42
  like
• 13:42
  I've got it
• 13:43
  exactly
• 13:43
  in place.
• 13:44
  And so
• 13:46
  many
• 13:46
  centers
• 13:46
  also
• 13:47
  bring
• 13:47
  their
• 13:47
  ultrasonographer
• 13:48
  or do
• 13:48
  intraoperative
• 13:49
  ultrasonography.
• 13:50
  So that's
• 13:51
  just a
• 13:51
  third way
• 13:52
  you can
• 13:52
  increase
• 13:53
  the
• 13:53
  accuracy
• 13:53
  of the placement.
• 13:54
  So
• 13:55
  we always
• 13:55
  check.
• 13:56
  And I
• 13:56
  think
• 13:56
  most
• 13:56
  centers
• 13:57
  now do
• 13:58
  an
• 13:58
  ultrasound
• 13:59
  during
• 13:59
  the surgery
• 14:00
  where
• 14:01
  after
• 14:01
  everything
• 14:01
  is in
• 14:02
  place
• 14:02
  we look
• 14:03
  and say,
• 14:04
  you
• 14:04
  know, is
• 14:04
  this is
• 14:04
  everything
• 14:05
  accurate?
• 14:06
  Is
• 14:06
  the plaque,
• 14:07
  is it
• 14:08
  lying is
• 14:09
  or the
• 14:09
  dimensions
• 14:10
  usually
• 14:11
  sort of
• 14:11
  front
• 14:11
  to back
• 14:12
  and from
• 14:13
  side to
• 14:13
  side.
• 14:13
  We usually
• 14:14
  have two
• 14:14
  major
• 14:15
  dimensions
• 14:15
  on
• 14:15
  ultrasound.
• 14:16
  We want to
• 14:17
  make sure
• 14:17
  that the
• 14:17
  plaque
• 14:18
  is
• 14:18
  centered
• 14:18
  over
• 14:19
  the tumor.
• 14:19
  And
• 14:19
  there's
• 14:20
  no areas
• 14:21
  of
• 14:21
  what we
• 14:21
  call edge
• 14:22
  miss or
• 14:22
  parts of
• 14:23
  the tumor
• 14:23
  that are
• 14:24
  not being
• 14:24
  properly
• 14:24
  covered
• 14:25
  by the
• 14:25
  plaque.
• 14:26
  And I
• 14:26
  also
• 14:26
  think
• 14:27
  it's
• 14:27
  really
• 14:27
  important
• 14:27
  to
• 14:28
  this is a part
• 14:29
  that is
• 14:29
  really
• 14:30
  critical,
• 14:30
  because
• 14:30
  we need
• 14:31
  to make
• 14:31
  sure that
• 14:32
  the
• 14:32
  treatment
• 14:32
  is as
• 14:33
  accurate,
• 14:33
  as
• 14:33
  accurate
• 14:34
  as can
• 14:34
  be.
• 14:35
  So
• 14:35
  we really
• 14:36
  take
• 14:36
  our time.
• 14:36
  We measure,
• 14:37
  we look,
• 14:37
  and
• 14:37
  if it doesn't
• 14:38
  look
• 14:38
  quite
• 14:38
  where
• 14:39
  we want it
• 14:39
  to be,
• 14:39
  or
• 14:40
  maybe
• 14:40
  it's a
• 14:40
  little
• 14:40
  lopsided,
• 14:41
  this is the opportunity
• 14:42
  to move it.
• 14:43
  So then
• 14:43
  you can move it
• 14:44
  so it
• 14:45
  shift.
• 14:46
  Look
• 14:46
  again
• 14:47
  by
• 14:47
  ultrasound.
• 14:48
  And a lot
• 14:49
  of
• 14:49
  centers
• 14:50
  in
• 14:50
  addition
• 14:50
  to ours
• 14:51
  have
• 14:51
  published
• 14:51
  on how
• 14:52
  ultrasound
• 14:52
  actually
• 14:53
  can help
• 14:53
  increase
• 14:54
  the
• 14:54
  accuracy
• 14:55
  of the
• 14:55
  brachytherapy
• 14:56
  treatment.
• 14:57
  and
• 14:58
  I think
• 14:58
  ultrasound
• 14:58
  is
• 14:58
  really critical.
• 14:59
  And
• 15:00
  even though
• 15:00
  I have
• 15:00
  all these
• 15:01
  years of
• 15:01
  doing
• 15:02
  this,
• 15:02
  I
• 15:02
  don't think
• 15:02
  I've ever
• 15:03
  had
• 15:03
  a time
• 15:04
  where
• 15:04
  I thought,
• 15:04
  you know,
• 15:04
  I don't
• 15:04
  need
• 15:04
  ultrasound
• 15:05
  anymore
• 15:06
  because
• 15:06
  I'm
• 15:06
  always
• 15:06
  surprised
• 15:07
  that if I
• 15:08
  if I do
• 15:08
  the trans
• 15:09
  illumination,
• 15:09
  we put it
• 15:10
  on,
• 15:10
  it's
• 15:10
  like,
• 15:10
  whoa,
• 15:10
  this
• 15:11
  didn't
• 15:11
  this wasn't
• 15:11
  this was off.
• 15:12
  So
• 15:12
  the ultrasound
• 15:13
  allows
• 15:14
  you
• 15:14
  to confirm.
• 15:16
  But also
• 15:17
  sometimes
• 15:18
  there may
• 15:18
  be a
• 15:18
  delay
• 15:19
  from
• 15:19
  the last
• 15:20
  ultrasound
• 15:20
  measurement
• 15:21
  to the
• 15:21
  time of
• 15:22
  surgery.
• 15:23
  So
• 15:23
  performing
• 15:24
  ultrasound
• 15:24
  also
• 15:25
  gives you
• 15:25
  an
• 15:25
  opportunity
• 15:26
  to
• 15:26
  remeasure
• 15:27
  the
• 15:28
  melanoma.
• 15:28
  And
• 15:28
  if you
• 15:29
  find that
• 15:29
  it's
• 15:30
  grown
• 15:30
  a little bit,
• 15:30
  you can give
• 15:31
  those
• 15:32
  extra
• 15:32
  numbers
• 15:33
  to the
• 15:33
  physics
• 15:33
  team.
• 15:34
  And we
• 15:34
  usually
• 15:35
  in
• 15:35
  situations
• 15:36
  like
• 15:36
  this,
• 15:36
  we may
• 15:37
  find that
• 15:37
  we're
• 15:37
  adding
• 15:38
  additional hours
• 15:39
  or
• 15:39
  sometimes
• 15:40
  an
• 15:40
  additional
• 15:40
  day
• 15:41
  to the
• 15:41
  brachytherapy
• 15:42
  treatment
• 15:43
  to make
• 15:43
  sure that
• 15:43
  everything
• 15:44
  is as
• 15:44
  accurate
• 15:45
  as can
• 15:45
  be.
• 15:46
  So
• 15:47
  all these
• 15:47
  things
• 15:47
  happen.
• 15:48
  Usually
• 15:48
  there's a
• 15:48
  lot of
• 15:49
  people
• 15:49
  in the
• 15:50
  operating
• 15:50
  room
• 15:50
  during
• 15:51
  brachytherapy.
• 15:52
  We have
• 15:52
  our
• 15:52
  radiation
• 15:53
  physicist,
• 15:54
  we have
• 15:54
  our
• 15:54
  radiation
• 15:55
  oncologist,
• 15:57
  in
• 15:57
  addition
• 15:57
  to all
• 15:57
  the
• 15:58
  technical
• 15:58
  team,
• 15:58
  in our
• 15:59
  case,
• 15:59
  our ultrasonographer
• 16:00
  comes in
• 16:01
  for all
• 16:01
  the cases
• 16:02
  in
• 16:02
  addition
• 16:03
  to all
• 16:03
  the
• 16:03
  people
• 16:04
  learning
• 16:04
  and
• 16:05
  observing.
• 16:05
  So it's
• 16:05
  a very
• 16:06
  busy,
• 16:06
  we like
• 16:07
  to call
• 16:07
  it.
• 16:07
  It's
• 16:07
  a party
• 16:08
  in the
• 16:08
  operating room.
• 16:09
  So
• 16:09
  there's
• 16:09
  lots of
• 16:10
  people
• 16:10
  who are
• 16:10
  watching
• 16:11
  and
• 16:11
  learning,
• 16:12
  and
• 16:12
  there's
• 16:12
  usually
• 16:13
  lots of
• 16:13
  conversation
• 16:14
  because
• 16:14
  people
• 16:15
  want to
• 16:15
  understand
• 16:16
  all the
• 16:16
  different
• 16:17
  steps,
• 16:17
  even,
• 16:17
  you know,
• 16:18
  outside
• 16:18
  of the patient.
• 16:19
  But
• 16:19
  all the people
• 16:20
  who are
• 16:20
  there
• 16:21
  are
• 16:21
  usually
• 16:22
  there's
• 16:22
  always
• 16:22
  people
• 16:23
  learning
• 16:23
  and
• 16:24
  visitors
• 16:24
  and such.
• 16:25
  So once
• 16:27
  everything
• 16:27
  is in
• 16:27
  place,
• 16:28
  then
• 16:28
  we can
• 16:29
  put the
• 16:29
  we can
• 16:30
  put
• 16:30
  everything
• 16:30
  back and
• 16:31
  the
• 16:32
  plaque
• 16:32
  remains
• 16:33
  sutured
• 16:33
  on to
• 16:34
  the eye.
• 16:35
  and
• 16:35
  there's,
• 16:36
  there's
• 16:36
  different
• 16:36
  ways to
• 16:37
  suture
• 16:37
  the plaque,
• 16:38
  but we do
• 16:38
  use
• 16:39
  stitches
• 16:40
  that hold
• 16:41
  the, the,
• 16:42
  the edge
• 16:42
  of the
• 16:42
  plaque
• 16:43
  against
• 16:44
  the sclera,
• 16:44
  which is
• 16:45
  the white
• 16:46
  non
• 16:46
  vascular
• 16:47
  part of
• 16:47
  the eye
• 16:48
  that
• 16:48
  we're we.
• 16:48
  So
• 16:48
  things to
• 16:50
  it's it's
• 16:51
  just this
• 16:51
  in a
• 16:51
  similar
• 16:52
  type of
• 16:52
  surgery
• 16:52
  where
• 16:53
  we do
• 16:53
  in
• 16:53
  retinal
• 16:54
  diseases
• 16:55
  doing
• 16:55
  retinal
• 16:55
  detachment
• 16:56
  surgery.
• 16:56
  We
• 16:57
  you know
• 16:57
  I also do
• 16:59
  surgical
• 16:59
  retina.
• 16:59
  If
• 17:00
  people
• 17:00
  have
• 17:00
  retinal
• 17:00
  attachments
• 17:01
  we often use
• 17:02
  a scleral
• 17:02
  buckle.
• 17:02
  So we so
• 17:04
  we sew
• 17:04
  sewing
• 17:05
  things
• 17:05
  on to
• 17:05
  sclera
• 17:06
  is not
• 17:06
  an unusual
• 17:07
  or
• 17:07
  rare thing.
• 17:08
  So
• 17:08
  putting on
• 17:09
  a plaque
• 17:09
  and
• 17:09
  sewing
• 17:10
  that on
• 17:10
  is
• 17:11
  something
• 17:11
  very
• 17:11
  doable.
• 17:12
  We have sutures
• 17:12
  that are
• 17:13
  very good
• 17:13
  for that.
• 17:14
  one of
• 17:14
  the ways,
• 17:15
  one
• 17:15
  of the
• 17:15
  things
• 17:15
  that
• 17:15
  we do
• 17:16
  is we,
• 17:16
  we so
• 17:17
  our plaques
• 17:17
  on a way
• 17:18
  that
• 17:18
  we can
• 17:18
  remove
• 17:19
  them in
• 17:19
  the
• 17:19
  office.
• 17:21
  so
• 17:21
  there's,
• 17:22
  there's
• 17:22
  different
• 17:22
  ways to
• 17:22
  do that.
• 17:23
  I think
• 17:23
  most
• 17:23
  people
• 17:24
  will
• 17:24
  come back
• 17:24
  for a
• 17:25
  second
• 17:25
  surgery
• 17:26
  that's
• 17:26
  usually
• 17:26
  much
• 17:26
  shorter
• 17:27
  just
• 17:27
  to remove
• 17:28
  the
• 17:28
  plaque.
• 17:29
  it's so
• 17:29
  fascinating.
• 17:30
  It's just
• 17:31
  amazing
• 17:32
  what
• 17:32
  modern
• 17:33
  medicine
• 17:33
  is doing.
• 17:33
  It
• 17:33
  really is.
• 17:34
  I think
• 17:34
  the
• 17:35
  the question
• 17:35
  I have
• 17:35
  right
• 17:36
  now is,
• 17:36
  after you
• 17:38
  stitch
• 17:38
  the plaque
• 17:39
  on the I
• 17:41
  and
• 17:41
  they go
• 17:41
  home, can
• 17:42
  they feel
• 17:42
  that
• 17:43
  in there
• 17:44
  That's
• 17:45
  a great question.
• 17:46
  So
• 17:47
  the further
• 17:47
  back
• 17:48
  the plaque
• 17:49
  is, so
• 17:49
  the more
• 17:50
  posterior
• 17:51
  the
• 17:51
  melanoma
• 17:52
  is
• 17:53
  there's
• 17:53
  nothing
• 17:53
  really
• 17:53
  to feel
• 17:54
  or even
• 17:54
  see back
• 17:55
  there.
• 17:56
  and often
• 17:57
  there's,
• 17:57
  there's
• 17:57
  not just
• 17:58
  the eye
• 17:59
  and
• 17:59
  there's
• 18:00
  so many,
• 18:00
  there's
• 18:01
  so much
• 18:01
  soft
• 18:01
  tissue
• 18:02
  in the orbit,
• 18:03
  which is
• 18:03
  like the
• 18:03
  eye
• 18:03
  socket
• 18:04
  where the
• 18:04
  eyeball
• 18:04
  sits.
• 18:05
  And
• 18:06
  because
• 18:06
  things
• 18:06
  are being
• 18:06
  moved
• 18:07
  and
• 18:07
  turned,
• 18:08
  there's
• 18:08
  a lot
• 18:08
  of
• 18:08
  swelling,
• 18:09
  in,
• 18:10
  in all the
• 18:10
  tissues
• 18:11
  in the eye.
• 18:11
  So we
• 18:12
  often
• 18:12
  give
• 18:13
  people,
• 18:13
  some
• 18:14
  a little
• 18:14
  bit of
• 18:14
  steroid
• 18:15
  during
• 18:15
  the surgery
• 18:15
  just
• 18:16
  to help
• 18:16
  that
• 18:16
  swelling
• 18:17
  go down
• 18:18
  and
• 18:18
  not be.
• 18:18
  so tense
• 18:19
  afterwards?
• 18:19
  Sometimes
• 18:19
  when
• 18:20
  everything's
• 18:20
  very
• 18:20
  swollen,
• 18:20
  it can be
• 18:21
  very
• 18:21
  painful
• 18:21
  as well.
• 18:22
  if people
• 18:23
  feel
• 18:23
  anything,
• 18:24
  it's
• 18:24
  really
• 18:24
  just
• 18:24
  the bit
• 18:25
  of
• 18:25
  swelling
• 18:26
  and a
• 18:26
  little
• 18:26
  bit of
• 18:26
  inflammation
• 18:27
  after the
• 18:28
  surgery.
• 18:29
  The funny thing
• 18:29
  is, even
• 18:30
  if the
• 18:31
  plaque
• 18:31
  is at
• 18:31
  the very
• 18:31
  front
• 18:32
  of the eye,
• 18:32
  and
• 18:32
  sometimes
• 18:33
  if you
• 18:33
  have like
• 18:34
  a, a
• 18:35
  tumor
• 18:36
  that
• 18:36
  involves
• 18:36
  the
• 18:37
  ciliary
• 18:37
  body,
• 18:38
  which is
• 18:38
  towards
• 18:38
  the very
• 18:39
  front
• 18:39
  of the eye,
• 18:40
  you can
• 18:40
  see
• 18:41
  oftentimes
• 18:42
  you'll
• 18:42
  see some
• 18:42
  of the
• 18:42
  gold from
• 18:43
  the front
• 18:44
  with
• 18:44
  the eye
• 18:44
  open.
• 18:45
  You'll
• 18:45
  see some
• 18:45
  a gold
• 18:46
  part
• 18:46
  of the
• 18:46
  plaque
• 18:47
  showing.
• 18:47
  And it's
• 18:48
  really
• 18:48
  quite
• 18:48
  amazing
• 18:49
  that that
• 18:49
  doesn't
• 18:50
  cause
• 18:50
  additional
• 18:51
  discomfort.
• 18:52
  And even
• 18:53
  sometimes
• 18:53
  we have
• 18:53
  our
• 18:54
  plaques
• 18:54
  hanging
• 18:55
  over
• 18:55
  the cornea,
• 18:56
  which is
• 18:56
  the front
• 18:57
  of the eye,
• 18:57
  which is a
• 18:58
  very,
• 18:58
  very
• 18:58
  sensitive
• 18:59
  structure.
• 19:00
  as long
• 19:00
  as
• 19:00
  everything
• 19:01
  is, is
• 19:01
  still
• 19:02
  and in
• 19:02
  place,
• 19:03
  there
• 19:03
  really
• 19:03
  isn't
• 19:03
  any
• 19:04
  discomfort
• 19:04
  from
• 19:05
  that.
• 19:05
  And so,
• 19:05
  so
• 19:06
  actually,
• 19:06
  I don't
• 19:06
  think
• 19:07
  people
• 19:07
  really
• 19:07
  feel the
• 19:08
  plaque
• 19:08
  at all.
• 19:09
  They may
• 19:09
  feel some
• 19:10
  swelling
• 19:11
  or
• 19:11
  just all
• 19:12
  the
• 19:12
  tissues
• 19:12
  being a
• 19:12
  little
• 19:13
  bit
• 19:13
  altered,
• 19:14
  but, I
• 19:14
  don't
• 19:15
  know.
• 19:15
  One has
• 19:15
  said, oh,
• 19:15
  I feel
• 19:16
  the edge.
• 19:16
  And it's,
• 19:17
  it's
• 19:17
  actually
• 19:17
  correlates.
• 19:18
  We, we
• 19:19
  really,
• 19:20
  amazingly
• 19:21
  don't
• 19:21
  feel the
• 19:22
  plaque
• 19:23
  on the eye.
• 19:25
  That is amazing
• 19:25
  because
• 19:26
  you get
• 19:26
  a tiny
• 19:26
  little
• 19:26
  eyelash
• 19:27
  in there
• 19:27
  and it
• 19:27
  drives
• 19:28
  you
• 19:28
  crazy.
• 19:29
  But
• 19:29
  the fact
• 19:29
  that
• 19:29
  you guys
• 19:30
  can put
• 19:30
  a whole
• 19:30
  plaque
• 19:31
  in there
• 19:31
  and
• 19:31
  they don't
• 19:31
  feel it,
• 19:32
  it's
• 19:32
  really
• 19:33
  blows
• 19:33
  your mind.
• 19:34
  I think
• 19:35
  it's it's
• 19:35
  just,
• 19:36
  because
• 19:36
  different
• 19:37
  parts of
• 19:37
  the eye
• 19:38
  have
• 19:38
  different,
• 19:39
  sensitivity
• 19:40
  and
• 19:40
  different
• 19:40
  innervation
• 19:41
  And the
• 19:41
  cornea
• 19:42
  being
• 19:42
  the most
• 19:43
  exposed
• 19:43
  part
• 19:44
  is it's
• 19:44
  like one
• 19:45
  of the
• 19:45
  most
• 19:45
  sensitive
• 19:46
  places
• 19:46
  with the
• 19:46
  dense
• 19:47
  nerve,
• 19:48
  receptors
• 19:49
  in the
• 19:49
  body.
• 19:49
  So that,
• 19:50
  I mean,
• 19:50
  for our
• 19:50
  protection.
• 19:51
  So if
• 19:52
  anything
• 19:52
  touches
• 19:52
  the eye,
• 19:53
  it's
• 19:53
  going to
• 19:53
  affect
• 19:53
  our vision.
• 19:54
  So
• 19:54
  we react,
• 19:55
  you know,
• 19:56
  in a
• 19:56
  very
• 19:56
  hyper
• 19:57
  reactive
• 19:57
  way.
• 19:57
  So like
• 19:58
  an
• 19:58
  eyelash.
• 19:58
  Exactly.
• 19:59
  As you
• 19:59
  say.
• 20:00
  even
• 20:00
  sometimes
• 20:00
  with
• 20:01
  the stitches.
• 20:02
  some
• 20:02
  people
• 20:02
  feel
• 20:03
  the stitches
• 20:03
  afterwards,
• 20:05
  but
• 20:05
  I feel
• 20:06
  like
• 20:06
  there's a
• 20:07
  lot of
• 20:07
  times
• 20:08
  I'm
• 20:08
  really
• 20:08
  amazed
• 20:09
  that even
• 20:10
  if
• 20:10
  there's
• 20:10
  little
• 20:10
  strings
• 20:11
  hanging
• 20:11
  that are
• 20:12
  about to
• 20:12
  dissolve,
• 20:13
  people
• 20:14
  just it
• 20:14
  really
• 20:15
  just is
• 20:15
  part of
• 20:16
  the eye.
• 20:17
  But, you
• 20:17
  know, it
• 20:17
  also,
• 20:18
  there's
• 20:18
  little
• 20:18
  details
• 20:18
  too.
• 20:19
  So
• 20:19
  there's
• 20:19
  different
• 20:19
  types
• 20:20
  of suture
• 20:20
  material
• 20:21
  and
• 20:22
  suture
• 20:22
  material
• 20:23
  that is
• 20:23
  more,
• 20:24
  sort
• 20:24
  of what
• 20:24
  we call
• 20:25
  hydrophilic
• 20:25
  or
• 20:26
  sort of
• 20:26
  water
• 20:26
  loving.
• 20:27
  those
• 20:27
  tend
• 20:28
  to be
• 20:28
  less
• 20:28
  noticeable,
• 20:30
  as
• 20:30
  opposed
• 20:30
  to
• 20:30
  certain
• 20:31
  types
• 20:31
  of
• 20:31
  stitches
• 20:32
  that are
• 20:33
  caused
• 20:33
  more
• 20:33
  irritation.
• 20:34
  So there
• 20:34
  definitely
• 20:34
  can be
• 20:35
  variations
• 20:36
  in
• 20:37
  materials
• 20:38
  that
• 20:38
  people
• 20:38
  use, in
• 20:39
  surgery.
• 20:40
  But
• 20:40
  the plaque
• 20:41
  itself
• 20:41
  usually
• 20:42
  does not,
• 20:43
  is not
• 20:43
  felt.
• 20:44
  and, and
• 20:45
  really
• 20:45
  for that
• 20:45
  week
• 20:47
  that the
• 20:47
  plaque
• 20:48
  is in
• 20:48
  place,
• 20:48
  it's
• 20:49
  normal
• 20:50
  to feel
• 20:51
  to have
• 20:51
  that same
• 20:52
  discharge
• 20:53
  coming
• 20:53
  out of
• 20:53
  the eye
• 20:54
  like
• 20:54
  tearing.
• 20:55
  And it's
• 20:55
  normal
• 20:56
  to
• 20:56
  kind of
• 20:56
  look in
• 20:57
  the
• 20:57
  mirror
• 20:57
  and see
• 20:58
  everything
• 20:58
  is
• 20:58
  totally
• 20:58
  swollen,
• 20:59
  like
• 21:00
  you were
• 21:00
  in
• 21:00
  a fight
• 21:01
  and
• 21:01
  everything
• 21:01
  looking
• 21:01
  red.
• 21:03
  but all
• 21:03
  that,
• 21:04
  once that
• 21:05
  week is over
• 21:06
  and
• 21:06
  the plaque
• 21:06
  is out,
• 21:07
  you know,
• 21:07
  everything
• 21:08
  heals
• 21:08
  very
• 21:09
  quickly.
• 21:09
  Like
• 21:09
  within
• 21:10
  a matter
• 21:10
  of even
• 21:12
  a couple
• 21:12
  of weeks
• 21:13
  later,
• 21:13
  when
• 21:13
  you look
• 21:14
  at the
• 21:14
  surface
• 21:15
  of
• 21:15
  the eye
• 21:16
  under
• 21:16
  the microscope,
• 21:17
  you can't
• 21:17
  even see
• 21:18
  where
• 21:19
  those
• 21:19
  incisions
• 21:20
  in the
• 21:20
  conjunctiva
• 21:21
  were.
• 21:21
  You can
• 21:22
  see
• 21:22
  little.
• 21:22
  The
• 21:22
  tissue is
• 21:23
  irregular
• 21:24
  because
• 21:24
  it's
• 21:24
  healing,
• 21:25
  but the
• 21:25
  healing
• 21:25
  happens
• 21:26
  very quickly.
• 21:27
  but
• 21:28
  it definitely
• 21:28
  can feel
• 21:29
  like a
• 21:29
  very
• 21:29
  prolonged,
• 21:30
  uncomfortable,
• 21:31
  I mean,
• 21:32
  uncomfortable,
• 21:33
  not
• 21:33
  so much
• 21:34
  in the
• 21:34
  sense of
• 21:35
  being painful,
• 21:35
  but just
• 21:37
  everything
• 21:37
  being so
• 21:38
  out of
• 21:38
  sorts
• 21:39
  and the
• 21:39
  swelling
• 21:40
  and
• 21:40
  looking
• 21:41
  red and
• 21:41
  feeling
• 21:42
  bumpy.
• 21:42
  I mean,
• 21:43
  that's
• 21:43
  all very
• 21:44
  normal.
• 21:45
  what isn't
• 21:46
  normal,
• 21:46
  though,
• 21:47
  is if
• 21:47
  you have
• 21:48
  a lot
• 21:49
  of pain,
• 21:49
  like
• 21:50
  if it
• 21:50
  feels
• 21:50
  very
• 21:50
  painful,
• 21:52
  especially
• 21:52
  if you
• 21:52
  have pain
• 21:53
  that
• 21:53
  develops
• 21:54
  during
• 21:55
  the
• 21:55
  the few
• 21:55
  days that
• 21:56
  the plaque
• 21:57
  is in
• 21:57
  place
• 21:57
  that wasn't
• 21:58
  there
• 21:58
  before.
• 21:59
  If you
• 21:59
  notice
• 21:59
  anything
• 22:00
  that
• 22:01
  seems
• 22:01
  unusual
• 22:02
  or
• 22:02
  uncomfortable,
• 22:03
  always
• 22:03
  call your
• 22:05
  ophthalmologist.
• 22:06
  Don't
• 22:06
  just
• 22:06
  kind of
• 22:07
  wait.
• 22:07
  And you
• 22:08
  know,
• 22:08
  if you
• 22:09
  know,
• 22:09
  pain that
• 22:09
  develops
• 22:10
  during
• 22:11
  the treatment
• 22:12
  period
• 22:12
  needs
• 22:12
  to be
• 22:13
  reported.
• 22:13
  I mean,
• 22:14
  it's
• 22:14
  possible,
• 22:15
  you know,
• 22:15
  what
• 22:15
  are the
• 22:15
  reasons
• 22:16
  that
• 22:16
  we want
• 22:17
  to
• 22:17
  watch out
• 22:17
  for?
• 22:17
  You could be
• 22:18
  developing
• 22:19
  high
• 22:19
  pressure
• 22:20
  in the
• 22:20
  eye.
• 22:22
  you
• 22:22
  could be
• 22:22
  developing
• 22:23
  an
• 22:23
  infection,
• 22:23
  although
• 22:24
  very
• 22:24
  uncommon,
• 22:25
  but
• 22:25
  still,
• 22:25
  I mean,
• 22:26
  it happens.
• 22:27
  So
• 22:27
  if you
• 22:28
  have any
• 22:28
  unusual
• 22:29
  pain,
• 22:29
  always
• 22:29
  call.
• 22:30
  don't.
• 22:30
  It's
• 22:31
  better
• 22:31
  to be
• 22:31
  safe than
• 22:31
  sorry if.
• 22:33
  And but
• 22:33
  the thing
• 22:33
  that we
• 22:33
  find is
• 22:34
  sometimes
• 22:34
  people
• 22:35
  take take
• 22:35
  photos
• 22:36
  with
• 22:36
  their
• 22:36
  phone
• 22:37
  of what
• 22:37
  it looks like
• 22:38
  and
• 22:38
  they say,
• 22:38
  is this
• 22:38
  normal?
• 22:39
  Or is,
• 22:39
  you know,
• 22:40
  there's
• 22:40
  a string
• 22:41
  I see
• 22:41
  here,
• 22:42
  you know,
• 22:42
  is this
• 22:43
  should I
• 22:43
  be
• 22:43
  concerned?
• 22:44
  So
• 22:45
  I always
• 22:45
  encourage
• 22:46
  people
• 22:46
  to, to
• 22:47
  sort of
• 22:47
  engage
• 22:48
  with your
• 22:49
  ophthalmologist,
• 22:50
  like
• 22:50
  reach
• 22:50
  out to
• 22:51
  the team
• 22:51
  like ask
• 22:52
  questions.
• 22:53
  you don't
• 22:53
  want to
• 22:54
  be kind
• 22:54
  of
• 22:54
  worrying
• 22:55
  during
• 22:55
  that
• 22:55
  week.
• 22:56
  and, and,
• 22:57
  you know,
• 22:57
  pain
• 22:58
  you in
• 22:59
  terms
• 22:59
  of it's
• 23:00
  normal
• 23:00
  to be
• 23:00
  uncomfortable,
• 23:02
  but
• 23:02
  that should,
• 23:03
  even as
• 23:03
  the time
• 23:04
  goes by,
• 23:05
  should
• 23:05
  ease or
• 23:06
  remain
• 23:06
  stable.
• 23:08
  and
• 23:08
  as soon
• 23:08
  as the
• 23:08
  plaque
• 23:09
  comes out
• 23:10
  with each
• 23:10
  passing
• 23:10
  day,
• 23:11
  it should
• 23:11
  start to
• 23:11
  feel
• 23:11
  better
• 23:12
  and
• 23:12
  better.
• 23:13
  So if
• 23:13
  anything
• 23:14
  doesn't
• 23:14
  quite fit
• 23:15
  that,
• 23:15
  or you're
• 23:15
  not sure,
• 23:16
  always
• 23:17
  call.
• 23:17
  I can't
• 23:18
  stress
• 23:18
  that
• 23:18
  enough.
• 23:18
  There's
• 23:19
  there's
• 23:19
  always
• 23:19
  someone
• 23:20
  available
• 23:20
  to answer
• 23:21
  questions
• 23:22
  at major
• 23:22
  centers.
• 23:23
  and so
• 23:24
  definitely
• 23:25
  use them.
• 23:26
  So
• 23:26
  that's
• 23:26
  why
• 23:26
  we have
• 23:27
  all
• 23:27
  the people
• 23:27
  that we do
• 23:28
  so that
• 23:29
  we can
• 23:29
  help
• 23:29
  people
• 23:30
  and bring
• 23:31
  people
• 23:31
  in.
• 23:31
  If there's
• 23:31
  any
• 23:32
  reason
• 23:32
  to double
• 23:32
  check
• 23:33
  something
• 23:33
  during
• 23:33
  the
• 23:33
  treatment.
• 23:35
  and then,
• 23:36
  while
• 23:37
  the
• 23:37
  plaque is
• 23:37
  in place.
• 23:39
  You know,
• 23:39
  often
• 23:40
  I find
• 23:40
  that
• 23:40
  sometimes
• 23:41
  people
• 23:42
  think
• 23:42
  that,
• 23:43
  you know,
• 23:43
  when the
• 23:43
  plaque
• 23:44
  comes out
• 23:44
  that
• 23:44
  melanoma
• 23:45
  is going
• 23:45
  to be gone.
• 23:46
  So
• 23:46
  what actually
• 23:47
  happens
• 23:47
  is the
• 23:48
  the
• 23:48
  radiation
• 23:49
  destroys
• 23:50
  the DNA
• 23:52
  in the
• 23:52
  melanoma
• 23:53
  tissue
• 23:53
  and does
• 23:53
  destroys
• 23:54
  the DNA
• 23:55
  in
• 23:55
  anything
• 23:55
  in its
• 23:56
  path.
• 23:56
  But
• 23:56
  because
• 23:57
  cancer
• 23:58
  cells
• 23:58
  are more
• 23:59
  rapidly
• 23:59
  dividing,
• 24:00
  their DNA
• 24:01
  is
• 24:02
  more sensitive.
• 24:03
  And so
• 24:04
  the those
• 24:05
  cancer
• 24:05
  cells are
• 24:06
  very
• 24:06
  prone to
• 24:07
  and
• 24:07
  they're
• 24:07
  very
• 24:08
  responsive
• 24:08
  to the
• 24:08
  radiation
• 24:09
  treatment.
• 24:10
  but right
• 24:11
  when the
• 24:11
  plaque
• 24:11
  comes
• 24:12
  out,
• 24:12
  things
• 24:13
  generally
• 24:13
  look
• 24:14
  about
• 24:14
  the same.
• 24:15
  They
• 24:15
  don't,
• 24:15
  it
• 24:15
  doesn't
• 24:16
  you
• 24:16
  really
• 24:16
  can't
• 24:17
  tell much
• 24:18
  difference
• 24:18
  in just a
• 24:19
  few days.
• 24:20
  However,
• 24:21
  often
• 24:22
  times
• 24:22
  by about
• 24:23
  a month
• 24:23
  afterwards,
• 24:24
  there
• 24:25
  are the
• 24:25
  the tumor
• 24:26
  can start
• 24:27
  looking
• 24:27
  different.
• 24:28
  one thing
• 24:28
  to point out
• 24:29
  is that
• 24:29
  depending
• 24:30
  on
• 24:30
  how big
• 24:31
  your tumor
• 24:31
  is to
• 24:32
  start
• 24:32
  with,
• 24:32
  that
• 24:33
  depends.
• 24:33
  That will
• 24:34
  determine
• 24:34
  how much
• 24:35
  change
• 24:35
  we see.
• 24:36
  So
• 24:37
  a person
• 24:37
  who has a
• 24:38
  very
• 24:38
  large
• 24:38
  melanoma
• 24:39
  will see
• 24:40
  a lot
• 24:40
  of
• 24:40
  changes
• 24:41
  faster
• 24:42
  in the
• 24:42
  recovery
• 24:43
  period.
• 24:43
  If
• 24:44
  you start off
• 24:44
  with a
• 24:44
  really
• 24:45
  tiny
• 24:45
  melanoma,
• 24:46
  we might not
• 24:47
  see
• 24:47
  very much
• 24:48
  right
• 24:48
  after
• 24:48
  the treatment.
• 24:49
  And
• 24:49
  it might
• 24:50
  take
• 24:51
  several
• 24:51
  visits
• 24:52
  to
• 24:52
  actually
• 24:53
  see
• 24:54
  reduction
• 24:55
  and
• 24:55
  leaking
• 24:56
  or even a
• 24:57
  little
• 24:57
  shriveling.
• 24:58
  So
• 24:58
  the smaller
• 24:59
  something
• 24:59
  is,
• 25:00
  the longer
• 25:00
  it's
• 25:01
  going
• 25:01
  to take
• 25:01
  to see
• 25:01
  much
• 25:02
  difference.
• 25:03
  But
• 25:03
  the bigger
• 25:03
  it is,
• 25:04
  the faster
• 25:05
  we see
• 25:05
  response.
• 25:07
  And so
• 25:07
  that's
• 25:07
  something
• 25:08
  to keep
• 25:08
  in mind
• 25:08
  because
• 25:08
  I, I know
• 25:09
  that it's
• 25:10
  normal
• 25:11
  when
• 25:11
  you get
• 25:11
  checked
• 25:11
  afterwards
• 25:12
  to kind
• 25:13
  of be
• 25:14
  hoping
• 25:14
  that I
• 25:14
  hope that
• 25:15
  it's
• 25:15
  shrunken,
• 25:15
  I hope
• 25:16
  that it's
• 25:16
  gone.
• 25:17
  But,
• 25:17
  you know,
• 25:18
  one thing
• 25:18
  to point out
• 25:19
  is that
• 25:19
  really
• 25:20
  whether
• 25:20
  if it
• 25:21
  if it's
• 25:22
  decreased
• 25:22
  in size
• 25:23
  or about
• 25:24
  the same
• 25:24
  size,
• 25:25
  that's
• 25:25
  kind of
• 25:25
  the same,
• 25:26
  in terms
• 25:27
  of the
• 25:27
  ocular
• 25:28
  oncologist
• 25:28
  perspective,
• 25:29
  when
• 25:29
  we're
• 25:29
  looking,
• 25:30
  if it
• 25:31
  doesn't
• 25:31
  shrink
• 25:31
  a little
• 25:32
  bit,
• 25:32
  it
• 25:33
  doesn't
• 25:33
  matter
• 25:33
  one way
• 25:34
  or the
• 25:34
  other
• 25:34
  to us.
• 25:34
  So, so
• 25:35
  we don't
• 25:35
  feel bad
• 25:36
  at all.
• 25:36
  So
• 25:36
  I want to
• 25:37
  point out
• 25:37
  that
• 25:38
  that's
• 25:38
  not
• 25:39
  necessarily
• 25:40
  like
• 25:40
  bad news
• 25:41
  if we don't
• 25:41
  see
• 25:42
  shrinkage
• 25:42
  and even,
• 25:43
  you know,
• 25:44
  years
• 25:44
  after
• 25:44
  follow
• 25:45
  up,
• 25:45
  we might see
• 25:46
  some
• 25:46
  reduction.
• 25:47
  And then
• 25:47
  it's the
• 25:47
  same
• 25:48
  measurements
• 25:49
  for
• 25:49
  a lot of
• 25:49
  time,
• 25:50
  then
• 25:50
  make it
• 25:50
  a little
• 25:50
  smaller.
• 25:51
  But,
• 25:52
  you know,
• 25:52
  as long
• 25:52
  as it's,
• 25:53
  you know,
• 25:53
  responded
• 25:54
  from its
• 25:54
  original
• 25:55
  state,
• 25:55
  you know,
• 25:56
  we're
• 25:56
  we're
• 25:56
  ahead.
• 25:59
  most
• 25:59
  times,
• 26:00
  you know,
• 26:00
  most
• 26:01
  centers
• 26:01
  do
• 26:02
  anywhere
• 26:02
  from 4
• 26:03
  to 7 days
• 26:05
  of a
• 26:05
  brachytherapy
• 26:06
  treatment.
• 26:06
  And
• 26:07
  you know
• 26:07
  the
• 26:07
  question.
• 26:08
  You know
• 26:08
  what?
• 26:09
  You know,
• 26:09
  we see
• 26:09
  a lot
• 26:09
  of people
• 26:10
  for
• 26:10
  second
• 26:10
  opinions.
• 26:11
  And
• 26:11
  people
• 26:11
  are
• 26:11
  wondering,
• 26:12
  why would I
• 26:13
  have,
• 26:13
  like,
• 26:14
  why do I have
• 26:15
  to have
• 26:15
  X number
• 26:16
  of days
• 26:16
  versus
• 26:16
  another?
• 26:17
  Well,
• 26:17
  it
• 26:18
  usually
• 26:18
  is just
• 26:18
  based on
• 26:19
  logistics.
• 26:20
  And for
• 26:21
  example,
• 26:22
  the ocular
• 26:23
  surgeon
• 26:23
  might put
• 26:24
  the plaque
• 26:24
  in on
• 26:24
  a Monday
• 26:25
  and it's
• 26:25
  convenient
• 26:26
  to
• 26:26
  take it
• 26:26
  out on
• 26:26
  a Friday.
• 26:27
  You know,
• 26:28
  at
• 26:28
  our center,
• 26:29
  we,
• 26:29
  we always
• 26:29
  plan for
• 26:30
  seven day
• 26:30
  plaques
• 26:31
  just
• 26:31
  so that
• 26:32
  we
• 26:32
  come back
• 26:33
  to
• 26:33
  the day
• 26:33
  that
• 26:34
  I have
• 26:34
  assigned
• 26:35
  to me
• 26:35
  to do
• 26:35
  surgery
• 26:36
  at our center.
• 26:37
  And,
• 26:38
  just
• 26:38
  because
• 26:39
  we have
• 26:39
  a lot
• 26:39
  of number
• 26:40
  of days
• 26:40
  doesn't
• 26:41
  mean
• 26:41
  we have
• 26:41
  any more
• 26:42
  radiation.
• 26:43
  So what
• 26:43
  the physics
• 26:44
  the physicists
• 26:45
  do is
• 26:45
  they
• 26:46
  determine
• 26:46
  how much
• 26:46
  radiation
• 26:47
  is needed
• 26:48
  to kill
• 26:48
  a
• 26:48
  melanoma
• 26:49
  of
• 26:49
  that size,
• 26:50
  and then
• 26:51
  they look
• 26:51
  at the
• 26:52
  amount
• 26:52
  of time
• 26:52
  that they
• 26:52
  have to
• 26:53
  to have
• 26:53
  the
• 26:54
  radiation
• 26:55
  be
• 26:55
  released.
• 26:55
  And so
• 26:56
  when you
• 26:57
  have a
• 26:57
  longer
• 26:57
  number
• 26:58
  of days,
• 26:58
  usually
• 26:58
  the
• 26:59
  radiation
• 26:59
  release
• 26:59
  is slower.
• 27:01
  If you have a
• 27:01
  very if
• 27:02
  you're
• 27:02
  only,
• 27:02
  say,
• 27:02
  putting it
• 27:03
  in for
• 27:03
  three
• 27:03
  days,
• 27:04
  then
• 27:05
  our physics,
• 27:05
  our physicists
• 27:06
  like to
• 27:06
  call,
• 27:07
  they call
• 27:07
  that
• 27:07
  like
• 27:07
  a very
• 27:08
  hot
• 27:08
  plaque,
• 27:08
  because
• 27:09
  there's
• 27:09
  much more
• 27:10
  radiation
• 27:10
  coming
• 27:11
  out,
• 27:11
  because
• 27:11
  all of it
• 27:11
  has to
• 27:12
  come out
• 27:12
  in
• 27:12
  three days.
• 27:14
  So
• 27:14
  it really
• 27:14
  just
• 27:14
  depends
• 27:15
  on
• 27:15
  planning.
• 27:16
  The amount
• 27:17
  of
• 27:17
  radiation
• 27:17
  that is
• 27:18
  used is
• 27:19
  really
• 27:19
  based on
• 27:20
  the tumor
• 27:21
  dimensions
• 27:22
  that the
• 27:22
  radiation
• 27:23
  team
• 27:23
  get
• 27:24
  when they
• 27:24
  construct
• 27:25
  the
• 27:25
  plaque.
• 27:26
  and
• 27:26
  sometimes
• 27:27
  I
• 27:27
  mentioned
• 27:28
  before
• 27:28
  that,
• 27:28
  you know,
• 27:29
  some
• 27:29
  ultrasound
• 27:30
  can help
• 27:30
  give more
• 27:31
  information
• 27:31
  during
• 27:32
  the surgery,
• 27:33
  for
• 27:33
  example,
• 27:34
  a larger
• 27:34
  size
• 27:34
  melanoma.
• 27:35
  We
• 27:36
  we always
• 27:36
  remeasure them
• 27:37
  because
• 27:38
  they
• 27:38
  the bigger
• 27:39
  the tumor
• 27:40
  is like
• 27:40
  the more
• 27:41
  cancer
• 27:41
  cells
• 27:41
  there
• 27:41
  are.
• 27:42
  So
• 27:42
  the higher
• 27:42
  the
• 27:42
  likelihood
• 27:43
  that it
• 27:43
  can
• 27:43
  increase
• 27:44
  in size.
• 27:45
  if you
• 27:46
  if you
• 27:46
  have a
• 27:46
  delay in
• 27:47
  treatment,
• 27:47
  like
• 27:48
  if it's
• 27:48
  say that
• 27:49
  you're
• 27:49
  supposed
• 27:49
  to go,
• 27:50
  but
• 27:50
  you were
• 27:50
  delayed
• 27:50
  a couple of weeks.
• 27:51
  So really
• 27:52
  confirming
• 27:53
  the
• 27:53
  measurement
• 27:54
  at
• 27:54
  the time
• 27:55
  of
• 27:55
  surgery
• 27:55
  is
• 27:55
  really important.
• 27:56
  Because
• 27:56
  if we add
• 27:56
  extra
• 27:57
  days,
• 27:58
  it's to
• 27:58
  help make
• 27:59
  sure
• 27:59
  we get
• 27:59
  the treatment.
• 28:00
  And then
• 28:01
  there's
• 28:01
  another
• 28:01
  reason
• 28:01
  sometimes
• 28:02
  we add
• 28:02
  a day
• 28:03
  or so is
• 28:04
  because
• 28:05
  when we
• 28:05
  look
• 28:05
  at it
• 28:06
  by
• 28:06
  ultrasound,
• 28:07
  sometimes
• 28:08
  these
• 28:08
  breakthrough
• 28:08
  therapy
• 28:09
  plaques,
• 28:10
  they don't
• 28:10
  fit
• 28:11
  perfectly
• 28:12
  around
• 28:12
  the
• 28:12
  roundness
• 28:13
  of the eye.
• 28:13
  And
• 28:13
  sometimes
• 28:14
  when
• 28:14
  you see
• 28:15
  by
• 28:15
  ultrasound,
• 28:16
  you can see
• 28:16
  that
• 28:16
  the plaque
• 28:17
  might be
• 28:17
  a little
• 28:17
  bit away
• 28:18
  from
• 28:18
  the eye
• 28:19
  wall.
• 28:20
  And so
• 28:20
  what
• 28:20
  we do
• 28:21
  is we
• 28:21
  measure
• 28:22
  that
• 28:22
  space
• 28:23
  and
• 28:23
  recalculate
• 28:24
  because
• 28:25
  we don't
• 28:25
  want to
• 28:25
  under
• 28:26
  treat
• 28:26
  just
• 28:26
  because
• 28:26
  the
• 28:26
  plaque
• 28:27
  is a
• 28:27
  little
• 28:27
  bit away
• 28:28
  from
• 28:28
  the eye
• 28:28
  wall.
• 28:29
  and
• 28:30
  the reason
• 28:30
  for this
• 28:31
  is
• 28:31
  because
• 28:31
  there's,
• 28:31
  there's,
• 28:32
  there's
• 28:32
  a lot
• 28:32
  of
• 28:32
  tissues
• 28:33
  in the,
• 28:34
  in
• 28:34
  the eye
• 28:34
  space,
• 28:35
  and
• 28:35
  especially
• 28:36
  when
• 28:36
  the tumors
• 28:37
  are very
• 28:38
  posterior
• 28:38
  at the
• 28:38
  back
• 28:39
  of the eye
• 28:39
  or the
• 28:39
  very tiny,
• 28:40
  sometimes
• 28:41
  on
• 28:41
  ultrasound,
• 28:41
  we can see
• 28:42
  some
• 28:42
  tissue
• 28:42
  between
• 28:43
  the plaque
• 28:44
  and
• 28:44
  the eye
• 28:44
  wall.
• 28:45
  And even
• 28:46
  if you go
• 28:46
  and try
• 28:46
  to move
• 28:47
  the tissue,
• 28:47
  sometimes
• 28:48
  you just
• 28:48
  can't.
• 28:49
  Nothing
• 28:49
  really
• 28:50
  moves
• 28:50
  depending
• 28:51
  on
• 28:51
  where it is.
• 28:51
  So
• 28:51
  we just
• 28:52
  recalculate
• 28:53
  the treatment.
• 28:53
  So
• 28:54
  a lot of
• 28:54
  adjustments
• 28:54
  can
• 28:55
  happen
• 28:55
  to the
• 28:56
  treatment
• 28:56
  plan at
• 28:57
  the time
• 28:57
  of
• 28:57
  surgery.
• 28:58
  and it's
• 28:59
  important
• 28:59
  to
• 28:59
  kind of
• 29:00
  look for
• 29:00
  things
• 29:01
  and allow
• 29:01
  for being
• 29:02
  flexible
• 29:03
  if
• 29:03
  it's going
• 29:04
  to
• 29:04
  result in
• 29:04
  better
• 29:05
  treatment.
• 29:07
  While
• 29:08
  they have
• 29:08
  it on
• 29:09
  whether
• 29:10
  it's
• 29:10
  four days
• 29:10
  or
• 29:10
  seven
• 29:11
  days or
• 29:11
  whatever,
• 29:11
  what
• 29:12
  can they
• 29:12
  expect?
• 29:13
  Like are
• 29:13
  they,
• 29:14
  are they going
• 29:14
  to feel
• 29:15
  nauseous?
• 29:15
  Are
• 29:15
  they
• 29:15
  allowed
• 29:15
  to drive?
• 29:16
  Do
• 29:16
  they need
• 29:16
  a special
• 29:17
  diet?
• 29:17
  Like
• 29:17
  what's
• 29:18
  that time
• 29:19
  with the
• 29:19
  patch on
• 29:20
  going to
• 29:20
  look
• 29:20
  like?
• 29:22
  Yeah,
• 29:22
  that's a
• 29:22
  great question.
• 29:25
  so we
• 29:26
  generally
• 29:27
  recommend
• 29:28
  well,
• 29:28
  first
• 29:28
  of all
• 29:28
  I'm going
• 29:29
  to just
• 29:29
  go real
• 29:29
  basic.
• 29:30
  So
• 29:30
  are really
• 29:31
  are
• 29:31
  physicists
• 29:32
  recommend
• 29:32
  that
• 29:33
  people
• 29:33
  don't go
• 29:34
  into
• 29:34
  crowds of
• 29:35
  people.
• 29:36
  and, and
• 29:36
  I
• 29:37
  always say
• 29:37
  if you're
• 29:37
  around
• 29:38
  people
• 29:38
  or pets,
• 29:39
  just wear
• 29:40
  the lead
• 29:40
  shield
• 29:41
  and, they
• 29:42
  we often
• 29:43
  provide
• 29:43
  most
• 29:43
  centers
• 29:43
  provide
• 29:44
  literally
• 29:45
  like a
• 29:45
  pirate
• 29:45
  patch
• 29:46
  with a
• 29:46
  lead
• 29:46
  on it
• 29:46
  to,
• 29:47
  to reduce
• 29:48
  or to
• 29:48
  really
• 29:48
  to
• 29:49
  prevent
• 29:50
  any
• 29:50
  extraneous
• 29:51
  radiation
• 29:52
  from
• 29:52
  coming
• 29:52
  around.
• 29:54
  and, and,
• 29:55
  you know,
• 29:55
  it's
• 29:56
  important
• 29:56
  to
• 29:56
  keep in
• 29:56
  mind that
• 29:58
  the
• 29:58
  amount
• 29:59
  the
• 29:59
  eyeball
• 29:59
  is so
• 29:59
  small,
• 30:01
  a
• 30:01
  melanoma,
• 30:01
  even a
• 30:02
  you know,
• 30:03
  the size
• 30:03
  of tumors
• 30:04
  is very
• 30:04
  relative
• 30:05
  but
• 30:05
  relative,
• 30:06
  the whole
• 30:06
  body
• 30:07
  very tiny.
• 30:08
  So
• 30:08
  the amount
• 30:08
  of
• 30:08
  radiation
• 30:09
  that even
• 30:09
  can be
• 30:10
  detected
• 30:10
  close
• 30:11
  to
• 30:11
  a person
• 30:12
  with the
• 30:12
  brachytherapy
• 30:13
  plaque,
• 30:14
  even a
• 30:14
  treating
• 30:15
  a large
• 30:15
  tumor is
• 30:16
  very low.
• 30:17
  But
• 30:18
  because,
• 30:19
  you know,
• 30:19
  like most
• 30:19
  physics
• 30:20
  and
• 30:20
  radiation
• 30:21
  oncology
• 30:21
  departments,
• 30:22
  we
• 30:22
  recommend
• 30:23
  just
• 30:23
  the same
• 30:24
  protocols,
• 30:25
  whether
• 30:25
  you're
• 30:25
  having,
• 30:26
  you know,
• 30:27
  whatever
• 30:27
  the organ
• 30:27
  is.
• 30:28
  So
• 30:28
  they always
• 30:28
  recommend
• 30:29
  wearing
• 30:29
  the lead
• 30:30
  being,
• 30:31
  a certain
• 30:31
  amount,
• 30:32
  a certain
• 30:32
  amount of
• 30:33
  distance
• 30:33
  away
• 30:33
  from people.
• 30:34
  But
• 30:35
  I just
• 30:35
  sort of
• 30:36
  simplify
• 30:36
  it to
• 30:37
  if there
• 30:37
  if people
• 30:38
  around
• 30:38
  you
• 30:38
  put it
• 30:38
  on,
• 30:39
  if you're
• 30:39
  by
• 30:39
  yourself,
• 30:40
  have it
• 30:40
  open.
• 30:42
  and and
• 30:43
  just
• 30:43
  try to
• 30:44
  minimize
• 30:44
  that, but
• 30:45
  not
• 30:45
  to be alarmed
• 30:46
  if
• 30:46
  suddenly
• 30:47
  your
• 30:47
  family
• 30:47
  member
• 30:48
  is
• 30:48
  sitting
• 30:48
  on your
• 30:48
  lap and
• 30:50
  oops,
• 30:50
  we forgot
• 30:50
  about
• 30:51
  that,
• 30:51
  you can
• 30:51
  just,
• 30:52
  you know,
• 30:52
  nothing,
• 30:53
  nothing
• 30:54
  is going
• 30:54
  to
• 30:54
  happen.
• 30:54
  And we've
• 30:55
  never
• 30:55
  heard of
• 30:56
  a case
• 30:56
  of
• 30:56
  someone
• 30:57
  developing
• 30:57
  a problem
• 30:58
  with
• 30:59
  a partner
• 30:59
  or
• 30:59
  somebody
• 31:00
  getting
• 31:00
  exposed.
• 31:01
  But we
• 31:01
  just
• 31:02
  do it
• 31:02
  for
• 31:02
  safety.
• 31:03
  most
• 31:04
  people
• 31:04
  feel
• 31:05
  nauseous.
• 31:06
  If people
• 31:07
  feel
• 31:07
  nauseous
• 31:08
  the day
• 31:09
  after
• 31:09
  surgery,
• 31:10
  it's
• 31:10
  in my
• 31:11
  experience,
• 31:11
  it's
• 31:11
  usually
• 31:12
  the
• 31:12
  anesthesia
• 31:13
  that's
• 31:14
  wearing
• 31:14
  off.
• 31:14
  And,
• 31:15
  and I
• 31:15
  find
• 31:16
  that,
• 31:16
  you know,
• 31:16
  when
• 31:17
  we're
• 31:17
  checking
• 31:17
  people
• 31:17
  the first
• 31:18
  day after
• 31:18
  surgery,
• 31:19
  a
• 31:19
  lot of people,
• 31:20
  not
• 31:20
  a lot of
• 31:20
  people,
• 31:20
  but some
• 31:21
  people,
• 31:21
  especially
• 31:21
  younger
• 31:22
  people,
• 31:22
  young men
• 31:23
  tend
• 31:23
  to be
• 31:24
  kind of
• 31:25
  not like
• 31:25
  they're
• 31:26
  kind of
• 31:26
  passing
• 31:26
  out
• 31:27
  or not
• 31:27
  feeling
• 31:27
  good.
• 31:28
  it's it's
• 31:29
  a lot
• 31:29
  of it
• 31:30
  is the
• 31:30
  anesthetic
• 31:31
  that is
• 31:31
  that is
• 31:32
  still in
• 31:32
  the system.
• 31:33
  And that
• 31:34
  usually
• 31:34
  passes
• 31:35
  after
• 31:35
  about a day.
• 31:36
  So
• 31:36
  I would
• 31:36
  tell
• 31:37
  people
• 31:37
  to be
• 31:38
  just,
• 31:38
  you know,
• 31:39
  and in
• 31:39
  terms of diet
• 31:40
  and what
• 31:41
  you should
• 31:41
  eat,
• 31:41
  don't
• 31:41
  don't
• 31:42
  rush
• 31:42
  anything
• 31:43
  because
• 31:43
  if you're
• 31:44
  kind of
• 31:45
  a little
• 31:45
  bit on a
• 31:46
  roller
• 31:46
  coaster
• 31:47
  in terms
• 31:48
  of nausea
• 31:48
  and not
• 31:48
  feeling
• 31:49
  great
• 31:49
  the very
• 31:50
  next day
• 31:50
  after
• 31:51
  surgery,
• 31:51
  you want to
• 31:51
  take it
• 31:52
  easy.
• 31:52
  So go.
• 31:54
  You know,
• 31:54
  you
• 31:54
  probably
• 31:55
  people
• 31:55
  have been
• 31:56
  sort of,
• 31:56
  you know,
• 31:56
  no food
• 31:57
  or drink
• 31:57
  before
• 31:58
  midnight
• 31:58
  and
• 31:58
  people
• 31:58
  have been
• 31:59
  eating up
• 32:00
  until the
• 32:00
  surgery.
• 32:01
  So go
• 32:01
  really
• 32:01
  slow.
• 32:02
  Lots of
• 32:02
  fluids.
• 32:03
  you know,
• 32:04
  don't
• 32:04
  don't
• 32:04
  rush into
• 32:05
  a big meal
• 32:05
  right
• 32:06
  after the
• 32:06
  surgery.
• 32:07
  Just go
• 32:07
  slowly,
• 32:08
  and
• 32:09
  sort of
• 32:09
  build up
• 32:09
  your appetite.
• 32:10
  Wait
• 32:10
  till you
• 32:10
  really
• 32:11
  have a
• 32:11
  strong
• 32:11
  appetite
• 32:12
  because
• 32:12
  it's not
• 32:13
  unusual
• 32:14
  to feel
• 32:14
  a bit off
• 32:15
  after
• 32:15
  you have
• 32:16
  a procedure.
• 32:17
  And
• 32:17
  much of
• 32:17
  it isn't.
• 32:18
  As
• 32:18
  I said,
• 32:18
  it's
• 32:18
  mainly
• 32:19
  the anesthetic.
• 32:19
  It's not
• 32:20
  necessarily
• 32:20
  the,
• 32:21
  you know,
• 32:22
  manipulating
• 32:23
  the eye
• 32:23
  itself,
• 32:24
  although
• 32:25
  some
• 32:25
  people,
• 32:26
  if you
• 32:26
  feel
• 32:26
  really
• 32:27
  nauseous
• 32:27
  or
• 32:28
  unwell,
• 32:29
  we really
• 32:29
  we have
• 32:29
  to
• 32:30
  make sure
• 32:31
  that
• 32:31
  the eye
• 32:31
  is doing
• 32:32
  okay.
• 32:32
  And
• 32:32
  that's
• 32:32
  why we
• 32:33
  check
• 32:33
  people
• 32:33
  the day
• 32:34
  after
• 32:34
  surgery
• 32:35
  to check
• 32:35
  the
• 32:36
  intraocular
• 32:36
  pressure.
• 32:37
  Now
• 32:37
  sometimes
• 32:38
  the
• 32:38
  pressure
• 32:38
  can go up
• 32:39
  just
• 32:40
  having
• 32:40
  surgery.
• 32:41
  So
• 32:41
  we want to
• 32:41
  make sure
• 32:42
  if that
• 32:42
  is the
• 32:43
  case,
• 32:43
  that we
• 32:43
  treat it
• 32:44
  during
• 32:44
  the
• 32:44
  post-operative
• 32:45
  period.
• 32:47
  usually
• 32:48
  with each
• 32:48
  passing
• 32:49
  day the
• 32:50
  the person
• 32:51
  should
• 32:51
  feel a
• 32:51
  little
• 32:52
  bit more
• 32:52
  comfortable
• 32:53
  and,
• 32:53
  you know,
• 32:54
  the
• 32:54
  swelling
• 32:54
  will get
• 32:55
  less.
• 32:55
  and I
• 32:56
  encourage,
• 32:57
  you know,
• 32:57
  if,
• 32:57
  if
• 32:58
  the
• 32:58
  eye is
• 32:58
  so
• 32:58
  swollen
• 32:59
  that it
• 33:00
  can't
• 33:00
  even move
• 33:01
  when the,
• 33:02
  when the
• 33:02
  patch
• 33:02
  comes off
• 33:03
  and it's
• 33:03
  being
• 33:03
  checked
• 33:04
  that
• 33:04
  a person
• 33:05
  do
• 33:05
  a short
• 33:05
  course
• 33:06
  of, of
• 33:06
  of
• 33:06
  steroids,
• 33:07
  like,
• 33:07
  like a
• 33:08
  medrol
• 33:08
  dose pack
• 33:09
  because
• 33:10
  the pain
• 33:10
  when
• 33:11
  tissues
• 33:11
  are
• 33:11
  swollen
• 33:12
  can be
• 33:12
  excruciating.
• 33:13
  And it's
• 33:14
  very safe
• 33:15
  to have
• 33:15
  something
• 33:16
  to just
• 33:16
  to
• 33:16
  get you
• 33:16
  to feel
• 33:17
  okay
• 33:18
  afterwards.
• 33:19
  we use
• 33:20
  solu
• 33:20
  medrol
• 33:21
  intravenously
• 33:22
  for
• 33:23
  during
• 33:23
  our operations
• 33:24
  and ever
• 33:25
  like a
• 33:26
  colleague
• 33:26
  of mine.
• 33:27
  was doing
• 33:28
  this for
• 33:28
  scleral
• 33:29
  buckles,
• 33:29
  and I
• 33:30
  started
• 33:30
  doing it,
• 33:31
  I don't
• 33:31
  know,
• 33:31
  maybe 12
• 33:32
  years
• 33:32
  ago.
• 33:33
  And it's
• 33:33
  just
• 33:33
  it's day
• 33:34
  and
• 33:34
  night.
• 33:35
  We used
• 33:35
  to have
• 33:36
  so much
• 33:36
  trouble
• 33:36
  taking
• 33:37
  the patch off
• 33:37
  because
• 33:37
  people
• 33:38
  were
• 33:38
  so sore
• 33:38
  because
• 33:39
  of the
• 33:39
  swelling.
• 33:39
  And now
• 33:40
  people
• 33:40
  walk in
• 33:41
  like like
• 33:42
  nothing's
• 33:42
  happened.
• 33:42
  So
• 33:43
  it really
• 33:43
  makes a
• 33:44
  difference.
• 33:44
  So really
• 33:45
  kind of,
• 33:45
  you know,
• 33:45
  there's
• 33:46
  little
• 33:46
  things
• 33:46
  you can
• 33:46
  do.
• 33:46
  And
• 33:46
  I also
• 33:47
  tell
• 33:47
  people
• 33:47
  to use
• 33:48
  a lot of ice.
• 33:49
  So
• 33:50
  the swelling
• 33:51
  can be
• 33:51
  if it's
• 33:52
  a lot of
• 33:52
  inflammatory
• 33:53
  swelling.
• 33:53
  So
• 33:54
  if you have
• 33:54
  like ice
• 33:55
  chips
• 33:55
  or frozen
• 33:56
  peas
• 33:56
  in a bag,
• 33:57
  put it
• 33:57
  in a Ziploc
• 33:58
  bag and
• 33:58
  just
• 33:58
  hold it
• 33:59
  over
• 33:59
  your eye.
• 34:00
  That'll
• 34:00
  really
• 34:01
  help with
• 34:01
  the swelling.
• 34:02
  And
• 34:02
  if you
• 34:02
  use do
• 34:03
  a lot
• 34:03
  of icing
• 34:05
  of
• 34:05
  the eye,
• 34:06
  you will
• 34:06
  probably
• 34:08
  you need
• 34:08
  to use
• 34:08
  less
• 34:09
  Tylenol
• 34:09
  or Advil,
• 34:10
  and I
• 34:11
  recommend
• 34:11
  everybody
• 34:12
  use
• 34:12
  Tylenol
• 34:12
  and Advil
• 34:13
  if they're
• 34:14
  uncomfortable.
• 34:15
  we have
• 34:15
  not
• 34:16
  had to
• 34:16
  use
• 34:17
  narcotics
• 34:18
  for many
• 34:19
  years
• 34:19
  now.
• 34:20
  and so
• 34:21
  there are
• 34:21
  measures
• 34:22
  that you
• 34:22
  can do
• 34:23
  to help
• 34:23
  alleviate
• 34:24
  the sort
• 34:24
  of
• 34:24
  post-operative
• 34:25
  pain and
• 34:25
  discomfort.
• 34:27
  think the
• 34:27
  the last
• 34:28
  part of
• 34:28
  it
• 34:28
  would be
• 34:28
  what's
• 34:29
  their
• 34:29
  activity
• 34:29
  level?
• 34:30
  Are they
• 34:30
  should
• 34:30
  they be
• 34:31
  kind of
• 34:31
  laying
• 34:31
  low, not
• 34:32
  driving,
• 34:33
  or
• 34:33
  can they
• 34:34
  do
• 34:34
  anything.
• 34:35
  Yeah,
• 34:36
  that's
• 34:36
  a great question.
• 34:37
  So
• 34:37
  you know
• 34:38
  I tell
• 34:38
  people
• 34:39
  to just
• 34:39
  you know,
• 34:39
  if you're
• 34:40
  feeling
• 34:40
  well just
• 34:42
  go back
• 34:42
  and do
• 34:42
  your
• 34:43
  physical
• 34:43
  activities.
• 34:44
  There's
• 34:44
  really,
• 34:45
  no reason
• 34:46
  to
• 34:46
  kind of
• 34:47
  rest
• 34:48
  and lay
• 34:48
  in bed
• 34:49
  and
• 34:49
  really
• 34:50
  chill
• 34:50
  out.
• 34:51
  I
• 34:51
  find that
• 34:51
  when the
• 34:52
  more
• 34:52
  people
• 34:53
  kind of
• 34:53
  get back
• 34:54
  to doing
• 34:54
  things
• 34:55
  moving
• 34:55
  around
• 34:56
  their home
• 34:56
  or,
• 34:57
  you know,
• 34:57
  doing
• 34:58
  light
• 34:58
  exercise,
• 34:59
  the people
• 35:00
  recover
• 35:01
  much
• 35:01
  better.
• 35:02
  You know,
• 35:02
  it's it's
• 35:03
  know
• 35:03
  nowadays
• 35:04
  especially
• 35:05
  we used
• 35:05
  to do
• 35:06
  a lot
• 35:06
  more
• 35:06
  positioning
• 35:07
  in
• 35:08
  retinal
• 35:08
  surgery.
• 35:09
  Have
• 35:09
  people be
• 35:09
  face down
• 35:10
  for two
• 35:10
  weeks
• 35:10
  or do
• 35:11
  even,
• 35:11
  you know,
• 35:12
  way back
• 35:12
  when people
• 35:13
  have
• 35:13
  to be
• 35:13
  in
• 35:13
  patients
• 35:14
  to have
• 35:14
  cataract
• 35:15
  surgery?
• 35:15
  We've
• 35:16
  really
• 35:16
  moved
• 35:16
  away from
• 35:17
  that.
• 35:17
  Now.
• 35:17
  People
• 35:18
  don't
• 35:18
  even
• 35:18
  position
• 35:19
  a lot of times
• 35:20
  for
• 35:20
  retinal surgery.
• 35:21
  and
• 35:22
  so it's
• 35:23
  really
• 35:23
  important
• 35:24
  to get
• 35:24
  people,
• 35:25
  you know,
• 35:25
  feeling
• 35:25
  good
• 35:26
  as soon
• 35:26
  as
• 35:26
  possible
• 35:26
  and doing
• 35:28
  things
• 35:28
  that
• 35:28
  they feel
• 35:28
  comfortable.
• 35:29
  I tell people,
• 35:29
  if you're
• 35:30
  feeling
• 35:30
  if
• 35:31
  something
• 35:31
  you're
• 35:31
  doing
• 35:31
  makes you
• 35:32
  feel
• 35:32
  uncomfortable,
• 35:33
  like even
• 35:33
  you
• 35:33
  mentioned
• 35:33
  driving,
• 35:34
  technically
• 35:35
  you can
• 35:35
  drive
• 35:36
  legally,
• 35:37
  but it's
• 35:38
  really
• 35:38
  a matter
• 35:38
  of
• 35:39
  comfort.
• 35:39
  So once
• 35:40
  you're
• 35:40
  comfortable
• 35:40
  moving
• 35:41
  around
• 35:41
  your home,
• 35:42
  it is
• 35:42
  probably
• 35:43
  is it
• 35:44
  safe
• 35:44
  to go
• 35:45
  very
• 35:45
  short
• 35:45
  distances
• 35:46
  if you want
• 35:47
  to, if
• 35:47
  you're
• 35:47
  just if
• 35:47
  you're
• 35:47
  feeling
• 35:48
  unwell
• 35:48
  or not
• 35:49
  good,
• 35:49
  or
• 35:49
  you feel off
• 35:50
  because
• 35:51
  your eye
• 35:51
  is
• 35:51
  really blurry,
• 35:52
  then
• 35:52
  definitely
• 35:53
  have
• 35:53
  people
• 35:53
  help you,
• 35:54
  you know,
• 35:54
  and wait
• 35:55
  till
• 35:55
  you feel
• 35:56
  comfortable
• 35:56
  before
• 35:57
  venturing
• 35:58
  back into
• 35:59
  all the
• 35:59
  regular
• 35:59
  activities.
• 36:00
  But in
• 36:01
  general,
• 36:01
  I
• 36:02
  recommend
• 36:03
  people
• 36:03
  don't
• 36:03
  lay low
• 36:04
  for that
• 36:05
  week.
• 36:06
  it's just
• 36:06
  important
• 36:07
  to
• 36:08
  stay active,
• 36:08
  you know,
• 36:09
  I have
• 36:09
  some people,
• 36:10
  if you feel
• 36:10
  really
• 36:10
  great
• 36:11
  the day
• 36:12
  the plaque
• 36:12
  comes
• 36:12
  off, then
• 36:13
  you can
• 36:13
  go for
• 36:14
  a walk
• 36:14
  or,
• 36:15
  you know,
• 36:15
  do some
• 36:16
  light
• 36:16
  exercise.
• 36:17
  it's just
• 36:18
  really
• 36:18
  important
• 36:18
  to just
• 36:19
  keep
• 36:19
  yourself
• 36:19
  moving
• 36:20
  and not
• 36:20
  completely
• 36:21
  kind of
• 36:22
  regress
• 36:22
  into it,
• 36:23
  because
• 36:23
  then
• 36:23
  you
• 36:23
  have
• 36:23
  to kind
• 36:24
  of climb
• 36:24
  out of
• 36:24
  that
• 36:25
  afterwards.
• 36:25
  And, it's
• 36:26
  just
• 36:26
  so much
• 36:27
  better
• 36:27
  for your
• 36:28
  overall
• 36:30
  wellness
• 36:30
  and just
• 36:31
  feeling
• 36:31
  good
• 36:31
  about
• 36:32
  things
• 36:32
  to be
• 36:32
  a little
• 36:33
  more
• 36:33
  active.
• 36:34
  the main
• 36:35
  difference
• 36:35
  with
• 36:35
  brachytherapy
• 36:36
  and
• 36:36
  proton
• 36:37
  therapy
• 36:37
  is that
• 36:38
  in
• 36:38
  brachytherapy
• 36:39
  the radiation
• 36:39
  comes
• 36:40
  from the
• 36:41
  plaque
• 36:42
  sort of
• 36:42
  behind
• 36:43
  the eye
• 36:43
  wall to
• 36:44
  the tumor,
• 36:44
  which is
• 36:45
  on
• 36:45
  the eye
• 36:45
  wall in
• 36:47
  proton
• 36:47
  beam
• 36:48
  therapy
• 36:48
  or
• 36:49
  any kind
• 36:49
  of
• 36:50
  external,
• 36:51
  radiation
• 36:52
  therapy.
• 36:53
  the radiation
• 36:54
  comes
• 36:54
  through
• 36:55
  the front
• 36:55
  of
• 36:55
  the eye
• 36:56
  and then
• 36:56
  culminates
• 36:57
  at
• 36:57
  the tumor
• 36:58
  to treat
• 36:58
  the
• 36:58
  tumor.
• 36:59
  So,
• 36:59
  proton
• 37:00
  therapy,
• 37:01
  involves,
• 37:02
  and I
• 37:03
  used to
• 37:03
  in my
• 37:04
  training,
• 37:04
  I, my
• 37:05
  training
• 37:05
  was at
• 37:06
  the
• 37:06
  Massachusetts
• 37:07
  Eye and
• 37:07
  your
• 37:07
  infirmary
• 37:08
  at
• 37:08
  Harvard
• 37:08
  Medical School,
• 37:09
  and
• 37:09
  we had
• 37:10
  the
• 37:10
  northwest
• 37:11
  pro
• 37:11
  northeast
• 37:11
  proton
• 37:12
  beam
• 37:12
  center,
• 37:13
  where,
• 37:13
  when
• 37:14
  I was
• 37:14
  a fellow
• 37:14
  in
• 37:14
  training,
• 37:15
  we spent
• 37:16
  a lot of
• 37:16
  time with
• 37:17
  people
• 37:18
  who were
• 37:18
  having
• 37:19
  proton
• 37:19
  beam and
• 37:19
  kind of
• 37:20
  going
• 37:20
  through
• 37:20
  everything.
• 37:21
  So
• 37:21
  I feel,
• 37:22
  I mean,
• 37:22
  if it's
• 37:22
  like
• 37:22
  yesterday,
• 37:23
  but what?
• 37:24
  So
• 37:24
  people,
• 37:25
  you still
• 37:25
  need
• 37:26
  to have
• 37:26
  a surgery
• 37:27
  to mark
• 37:28
  the
• 37:28
  borders
• 37:28
  of
• 37:28
  the tumor.
• 37:29
  And in
• 37:30
  brachytherapy
• 37:31
  surgery
• 37:31
  you have
• 37:32
  the
• 37:32
  surgery.
• 37:33
  You find
• 37:33
  the tumor,
• 37:34
  you
• 37:34
  put the
• 37:34
  plaque
• 37:35
  in place
• 37:36
  for
• 37:36
  proton
• 37:36
  therapy,
• 37:37
  you have a
• 37:37
  surgery,
• 37:38
  you find the tumor
• 37:39
  and you
• 37:39
  put
• 37:39
  markers
• 37:40
  at the
• 37:41
  edge of
• 37:41
  the tumor.
• 37:42
  And these
• 37:42
  markers
• 37:43
  will can
• 37:44
  be
• 37:44
  detected
• 37:45
  on, on
• 37:46
  X-rays
• 37:47
  that
• 37:47
  they use
• 37:48
  at
• 37:48
  the proton
• 37:49
  beam.
• 37:49
  So
• 37:49
  you have
• 37:50
  a surgery
• 37:50
  to put
• 37:51
  markers
• 37:51
  and
• 37:51
  usually 1
• 37:52
  or 2
• 37:52
  weeks
• 37:53
  later,
• 37:54
  then
• 37:54
  you go
• 37:54
  for your
• 37:55
  sessions
• 37:55
  at the
• 37:56
  proton
• 37:56
  proton
• 37:57
  beam
• 37:57
  facility.
• 37:58
  And
• 37:58
  usually
• 37:58
  it's it's
• 37:59
  like five
• 38:00
  days,
• 38:00
  five
• 38:01
  consecutive
• 38:01
  days
• 38:02
  where
• 38:02
  each
• 38:02
  treatment
• 38:03
  may be
• 38:04
  about
• 38:04
  a minute,
• 38:05
  very short.
• 38:06
  But
• 38:06
  during
• 38:07
  those
• 38:07
  radiation
• 38:08
  treatments,
• 38:09
  you're
• 38:09
  awake.
• 38:11
  We don't use
• 38:11
  anesthesia
• 38:12
  for the
• 38:13
  actual
• 38:13
  radiation
• 38:14
  sessions.
• 38:14
  We do
• 38:15
  for the
• 38:15
  surgical part,
• 38:16
  but for
• 38:16
  the
• 38:16
  radiation
• 38:17
  sessions,
• 38:18
  it's
• 38:18
  important
• 38:19
  that you are.
• 38:20
  You are
• 38:20
  very,
• 38:20
  very
• 38:21
  still
• 38:21
  because
• 38:22
  you
• 38:23
  if you
• 38:23
  move or
• 38:24
  blink or
• 38:24
  move
• 38:25
  around,
• 38:26
  then
• 38:26
  the really
• 38:26
  the path
• 38:27
  of the
• 38:27
  radiation
• 38:28
  isn't
• 38:28
  as accurate.
• 38:29
  So in
• 38:30
  order to
• 38:30
  do that,
• 38:31
  to
• 38:31
  prepare
• 38:32
  for the
• 38:32
  radiation
• 38:32
  sessions,
• 38:33
  most
• 38:34
  places
• 38:34
  will have
• 38:35
  create
• 38:36
  sort of
• 38:36
  a frame
• 38:36
  for your
• 38:37
  face,
• 38:37
  which
• 38:37
  includes,
• 38:38
  certainly
• 38:39
  at the
• 38:39
  the
• 38:40
  northeast
• 38:40
  proton
• 38:40
  beam
• 38:40
  center,
• 38:41
  there was
• 38:41
  a bite
• 38:41
  block
• 38:42
  to clench
• 38:43
  your teeth around
• 38:44
  so
• 38:44
  you could
• 38:44
  hold
• 38:44
  your face
• 38:45
  really,
• 38:46
  really
• 38:46
  still.
• 38:46
  And there
• 38:47
  was
• 38:47
  something
• 38:47
  that,
• 38:48
  light
• 38:49
  or an
• 38:49
  indicator
• 38:49
  that you
• 38:50
  would
• 38:50
  look
• 38:50
  at to
• 38:50
  keep
• 38:51
  your gaze
• 38:51
  steady.
• 38:52
  And then
• 38:53
  there
• 38:53
  would be
• 38:53
  a monitor.
• 38:54
  There
• 38:54
  would be
• 38:54
  somebody
• 38:54
  monitoring.
• 38:55
  And
• 38:55
  certainly
• 38:56
  at
• 38:56
  the center
• 38:57
  I trained
• 38:57
  at,
• 38:57
  it was the fellow.
• 38:58
  So
• 38:59
  we would
• 38:59
  we would
• 38:59
  help the
• 39:00
  patients,
• 39:01
  open
• 39:01
  the eyelids
• 39:02
  and
• 39:02
  we would
• 39:02
  monitor
• 39:02
  that.
• 39:03
  The eye
• 39:04
  was
• 39:04
  exactly
• 39:04
  centered.
• 39:05
  And,
• 39:06
  you know,
• 39:06
  people
• 39:07
  were not
• 39:07
  sort of
• 39:08
  wandering
• 39:08
  the gaze.
• 39:09
  If
• 39:09
  a person
• 39:09
  started
• 39:10
  to drift,
• 39:10
  we
• 39:10
  we turned
• 39:11
  off,
• 39:12
  we were able
• 39:12
  to stop
• 39:13
  the treatment
• 39:14
  and then
• 39:14
  kind of
• 39:15
  get
• 39:15
  things
• 39:15
  on track
• 39:16
  again.
• 39:17
  and
• 39:17
  sometimes,
• 39:18
  you know,
• 39:18
  sometimes
• 39:19
  can be
• 39:19
  difficult.
• 39:19
  So
• 39:20
  we'd
• 39:20
  have to
• 39:20
  kind of
• 39:20
  stop and
• 39:21
  make sure
• 39:21
  that
• 39:21
  people
• 39:22
  knew what
• 39:22
  they
• 39:22
  should be
• 39:22
  looking
• 39:23
  straight
• 39:23
  at.
• 39:24
  but
• 39:24
  certainly
• 39:24
  the
• 39:24
  centers
• 39:25
  that have
• 39:25
  a lot
• 39:25
  of
• 39:25
  experience
• 39:26
  with
• 39:26
  proton
• 39:26
  beam,
• 39:27
  they're,
• 39:27
  they're
• 39:27
  really,
• 39:28
  you know,
• 39:28
  they're
• 39:28
  really
• 39:29
  good at
• 39:29
  making
• 39:29
  sure that
• 39:30
  everything's
• 39:30
  in place.
• 39:31
  And,
• 39:31
  you know,
• 39:31
  remember
• 39:32
  the
• 39:32
  radiation
• 39:32
  team was
• 39:33
  was
• 39:34
  incredibly
• 39:34
  excellent.
• 39:35
  Everybody
• 39:35
  knew
• 39:35
  how to
• 39:36
  just get
• 39:36
  things
• 39:36
  just
• 39:37
  right.
• 39:37
  So there
• 39:38
  there's
• 39:38
  a series
• 39:39
  of
• 39:39
  treatments.
• 39:39
  And so
• 39:40
  the end
• 39:40
  of
• 39:41
  about say
• 39:42
  it's
• 39:42
  usually
• 39:42
  that I'm
• 39:43
  familiar
• 39:43
  with
• 39:43
  about
• 39:43
  five
• 39:44
  sessions.
• 39:44
  that
• 39:44
  would be
• 39:45
  the end
• 39:45
  of the
• 39:45
  radiation
• 39:46
  treatment.
• 39:47
  and then
• 39:48
  the same
• 39:48
  monitoring
• 39:49
  happens.
• 39:50
  We,
• 39:50
  we
• 39:50
  see you
• 39:51
  afterwards.
• 39:52
  We then
• 39:52
  we start
• 39:53
  doing
• 39:53
  ultrasounds
• 39:54
  to
• 39:54
  confirm
• 39:55
  that
• 39:55
  there's
• 39:55
  been good
• 39:56
  treatment
• 39:56
  response.
• 39:58
  so, so
• 39:58
  proton
• 39:58
  beam
• 39:59
  therapy
• 39:59
  is very
• 40:00
  good at,
• 40:00
  destroying
• 40:01
  melanoma.
• 40:01
  No
• 40:01
  question.
• 40:02
  and
• 40:02
  I think
• 40:03
  that most
• 40:03
  centers
• 40:04
  know the
• 40:05
  interesting
• 40:06
  thing
• 40:06
  that I've
• 40:06
  learned
• 40:07
  over
• 40:07
  the years
• 40:07
  is that
• 40:07
  everybody
• 40:08
  does
• 40:08
  things
• 40:08
  a little
• 40:08
  bit
• 40:09
  different.
• 40:10
  And
• 40:10
  when I
• 40:11
  visit
• 40:11
  colleagues
• 40:12
  and
• 40:12
  see what
• 40:12
  they're doing,
• 40:13
  I learn
• 40:14
  that
• 40:14
  there's
• 40:14
  different,
• 40:14
  you know,
• 40:15
  people
• 40:15
  use
• 40:15
  slightly
• 40:15
  different
• 40:16
  techniques.
• 40:16
  Some people
• 40:17
  even
• 40:18
  measure
• 40:18
  for the
• 40:19
  Reiki
• 40:19
  therapy,
• 40:19
  like
• 40:20
  slightly
• 40:20
  differently.
• 40:21
  you know,
• 40:22
  it's just
• 40:22
  amazing
• 40:23
  the amount
• 40:23
  of
• 40:23
  variation
• 40:24
  that
• 40:24
  can happen
• 40:25
  that
• 40:25
  that's
• 40:26
  involved
• 40:26
  in this.
• 40:26
  Some people
• 40:27
  really
• 40:27
  like
• 40:28
  to take
• 40:28
  muzzles
• 40:28
  off,
• 40:29
  I don't like
• 40:30
  to take
• 40:30
  muscles off
• 40:30
  because
• 40:31
  it's just
• 40:31
  extra
• 40:31
  stuff.
• 40:32
  And I
• 40:32
  don't,
• 40:33
  you
• 40:33
  know,
• 40:33
  that
• 40:33
  that's
• 40:33
  another thing.
• 40:33
  I'll
• 40:33
  mention
• 40:34
  that
• 40:34
  sometimes
• 40:34
  in order
• 40:35
  to put
• 40:35
  the
• 40:35
  brachytherapy
• 40:36
  plaque
• 40:36
  in place,
• 40:37
  a muscle
• 40:38
  may have
• 40:38
  to be
• 40:38
  moved
• 40:39
  in order
• 40:39
  to
• 40:40
  to
• 40:40
  position
• 40:41
  the plaque.
• 40:42
  I find
• 40:42
  that when
• 40:43
  muscles
• 40:44
  are are
• 40:45
  on the eye,
• 40:45
  it really
• 40:46
  helps
• 40:46
  exposure
• 40:46
  because
• 40:47
  you need
• 40:47
  the muscles
• 40:47
  to
• 40:48
  turn the eye.
• 40:48
  If
• 40:48
  the eye
• 40:49
  has no
• 40:49
  muscles,
• 40:50
  no.
• 40:50
  You're
• 40:51
  just kind
• 40:51
  of like
• 40:52
  it's hard
• 40:52
  to just
• 40:52
  move the
• 40:53
  eyeball,
• 40:54
  but
• 40:54
  the muscles
• 40:54
  are kind
• 40:55
  of like
• 40:55
  the
• 40:55
  handles
• 40:56
  that help
• 40:56
  help
• 40:57
  expose
• 40:57
  and
• 40:58
  allow,
• 40:58
  tissues
• 40:58
  in place.
• 40:59
  But
• 40:59
  when we
• 40:59
  do have
• 41:00
  to move
• 41:00
  a muscle,
• 41:01
  usually
• 41:01
  if
• 41:01
  I have
• 41:01
  to.
• 41:02
  So right
• 41:03
  where
• 41:03
  the muscle is
• 41:04
  and I
• 41:04
  can't get
• 41:05
  the
• 41:05
  plaque
• 41:05
  there,
• 41:05
  well,
• 41:06
  what
• 41:06
  what happens
• 41:07
  is
• 41:08
  we will
• 41:09
  the
• 41:09
  muscle,
• 41:09
  each
• 41:10
  muscle of
• 41:10
  each of
• 41:11
  the four
• 41:11
  eye
• 41:11
  muscles
• 41:12
  is
• 41:12
  attached
• 41:13
  sort of
• 41:14
  at what
• 41:15
  we
• 41:15
  call the
• 41:15
  equator
• 41:16
  of
• 41:16
  the eye,
• 41:16
  which is
• 41:17
  just past
• 41:17
  where you
• 41:17
  can
• 41:18
  see it
• 41:18
  in the
• 41:18
  eye
• 41:19
  socket.
• 41:19
  And so
• 41:20
  you find
• 41:20
  where
• 41:20
  it's
• 41:21
  attached.
• 41:22
  And you,
• 41:22
  you use
• 41:23
  scissors
• 41:24
  to snip
• 41:24
  the attachment,
• 41:25
  but
• 41:26
  you sew
• 41:26
  the ends
• 41:27
  in place.
• 41:29
  And
• 41:29
  there's
• 41:29
  many
• 41:30
  different
• 41:30
  ways to
• 41:30
  sort of
• 41:31
  what
• 41:31
  we call
• 41:31
  this
• 41:31
  insert
• 41:32
  the muscle
• 41:32
  and then
• 41:33
  put it
• 41:33
  back.
• 41:34
  I like to
• 41:34
  use
• 41:34
  leave
• 41:35
  this
• 41:35
  the stitch
• 41:36
  in place.
• 41:36
  So
• 41:36
  when the plant
• 41:37
  comes out
• 41:37
  I just
• 41:38
  pull it
• 41:38
  back
• 41:39
  and tie
• 41:39
  it
• 41:40
  and then
• 41:40
  the muscles
• 41:40
  back in
• 41:41
  its place.
• 41:42
  and what
• 41:43
  we found,
• 41:43
  and
• 41:44
  certainly
• 41:45
  when we
• 41:45
  looked
• 41:45
  at our
• 41:46
  cases,
• 41:46
  who
• 41:47
  the people
• 41:47
  need
• 41:47
  to have
• 41:48
  the
• 41:48
  muscles
• 41:48
  moved
• 41:48
  just
• 41:49
  inserting
• 41:49
  a muscle
• 41:49
  does
• 41:50
  not have
• 41:50
  any
• 41:51
  effect
• 41:51
  on double
• 41:52
  vision
• 41:52
  afterwards.
• 41:53
  double
• 41:54
  vision
• 41:54
  is more
• 41:55
  sort of
• 41:55
  the
• 41:55
  location
• 41:56
  of
• 41:56
  the tumor,
• 41:57
  you know,
• 41:57
  the
• 41:58
  usually
• 41:58
  more in
• 41:58
  the
• 41:59
  posterior
• 41:59
  or part
• 41:59
  of the eye.
• 42:00
  But
• 42:00
  if you have
• 42:00
  to have
• 42:01
  a muscle
• 42:01
  removed,
• 42:02
  it's a
• 42:02
  very,
• 42:03
  very safe
• 42:03
  type of a
• 42:05
  procedure
• 42:05
  to help
• 42:05
  facilitate
• 42:06
  the
• 42:06
  surgery.
• 42:08
  You
• 42:09
  mentioned
• 42:09
  putting
• 42:09
  markers
• 42:10
  in the eye.
• 42:10
  What does that
• 42:11
  mean?
• 42:12
  Like,
• 42:12
  are you actually
• 42:12
  putting
• 42:13
  something
• 42:13
  in or
• 42:13
  are you
• 42:14
  just
• 42:14
  marking?
• 42:14
  Do
• 42:14
  you have to
• 42:15
  take it
• 42:15
  back out?
• 42:15
  What is that.
• 42:16
  Oh yes.
• 42:17
  Thank you,
• 42:17
  thank you
• 42:18
  I didn't
• 42:19
  I didn't
• 42:19
  speak
• 42:19
  completely,
• 42:20
  but so
• 42:20
  we use
• 42:21
  for
• 42:22
  proton
• 42:22
  beam
• 42:22
  markers.
• 42:23
  We
• 42:23
  actually.
• 42:24
  So what's
• 42:25
  called
• 42:25
  tantalum
• 42:26
  clips
• 42:27
  and
• 42:27
  they're
• 42:27
  like
• 42:28
  little metal.
• 42:30
  they're like
• 42:30
  metal,
• 42:30
  like like
• 42:31
  a, it's
• 42:32
  like a
• 42:32
  little fasten
• 42:33
  these little
• 42:34
  fasteners,
• 42:34
  like into
• 42:34
  the
• 42:35
  back of
• 42:35
  the dress
• 42:35
  has that
• 42:36
  extra
• 42:36
  fastening.
• 42:37
  It's a
• 42:37
  little
• 42:38
  tiny
• 42:38
  thing
• 42:38
  like that
• 42:38
  that you
• 42:39
  sew on
• 42:39
  with
• 42:39
  like a
• 42:40
  circle
• 42:40
  in it
• 42:40
  that
• 42:41
  you can
• 42:41
  you, you
• 42:42
  just
• 42:42
  so it
• 42:43
  in place
• 42:43
  and
• 42:44
  they are
• 42:45
  they're
• 42:45
  radio
• 42:46
  opaque
• 42:46
  so
• 42:47
  that when
• 42:47
  you are
• 42:48
  doing
• 42:48
  the proton
• 42:49
  beam
• 42:49
  treatment,
• 42:49
  you can actually
• 42:50
  see the
• 42:51
  markers
• 42:51
  and you
• 42:52
  line up
• 42:52
  the markers
• 42:53
  to line
• 42:54
  up the,
• 42:54
  the proton
• 42:54
  beam,
• 42:55
  and
• 42:55
  that's
• 42:55
  what.
• 42:56
  And they
• 42:56
  stay there
• 42:56
  forever.
• 42:57
  Actually,
• 42:58
  they never have
• 42:58
  to
• 42:58
  come out.
• 42:59
  They will never
• 43:01
  set off.
• 43:02
  like
• 43:02
  you can
• 43:02
  have
• 43:02
  an MRI.
• 43:03
  They're
• 43:04
  not
• 43:04
  they
• 43:04
  don't
• 43:04
  cause
• 43:04
  trouble.
• 43:05
  They don't
• 43:05
  set off
• 43:05
  metal
• 43:06
  detectors.
• 43:07
  and
• 43:07
  it's just
• 43:08
  the
• 43:08
  nature
• 43:08
  of that.
• 43:09
  It's
• 43:09
  called
• 43:09
  tantalum.
• 43:10
  and
• 43:11
  that's
• 43:11
  sort
• 43:11
  of the
• 43:12
  from what
• 43:12
  I
• 43:12
  understand,
• 43:12
  is the
• 43:13
  universal
• 43:13
  material
• 43:14
  that is
• 43:14
  used
• 43:15
  to, to,
• 43:15
  to
• 43:16
  the markers
• 43:16
  to place,
• 43:17
  to
• 43:17
  put them
• 43:18
  in place.
• 43:18
  And
• 43:18
  you don't
• 43:19
  feel them
• 43:19
  afterwards.
• 43:20
  They
• 43:21
  I don't think
• 43:22
  I've ever
• 43:22
  heard
• 43:22
  of a case
• 43:23
  of them
• 43:23
  coming
• 43:23
  out, but
• 43:24
  it's
• 43:24
  possible
• 43:24
  that they
• 43:26
  could
• 43:26
  just work
• 43:26
  themselves
• 43:27
  out.
• 43:27
  But
• 43:27
  but
• 43:27
  that's
• 43:27
  very
• 43:28
  uncommon.
• 43:29
  And
• 43:29
  they don't
• 43:29
  change,
• 43:30
  you know,
• 43:30
  they're
• 43:31
  very
• 43:31
  they're
• 43:31
  inert.
• 43:32
  I mean,
• 43:32
  so they
• 43:32
  don't
• 43:33
  really
• 43:33
  cause
• 43:33
  any
• 43:34
  trouble
• 43:34
  or
• 43:34
  additional
• 43:35
  inflammation
• 43:35
  of
• 43:36
  the eye.
• 43:36
  and
• 43:37
  the eye
• 43:37
  can have
• 43:37
  ultrasounds
• 43:38
  and
• 43:39
  really
• 43:39
  just,
• 43:41
  you know,
• 43:41
  very,
• 43:41
  very
• 43:42
  unusual
• 43:43
  activity
• 43:43
  afterwards.
• 43:44
  and we,
• 43:45
  we leave
• 43:45
  those
• 43:45
  markers
• 43:46
  or we
• 43:46
  call them
• 43:47
  clips.
• 43:48
  They
• 43:48
  stay in
• 43:48
  place
• 43:49
  forever.
• 43:51
  And
• 43:51
  you won't
• 43:51
  set off
• 43:52
  a metal
• 43:52
  detector
• 43:53
  or
• 43:53
  anything
• 43:53
  like
• 43:53
  that.
• 43:54
  You
• 43:54
  just go
• 43:54
  about
• 43:55
  your
• 43:55
  life.
• 43:56
  Yeah.
• 43:56
  But
• 43:56
  I should
• 43:56
  mention
• 43:57
  you
• 43:57
  mentioned
• 43:57
  metal
• 43:57
  detectors
• 43:58
  and going
• 43:59
  through
• 43:59
  like TSA.
• 44:00
  So
• 44:01
  if you happen
• 44:01
  to have
• 44:02
  a
• 44:02
  radioactive
• 44:03
  plaque
• 44:03
  on
• 44:03
  your eye,
• 44:04
  you will set
• 44:05
  off TSA
• 44:07
  alarms.
• 44:08
  So
• 44:08
  if you're
• 44:08
  planning
• 44:09
  to fly
• 44:10
  in that
• 44:10
  period
• 44:11
  where
• 44:11
  the plaque
• 44:12
  is on
• 44:12
  the eye,
• 44:13
  make sure
• 44:13
  you have
• 44:13
  a letter
• 44:14
  from
• 44:15
  maybe
• 44:15
  the physicist
• 44:16
  or
• 44:17
  somebody.
• 44:18
  Make sure
• 44:18
  you have a letter
• 44:19
  because
• 44:20
  it will.
• 44:20
  So we've
• 44:21
  we have
• 44:21
  we have
• 44:22
  patients
• 44:22
  who fly
• 44:22
  in,
• 44:23
  who are
• 44:23
  not
• 44:24
  who are
• 44:24
  not too far.
• 44:24
  So
• 44:24
  they'll fly
• 44:25
  like from
• 44:25
  Nevada,
• 44:26
  they'll
• 44:26
  fly
• 44:26
  back home
• 44:27
  or
• 44:27
  they'll
• 44:27
  drive.
• 44:28
  And we
• 44:28
  recommend
• 44:29
  most
• 44:29
  people
• 44:29
  stay
• 44:30
  nearby
• 44:30
  just for
• 44:30
  that
• 44:31
  time,
• 44:31
  just
• 44:31
  because
• 44:31
  most
• 44:32
  people
• 44:32
  don't
• 44:32
  want
• 44:32
  to be
• 44:32
  far away.
• 44:33
  But
• 44:34
  occasionally
• 44:34
  we've had
• 44:35
  that
• 44:35
  happen
• 44:35
  in the past.
• 44:35
  So just
• 44:37
  be aware,
• 44:37
  be
• 44:38
  prepared
• 44:39
  so that
• 44:39
  you can
• 44:39
  make your
• 44:40
  flight.
• 44:41
  So
• 44:43
  I'm sure
• 44:43
  this is
• 44:44
  a very
• 44:44
  complicated
• 44:45
  question,
• 44:45
  so feel
• 44:46
  free to,
• 44:46
  make this
• 44:47
  as simple
• 44:48
  as you
• 44:48
  need to,
• 44:49
  but
• 44:49
  how do you decide
• 44:50
  which one
• 44:51
  to do?
• 44:52
  How do you know
• 44:53
  what's
• 44:53
  the best
• 44:53
  choice
• 44:54
  for
• 44:54
  somebody,
• 44:55
  or do
• 44:55
  they
• 44:55
  have a
• 44:55
  say
• 44:56
  in it?
• 44:56
  Or do
• 44:56
  you
• 44:57
  kind of
• 44:57
  tell them
• 44:57
  which
• 44:58
  one?
• 44:59
  Yeah,
• 45:00
  that's a
• 45:00
  great
• 45:00
  question.
• 45:03
  and the
• 45:03
  truth is.
• 45:06
  What's
• 45:07
  the
• 45:07
  treatment
• 45:08
  that it's
• 45:08
  going
• 45:08
  to be
• 45:08
  recommended
• 45:09
  to
• 45:09
  a patient
• 45:10
  is going
• 45:11
  to be
• 45:11
  what the
• 45:11
  center
• 45:12
  does.
• 45:13
  And
• 45:14
  there's
• 45:15
  I can
• 45:15
  think of
• 45:16
  one
• 45:16
  center
• 45:17
  that does
• 45:18
  maybe
• 45:18
  two centers
• 45:19
  that do
• 45:20
  both
• 45:20
  brachytherapy
• 45:21
  and
• 45:21
  proton
• 45:22
  beam,
• 45:23
  but most
• 45:24
  places do
• 45:25
  exclusively
• 45:25
  one or
• 45:26
  the
• 45:26
  other.
• 45:27
  And
• 45:30
  so it's,
• 45:32
  you know,
• 45:33
  many times
• 45:34
  people
• 45:34
  find
• 45:34
  themselves
• 45:35
  referred
• 45:35
  to a
• 45:36
  particular
• 45:36
  oncologist
• 45:37
  and
• 45:38
  they have
• 45:39
  what's
• 45:39
  recommended.
• 45:40
  But also
• 45:41
  we have
• 45:41
  people
• 45:42
  who have
• 45:43
  have
• 45:43
  researched
• 45:44
  each of
• 45:44
  the centers
• 45:45
  all
• 45:46
  across
• 45:46
  the country
• 45:47
  and are
• 45:48
  visiting
• 45:48
  proton
• 45:48
  beam
• 45:49
  centers
• 45:49
  and,
• 45:50
  talking
• 45:50
  to
• 45:51
  people.
• 45:51
  So,
• 45:52
  you know,
• 45:53
  it's
• 45:54
  it really
• 45:55
  it's
• 45:55
  variable.
• 45:56
  And, and,
• 45:56
  you know,
• 45:56
  I have
• 45:57
  my own
• 45:57
  view
• 45:58
  of it.
• 45:58
  You know,
• 45:58
  I did
• 45:59
  all my prior
• 46:00
  to coming
• 46:01
  to UCLA,
• 46:01
  I did
• 46:01
  all my
• 46:02
  training
• 46:02
  at, at
• 46:03
  it,
• 46:03
  Massachusetts
• 46:04
  and
• 46:04
  for me
• 46:05
  and all
• 46:05
  they had
• 46:05
  was
• 46:05
  proton
• 46:06
  beam.
• 46:06
  And I
• 46:06
  was
• 46:07
  convinced
• 46:07
  that
• 46:08
  we had
• 46:08
  to get
• 46:08
  a proton,
• 46:09
  particle
• 46:10
  accelerator
• 46:10
  at UCLA
• 46:11
  in
• 46:11
  order to
• 46:11
  treat
• 46:12
  melanoma
• 46:12
  because I
• 46:13
  was so
• 46:13
  impressed
• 46:14
  with the
• 46:14
  results
• 46:15
  and etc..
• 46:15
  Then when
• 46:16
  I came
• 46:16
  to UCLA,
• 46:17
  which
• 46:18
  had been
• 46:18
  doing
• 46:19
  break
• 46:19
  therapy
• 46:19
  plaques
• 46:20
  for long
• 46:20
  before
• 46:21
  I was
• 46:21
  there, I,
• 46:22
  I was
• 46:23
  okay,
• 46:24
  fine,
• 46:24
  we'll do plaques,
• 46:25
  but
• 46:25
  we need
• 46:25
  to think
• 46:26
  about
• 46:26
  getting a
• 46:26
  proton
• 46:27
  beam
• 46:27
  set up
• 46:28
  at some
• 46:28
  point.
• 46:28
  So.
• 46:29
  But
• 46:29
  after a
• 46:29
  while,
• 46:30
  I was
• 46:30
  just
• 46:31
  I mean,
• 46:31
  I love
• 46:32
  doing
• 46:32
  brachytherapy
• 46:33
  plaques
• 46:33
  and
• 46:34
  I've been do
• 46:34
  it.
• 46:34
  And
• 46:34
  I just
• 46:34
  think
• 46:35
  it's
• 46:35
  such an
• 46:36
  elegant
• 46:36
  way and a
• 46:37
  relatively
• 46:38
  simple
• 46:38
  way
• 46:39
  to treat
• 46:39
  the problem.
• 46:40
  You know,
• 46:41
  we don't
• 46:41
  need a
• 46:41
  big
• 46:42
  particle
• 46:42
  accelerator
• 46:43
  and,
• 46:44
  you know,
• 46:44
  the
• 46:45
  the side
• 46:45
  effect
• 46:45
  profiles
• 46:46
  are
• 46:46
  slightly
• 46:47
  different
• 46:47
  between
• 46:48
  the two
• 46:49
  treatments.
• 46:51
  in
• 46:51
  addition,
• 46:52
  I think
• 46:52
  it's,
• 46:53
  you know,
• 46:53
  you
• 46:53
  really want it
• 46:54
  the
• 46:54
  most important
• 46:55
  thing
• 46:55
  that
• 46:55
  matters
• 46:55
  at number
• 46:56
  one is
• 46:57
  accuracy.
• 46:58
  So,
• 46:59
  you know,
• 47:00
  if you
• 47:00
  look at
• 47:00
  there's
• 47:01
  not a lot
• 47:01
  of proton
• 47:01
  beam
• 47:02
  centers,
• 47:02
  actually,
• 47:03
  the vast
• 47:03
  majority
• 47:04
  of places
• 47:05
  that
• 47:05
  treat
• 47:06
  ocular
• 47:06
  melanoma
• 47:07
  do
• 47:07
  brachytherapy
• 47:08
  plaque.
• 47:08
  So among
• 47:10
  the few
• 47:10
  centers
• 47:11
  that do
• 47:11
  proton
• 47:12
  beam,
• 47:12
  what I've
• 47:13
  learned
• 47:13
  from my
• 47:13
  colleagues
• 47:14
  who do
• 47:14
  proton
• 47:15
  beam and
• 47:15
  also
• 47:15
  colleagues
• 47:16
  in
• 47:16
  Europe,
• 47:16
  there's
• 47:17
  some
• 47:17
  centers,
• 47:17
  major
• 47:18
  centers
• 47:18
  there
• 47:18
  that the
• 47:18
  proton
• 47:19
  beam is
• 47:19
  that each
• 47:20
  proton
• 47:20
  beam
• 47:21
  is
• 47:22
  different.
• 47:22
  It's
• 47:22
  collimated
• 47:23
  differently.
• 47:24
  It's
• 47:24
  it's it's
• 47:25
  calibrated
• 47:26
  differently.
• 47:26
  And so
• 47:27
  they
• 47:27
  all work
• 47:28
  a little
• 47:28
  differently
• 47:29
  there.
• 47:30
  Not as
• 47:30
  I think
• 47:31
  that
• 47:31
  there's
• 47:31
  less
• 47:31
  uniformity.
• 47:33
  So
• 47:33
  it's important
• 47:34
  if you're
• 47:35
  going to
• 47:35
  a proton
• 47:35
  beam
• 47:36
  center
• 47:36
  that you
• 47:37
  you know,
• 47:38
  you
• 47:38
  can ask
• 47:39
  about
• 47:39
  what are the,
• 47:39
  you know,
• 47:40
  what
• 47:40
  are the
• 47:40
  success
• 47:41
  rates,
• 47:41
  what is
• 47:41
  your
• 47:41
  recurrence
• 47:42
  rate,
• 47:42
  and all
• 47:43
  sorts
• 47:43
  of
• 47:43
  things.
• 47:44
  I mean,
• 47:44
  these are
• 47:44
  things
• 47:44
  people
• 47:45
  should
• 47:45
  ask
• 47:45
  anybody,
• 47:46
  actually,
• 47:46
  you know,
• 47:47
  what is
• 47:47
  what is
• 47:48
  not just
• 47:48
  what
• 47:48
  is the
• 47:49
  success
• 47:49
  rate,
• 47:49
  but
• 47:49
  what is
• 47:50
  your
• 47:50
  success
• 47:51
  rate,
• 47:51
  because
• 47:52
  every
• 47:52
  center
• 47:53
  has a
• 47:53
  different
• 47:53
  rate of
• 47:54
  success
• 47:55
  and
• 47:55
  different
• 47:56
  it's all
• 47:57
  there's
• 47:57
  so many
• 47:58
  details
• 47:58
  that go
• 47:58
  into this.
• 47:59
  But with
• 48:00
  proton
• 48:00
  beam
• 48:00
  there's
• 48:01
  a little
• 48:01
  more
• 48:01
  variability.
• 48:02
  And
• 48:03
  I think
• 48:03
  a center
• 48:04
  when
• 48:04
  I'm very
• 48:05
  biased to
• 48:05
  my old
• 48:05
  training
• 48:06
  center.
• 48:06
  But
• 48:07
  the Northeast
• 48:08
  proton
• 48:08
  proton
• 48:08
  beam
• 48:08
  center,
• 48:09
  they had
• 48:09
  phenomenal,
• 48:11
  success
• 48:11
  rates.
• 48:12
  They and
• 48:12
  they were
• 48:13
  very good
• 48:13
  about
• 48:14
  publishing.
• 48:14
  They published
• 48:15
  their data
• 48:16
  over many
• 48:16
  decades,
• 48:17
  like
• 48:17
  starting
• 48:18
  in
• 48:18
  the 70s.
• 48:19
  their success
• 48:19
  rate is
• 48:20
  very high
• 48:20
  for
• 48:21
  their treatment.
• 48:22
  And so
• 48:22
  they have
• 48:23
  a
• 48:23
  they have
• 48:23
  a
• 48:23
  well-oiled
• 48:24
  machine.
• 48:24
  I think
• 48:24
  there's
• 48:25
  other places
• 48:25
  that are
• 48:26
  sort of
• 48:26
  thinking
• 48:27
  of
• 48:27
  introducing
• 48:27
  proton
• 48:28
  beam,
• 48:28
  but
• 48:29
  you know,
• 48:29
  there's
• 48:30
  it's
• 48:30
  it's all
• 48:31
  there's
• 48:31
  so
• 48:31
  many details.
• 48:32
  So
• 48:32
  I think,
• 48:33
  you know,
• 48:34
  part of
• 48:35
  when you
• 48:36
  get
• 48:36
  diagnosed
• 48:37
  and
• 48:37
  you're
• 48:37
  learning
• 48:38
  about
• 48:38
  the
• 48:38
  treatment
• 48:38
  options
• 48:39
  is you,
• 48:40
  first
• 48:40
  of all,
• 48:40
  talk to
• 48:41
  the person
• 48:41
  that
• 48:41
  you're in
• 48:42
  front
• 48:42
  of first
• 48:43
  and
• 48:43
  find out
• 48:43
  know
• 48:44
  what?
• 48:44
  What
• 48:45
  do they
• 48:45
  do.
• 48:45
  What are the
• 48:46
  recommended.
• 48:46
  What do they
• 48:47
  think
• 48:47
  about
• 48:47
  proton
• 48:48
  beam.
• 48:48
  And you
• 48:49
  know,
• 48:49
  if
• 48:49
  it was their
• 48:50
  eye, what
• 48:50
  would
• 48:50
  they want
• 48:51
  to be
• 48:51
  doing.
• 48:53
  I know
• 48:53
  for using
• 48:54
  brachytherapy,
• 48:55
  brachytherapy
• 48:56
  allows
• 48:57
  you know,
• 48:57
  at UCLA
• 48:58
  we also
• 48:59
  do
• 49:00
  we place
• 49:01
  silicone
• 49:01
  oil
• 49:02
  in the eye,
• 49:02
  which
• 49:02
  helps
• 49:03
  minimize
• 49:03
  the radiation
• 49:04
  to
• 49:04
  healthy
• 49:04
  tissues.
• 49:05
  And
• 49:05
  that can
• 49:05
  only
• 49:06
  be done
• 49:06
  with
• 49:06
  brachytherapy
• 49:07
  because
• 49:07
  you can't
• 49:08
  if you
• 49:08
  put
• 49:08
  silicone
• 49:09
  oil
• 49:09
  in the eye
• 49:09
  and do
• 49:10
  proton
• 49:10
  you're
• 49:10
  going to
• 49:11
  you'll
• 49:11
  affect
• 49:12
  the radiation
• 49:13
  going to
• 49:13
  the tumor.
• 49:13
  So
• 49:14
  you can't
• 49:14
  it
• 49:14
  doesn't
• 49:14
  really
• 49:15
  work
• 49:15
  with
• 49:16
  proton
• 49:16
  proton
• 49:17
  beam
• 49:17
  therapy
• 49:18
  has
• 49:18
  you know
• 49:19
  it's been
• 49:19
  published.
• 49:20
  But
• 49:20
  there's a
• 49:20
  lot of it
• 49:20
  is a
• 49:21
  little
• 49:21
  bit more
• 49:22
  eyelid
• 49:22
  eyelash
• 49:23
  issues,
• 49:24
  more
• 49:24
  dry eye
• 49:26
  with
• 49:26
  proton
• 49:26
  therapy.
• 49:27
  But
• 49:27
  again,
• 49:28
  you need
• 49:28
  to ask
• 49:29
  the center
• 49:30
  that
• 49:30
  you're at
• 49:30
  and
• 49:30
  find out.
• 49:31
  You know
• 49:31
  what
• 49:32
  what is
• 49:33
  what what
• 49:33
  what
• 49:34
  should I
• 49:34
  expect.
• 49:35
  I know
• 49:36
  there's a
• 49:36
  proton
• 49:37
  beam
• 49:38
  center on
• 49:38
  in
• 49:39
  Northern
• 49:39
  California
• 49:40
  that
• 49:40
  a lot
• 49:41
  of
• 49:41
  different
• 49:41
  people
• 49:41
  use.
• 49:42
  and so
• 49:44
  it's it
• 49:44
  all
• 49:44
  depends
• 49:45
  on
• 49:45
  the details.
• 49:46
  So
• 49:47
  I think
• 49:49
  most of
• 49:49
  the time
• 49:49
  we don't
• 49:49
  have
• 49:50
  a choice
• 49:50
  like you
• 49:50
  asked,
• 49:50
  like,
• 49:51
  should
• 49:51
  can I
• 49:51
  choose
• 49:52
  what
• 49:52
  I want?
• 49:53
  I think
• 49:53
  in
• 49:54
  order to
• 49:54
  make
• 49:54
  a choice,
• 49:54
  you have to
• 49:55
  understand,
• 49:56
  what would be
• 49:57
  the pros
• 49:57
  and cons?
• 49:58
  You know,
• 49:58
  what
• 49:58
  would be
• 49:59
  the
• 49:59
  advantage
• 49:59
  of doing
• 50:00
  this
• 50:00
  versus
• 50:00
  that?
• 50:01
  Or,
• 50:01
  you know,
• 50:02
  should I
• 50:02
  go to
• 50:02
  a center
• 50:03
  that has a
• 50:03
  proton
• 50:03
  beam?
• 50:04
  Should I
• 50:04
  go to
• 50:05
  a center
• 50:05
  where
• 50:06
  there's
• 50:06
  brachytherapy?
• 50:07
  And I
• 50:07
  think
• 50:07
  the most
• 50:08
  important
• 50:08
  thing is
• 50:09
  to to go
• 50:09
  to a
• 50:10
  place
• 50:10
  that has
• 50:10
  a lot
• 50:11
  of
• 50:11
  experience
• 50:12
  in what
• 50:12
  they do
• 50:12
  and
• 50:13
  have them
• 50:13
  share
• 50:14
  what they
• 50:15
  what
• 50:15
  their
• 50:15
  experiences,
• 50:16
  and
• 50:16
  then ask
• 50:17
  what
• 50:17
  the opinion
• 50:18
  is of
• 50:18
  your
• 50:18
  doctor.
• 50:20
  You know,
• 50:20
  I feel like
• 50:21
  so
• 50:22
  many of
• 50:22
  my
• 50:22
  colleagues
• 50:23
  do
• 50:23
  slightly
• 50:23
  different
• 50:24
  things,
• 50:24
  but,
• 50:25
  you know,
• 50:25
  they're
• 50:25
  all
• 50:25
  very excellent.
• 50:27
  and you
• 50:27
  just
• 50:28
  want to
• 50:28
  do
• 50:29
  the due
• 50:29
  diligence,
• 50:30
  do your
• 50:30
  research,
• 50:31
  find out
• 50:31
  what is
• 50:32
  done.
• 50:33
  I think
• 50:34
  brachytherapy
• 50:34
  is pretty
• 50:35
  tried
• 50:36
  and true.
• 50:36
  It
• 50:37
  you know,
• 50:37
  as I said
• 50:37
  before,
• 50:38
  all
• 50:38
  radiation
• 50:39
  treatment
• 50:39
  will kill
• 50:39
  the
• 50:40
  melanoma.
• 50:41
  and
• 50:41
  if you
• 50:42
  are in
• 50:42
  a position
• 50:43
  to get
• 50:43
  a few
• 50:43
  opinions
• 50:44
  or to
• 50:44
  choose,
• 50:45
  then
• 50:46
  definitely
• 50:47
  do
• 50:47
  the
• 50:47
  research,
• 50:48
  learn
• 50:48
  about
• 50:49
  as
• 50:49
  much as
• 50:49
  you can,
• 50:49
  understand
• 50:50
  the differences.
• 50:51
  and,
• 50:51
  and
• 50:52
  if it's,
• 50:52
  there's
• 50:52
  a lot of
• 50:53
  there
• 50:53
  is
• 50:53
  literature
• 50:53
  kind of
• 50:54
  loosely
• 50:54
  comparing
• 50:55
  the two
• 50:56
  types of
• 50:57
  treatment
• 50:57
  and the
• 50:58
  comparisons
• 50:58
  that we
• 50:59
  published
• 50:59
  paper
• 50:59
  about a
• 51:00
  long
• 51:00
  time ago,
• 51:01
  looking
• 51:01
  at all
• 51:01
  the data
• 51:03
  in the
• 51:03
  two
• 51:03
  treatments,
• 51:03
  and
• 51:04
  they worked
• 51:05
  similarly.
• 51:06
  But, you
• 51:07
  really
• 51:07
  have
• 51:07
  to ask,
• 51:08
  ask very
• 51:09
  pointed
• 51:10
  questions
• 51:10
  to your,
• 51:11
  your
• 51:11
  oncologist.
• 51:12
  you know,
• 51:12
  there's
• 51:13
  there's
• 51:13
  no such
• 51:13
  thing
• 51:13
  as
• 51:13
  the only
• 51:14
  way to
• 51:14
  treat
• 51:14
  something.
• 51:15
  And even
• 51:16
  among
• 51:17
  centers
• 51:17
  that use
• 51:18
  the same
• 51:18
  treatments,
• 51:19
  there
• 51:19
  can be
• 51:19
  differences.
• 51:20
  so it's
• 51:21
  a hard
• 51:21
  question
• 51:21
  to answer.
• 51:22
  and
• 51:23
  but
• 51:24
  I think
• 51:24
  that,
• 51:24
  you know,
• 51:25
  the most
• 51:25
  important
• 51:25
  thing is
• 51:25
  you
• 51:25
  get the
• 51:26
  treatment
• 51:26
  and,
• 51:27
  you know,
• 51:28
  when you're
• 51:28
  getting
• 51:29
  opinions
• 51:29
  and doing
• 51:30
  research
• 51:30
  and
• 51:30
  learning
• 51:30
  about
• 51:31
  all the
• 51:31
  different
• 51:31
  options,
• 51:32
  I always
• 51:33
  hope
• 51:33
  people
• 51:33
  don't
• 51:33
  take
• 51:33
  too much
• 51:34
  time,
• 51:34
  really
• 51:35
  do it
• 51:35
  in as
• 51:36
  quick
• 51:36
  a time
• 51:36
  as you
• 51:36
  can, and
• 51:37
  then ask
• 51:38
  your
• 51:38
  ocular
• 51:39
  oncologist
• 51:39
  to help
• 51:41
  give you
• 51:41
  suggestions
• 51:41
  for
• 51:42
  second
• 51:42
  opinions.
• 51:43
  You know
• 51:43
  you
• 51:43
  don't.
• 51:44
  Don't
• 51:44
  feel bad
• 51:44
  about
• 51:45
  saying,
• 51:45
  well,
• 51:45
  can you
• 51:46
  give me 2
• 51:47
  or 3
• 51:47
  people
• 51:48
  that
• 51:48
  I could
• 51:48
  see a
• 51:49
  second
• 51:49
  opinion
• 51:49
  so that
• 51:49
  I can
• 51:50
  learn
• 51:50
  more
• 51:50
  information
• 51:51
  about my
• 51:52
  choices?
• 51:53
  That's my
• 51:53
  it
• 51:54
  would be
• 51:54
  my
• 51:54
  advice.
• 51:55
  I think
• 51:56
  that's
• 51:56
  really
• 51:56
  smart
• 51:56
  too.
• 51:57
  And don't
• 51:57
  be afraid
• 51:57
  of
• 51:58
  offending
• 51:58
  your doctor.
• 51:59
  Like
• 51:59
  I think
• 51:59
  that they
• 52:00
  want you
• 52:00
  to get
• 52:00
  second
• 52:01
  opinions
• 52:01
  and
• 52:01
  that's
• 52:01
  such a
• 52:02
  normal thing.
• 52:03
  But
• 52:03
  people
• 52:04
  are
• 52:04
  sometimes
• 52:04
  maybe
• 52:05
  a little
• 52:05
  afraid
• 52:05
  too,
• 52:06
  because
• 52:06
  they
• 52:06
  don't
• 52:06
  want to
• 52:06
  offend
• 52:07
  anybody.
• 52:07
  And I
• 52:07
  think you
• 52:07
  need to,
• 52:08
  put you
• 52:09
  first
• 52:10
  and
• 52:10
  understand
• 52:10
  that
• 52:10
  they know
• 52:11
  you're
• 52:11
  going
• 52:11
  to get
• 52:11
  a second
• 52:12
  opinion
• 52:12
  and
• 52:12
  they're
• 52:12
  not
• 52:12
  going to
• 52:13
  be offended.
• 52:13
  And
• 52:13
  if they are
• 52:14
  offended,
• 52:15
  maybe
• 52:15
  that's
• 52:15
  not
• 52:15
  even the
• 52:15
  right
• 52:16
  doctor
• 52:16
  for you.
• 52:17
  I 100%
• 52:18
  agree.
• 52:19
  You know,
• 52:20
  when
• 52:20
  if your doctor
• 52:21
  looks at
• 52:21
  you like,
• 52:21
  why would you
• 52:22
  get a
• 52:22
  second
• 52:22
  opinion
• 52:23
  after
• 52:23
  I've
• 52:23
  told you
• 52:24
  what I
• 52:24
  said?
• 52:24
  I mean,
• 52:25
  you know,
• 52:25
  that's
• 52:26
  not
• 52:26
  that's
• 52:26
  not the
• 52:27
  attitude
• 52:27
  of
• 52:27
  someone.
• 52:28
  You
• 52:28
  aren't
• 52:28
  looking
• 52:28
  after
• 52:29
  you.
• 52:29
  I'm
• 52:29
  just
• 52:29
  going to
• 52:29
  say it.
• 52:30
  If you
• 52:30
  if
• 52:30
  someone
• 52:31
  gives you
• 52:31
  a hard
• 52:31
  time with
• 52:31
  second
• 52:32
  opinion,
• 52:32
  then
• 52:32
  then just
• 52:33
  turn around
• 52:34
  and and
• 52:35
  find
• 52:35
  somebody
• 52:35
  else,
• 52:36
  you know,
• 52:36
  you need
• 52:37
  someone
• 52:37
  who's
• 52:37
  going
• 52:37
  to be
• 52:38
  responsive
• 52:39
  and
• 52:39
  understand
• 52:39
  while you
• 52:40
  have
• 52:40
  questions
• 52:40
  and
• 52:41
  someone
• 52:41
  who
• 52:41
  you can
• 52:41
  work
• 52:42
  with,
• 52:42
  you know,
• 52:42
  and this
• 52:43
  I mean,
• 52:44
  today,
• 52:45
  you know,
• 52:45
  maybe 25
• 52:46
  years
• 52:46
  ago, no
• 52:47
  one would
• 52:48
  we don't
• 52:48
  we
• 52:48
  wouldn't
• 52:48
  really
• 52:49
  know
• 52:49
  how to
• 52:50
  get the
• 52:50
  knowledge.
• 52:51
  But
• 52:51
  there's
• 52:51
  so much
• 52:52
  good
• 52:52
  information
• 52:53
  available
• 52:53
  now
• 52:54
  that it
• 52:54
  it really
• 52:55
  is.
• 52:55
  The
• 52:55
  responsibility
• 52:57
  is on
• 52:57
  patients
• 52:58
  to, you
• 52:59
  know,
• 52:59
  question
• 52:59
  their
• 52:59
  doctors,
• 53:00
  you know,
• 53:00
  don't
• 53:01
  you don't
• 53:01
  have
• 53:01
  to go to
• 53:02
  the person
• 53:02
  that
• 53:02
  you were
• 53:03
  referred
• 53:03
  to.
• 53:03
  You can
• 53:04
  maybe
• 53:05
  there's
• 53:05
  two
• 53:05
  maybe
• 53:06
  there's
• 53:06
  I mean
• 53:06
  there's
• 53:06
  not a
• 53:07
  lot of
• 53:07
  in
• 53:07
  colleges,
• 53:08
  but
• 53:08
  you know,
• 53:09
  sometimes
• 53:10
  you might
• 53:10
  have
• 53:10
  options,
• 53:11
  maybe
• 53:11
  there's
• 53:11
  like one
• 53:12
  or 2 or
• 53:13
  3 people
• 53:14
  in an area
• 53:14
  that you can
• 53:15
  you can go
• 53:16
  to.
• 53:16
  And,
• 53:17
  you know,
• 53:17
  even if
• 53:17
  you like
• 53:18
  your
• 53:18
  oncologist,
• 53:19
  and
• 53:19
  you're
• 53:19
  thinking
• 53:20
  you're
• 53:20
  probably
• 53:20
  going
• 53:20
  to go
• 53:20
  there,
• 53:21
  you can
• 53:21
  certainly
• 53:22
  get a
• 53:22
  second
• 53:22
  opinion
• 53:23
  just to
• 53:23
  learn
• 53:24
  more.
• 53:24
  You know,
• 53:25
  there's
• 53:25
  you can
• 53:25
  get a
• 53:26
  second
• 53:26
  opinion
• 53:26
  and just
• 53:27
  decide
• 53:27
  to stick
• 53:27
  with the
• 53:28
  first
• 53:28
  one.
• 53:28
  It's not,
• 53:29
  like
• 53:29
  you're
• 53:30
  leaving
• 53:30
  your
• 53:30
  doctor.
• 53:31
  And
• 53:32
  again,
• 53:33
  you know,
• 53:33
  doctors,
• 53:34
  I think
• 53:34
  we're,
• 53:34
  we're
• 53:35
  becoming
• 53:35
  better
• 53:36
  at,
• 53:37
  make it
• 53:37
  making
• 53:38
  this
• 53:38
  normal,
• 53:38
  getting
• 53:38
  and
• 53:39
  second
• 53:39
  opinions.
• 53:39
  But
• 53:39
  I do
• 53:40
  know it's
• 53:40
  still
• 53:40
  hard for
• 53:41
  some
• 53:42
  physicians
• 53:43
  to be
• 53:43
  open
• 53:44
  minded
• 53:44
  about
• 53:44
  second
• 53:44
  opinions,
• 53:45
  but
• 53:46
  that's
• 53:46
  just
• 53:46
  too bad.
• 53:47
  They're going
• 53:47
  to have
• 53:47
  to learn,
• 53:48
  because,
• 53:48
  you know,
• 53:49
  people,
• 53:49
  it's all
• 53:50
  about
• 53:50
  the patient
• 53:51
  and what
• 53:51
  what
• 53:51
  you feel
• 53:52
  comfortable
• 53:52
  about.
• 53:53
  and
• 53:53
  really
• 53:53
  just,
• 53:54
  you know,
• 53:54
  even if
• 53:55
  you
• 53:55
  belong to
• 53:55
  a health
• 53:56
  plan
• 53:56
  that
• 53:56
  might
• 53:56
  have a
• 53:57
  limited,
• 53:58
  you know,
• 53:58
  limited
• 53:58
  options,
• 53:59
  oftentimes
• 53:59
  you can
• 54:00
  ask for a
• 54:00
  second
• 54:00
  opinion,
• 54:01
  even
• 54:02
  if you
• 54:02
  have
• 54:02
  health
• 54:03
  insurance
• 54:03
  where
• 54:04
  only a
• 54:04
  particular
• 54:05
  acute
• 54:05
  oncologist
• 54:06
  is
• 54:06
  in-network.
• 54:07
  So ask,
• 54:07
  you know,
• 54:08
  the worst
• 54:08
  that can happen
• 54:08
  is they
• 54:09
  can just
• 54:09
  say no.
• 54:09
  But,
• 54:10
  you know,
• 54:10
  you
• 54:10
  definitely
• 54:11
  can ask
• 54:11
  and say,
• 54:11
  this is a
• 54:12
  rare
• 54:12
  condition.
• 54:13
  Few
• 54:13
  people
• 54:14
  have
• 54:14
  experience
• 54:14
  in this.
• 54:15
  And
• 54:15
  I feel
• 54:16
  that
• 54:16
  because I
• 54:16
  have this
• 54:17
  rare
• 54:17
  condition,
• 54:18
  I need
• 54:18
  to be
• 54:19
  approved
• 54:19
  for a
• 54:20
  second
• 54:20
  opinion
• 54:20
  at
• 54:20
  center X.
• 54:23
  So
• 54:23
  definitely,
• 54:23
  definitely
• 54:24
  you have
• 54:25
  a lot of
• 54:26
  leeway,
• 54:26
  especially
• 54:27
  if
• 54:27
  this is
• 54:27
  rare.
• 54:27
  If
• 54:28
  this is
• 54:28
  extremely
• 54:28
  common,
• 54:29
  then
• 54:30
  I mean
• 54:30
  there's
• 54:30
  usually
• 54:30
  a lot
• 54:31
  more
• 54:31
  providers,
• 54:31
  but
• 54:32
  this is
• 54:32
  a case
• 54:33
  where
• 54:33
  in ocular
• 54:33
  melanoma.
• 54:34
  it's very
• 54:35
  important
• 54:35
  to get a
• 54:36
  second
• 54:36
  opinion.
• 54:37
  And
• 54:37
  you need
• 54:38
  to be
• 54:38
  with
• 54:38
  a provider
• 54:39
  that
• 54:39
  you trust
• 54:40
  and that
• 54:41
  relationship
• 54:41
  is important.
• 54:42
  So even
• 54:42
  if you
• 54:44
  think
• 54:44
  that you
• 54:45
  do agree
• 54:45
  with what
• 54:45
  they're
• 54:45
  saying,
• 54:46
  if
• 54:46
  you don't
• 54:46
  feel that
• 54:47
  connection,
• 54:47
  it might
• 54:48
  be worth
• 54:48
  exploring
• 54:49
  another
• 54:49
  doctor
• 54:49
  just
• 54:49
  to find
• 54:50
  somebody
• 54:50
  that is
• 54:51
  a good
• 54:51
  fit
• 54:52
  for you.
• 54:54
  Yeah,
• 54:54
  I think
• 54:54
  that's
• 54:55
  that's
• 54:55
  so true.
• 54:56
  and,
• 54:57
  you know,
• 54:57
  you're
• 54:58
  you're
• 54:58
  you're
• 54:59
  never
• 54:59
  going
• 54:59
  to regret
• 55:00
  getting a
• 55:00
  second
• 55:00
  opinion
• 55:01
  unless
• 55:01
  you,
• 55:02
  you took
• 55:02
  a really
• 55:02
  long time
• 55:03
  to get
• 55:03
  it.
• 55:03
  And by
• 55:04
  really,
• 55:04
  you know,
• 55:04
  don't do
• 55:05
  all
• 55:05
  your opinions
• 55:07
  within
• 55:08
  like,
• 55:09
  you know,
• 55:10
  the
• 55:10
  majority
• 55:10
  of people
• 55:11
  have
• 55:11
  about 2
• 55:12
  to 4
• 55:12
  weeks.
• 55:13
  You know,
• 55:13
  this
• 55:13
  isn't
• 55:14
  something
• 55:14
  you have
• 55:14
  to treat
• 55:14
  tomorrow.
• 55:15
  You know,
• 55:16
  this is
• 55:16
  you know,
• 55:17
  there's
• 55:17
  usually
• 55:17
  time
• 55:18
  with
• 55:18
  ocular
• 55:18
  melanoma.
• 55:19
  you know,
• 55:20
  you don't
• 55:20
  want to
• 55:21
  leave it
• 55:21
  a long
• 55:21
  time.
• 55:22
  And
• 55:22
  obviously
• 55:23
  each case
• 55:23
  is a
• 55:23
  little
• 55:23
  different.
• 55:24
  Some people,
• 55:25
  we have to
• 55:25
  go faster
• 55:26
  than
• 55:26
  others.
• 55:26
  But the
• 55:27
  the
• 55:27
  majority
• 55:28
  of people,
• 55:28
  we have some leeway
• 55:30
  so that
• 55:30
  you don't
• 55:30
  have
• 55:30
  to rush
• 55:31
  into
• 55:31
  anything.
• 55:35
  Yeah,
• 55:35
  I think
• 55:35
  that's
• 55:35
  really
• 55:36
  important.
• 55:38
  let me think
• 55:38
  about
• 55:39
  other
• 55:39
  aspects
• 55:39
  of,
• 55:40
  treatment.
• 55:41
  you know,
• 55:41
  I think
• 55:42
  that one
• 55:43
  of the
• 55:43
  things
• 55:43
  that
• 55:43
  people
• 55:44
  often
• 55:44
  wonder
• 55:44
  about is,
• 55:45
  you know,
• 55:45
  after
• 55:46
  the
• 55:46
  treatment
• 55:47
  and
• 55:47
  having
• 55:47
  the
• 55:47
  surgery
• 55:48
  and
• 55:48
  procedures,
• 55:48
  people,
• 55:49
  want to know
• 55:50
  what
• 55:50
  is what
• 55:50
  what
• 55:51
  happens
• 55:51
  after,
• 55:52
  you know,
• 55:52
  what do
• 55:53
  I need
• 55:53
  to have
• 55:54
  more
• 55:54
  radiation?
• 55:55
  I'm going
• 55:55
  to have
• 55:56
  to have
• 55:56
  additional
• 55:57
  treatments.
• 55:57
  And,
• 55:58
  usually
• 55:59
  the answer
• 55:59
  is no.
• 56:00
  it's
• 56:00
  usually
• 56:01
  one
• 56:01
  surgery,
• 56:01
  one
• 56:02
  radiation.
• 56:03
  But it's
• 56:03
  important
• 56:04
  to still
• 56:05
  do
• 56:05
  the evaluations
• 56:07
  and still
• 56:08
  and I
• 56:08
  and I
• 56:09
  really
• 56:09
  strongly
• 56:10
  recommend
• 56:10
  that
• 56:11
  people
• 56:11
  stay with
• 56:12
  their
• 56:13
  oncologist
• 56:14
  if they can,
• 56:14
  because
• 56:15
  we have
• 56:15
  seen like
• 56:16
  nine
• 56:17
  years
• 56:17
  later,
• 56:18
  someone
• 56:18
  can start
• 56:19
  to get
• 56:19
  a recurrence.
• 56:20
  And
• 56:21
  if that wasn't
• 56:21
  if no one
• 56:22
  was
• 56:22
  really
• 56:22
  looking
• 56:23
  for that,
• 56:23
  it
• 56:23
  would have
• 56:24
  just
• 56:24
  sort of
• 56:25
  gone out
• 56:25
  of control.
• 56:26
  But
• 56:26
  if you
• 56:26
  find
• 56:26
  something
• 56:27
  like a
• 56:27
  recurrence
• 56:28
  later
• 56:29
  that's
• 56:29
  very
• 56:29
  small
• 56:30
  and very
• 56:30
  treatable
• 56:30
  in an eye
• 56:31
  with good
• 56:31
  vision,
• 56:32
  you can have
• 56:32
  a second
• 56:33
  brachytherapy
• 56:33
  plaque.
• 56:34
  You know,
• 56:34
  it's
• 56:35
  becoming
• 56:35
  pretty
• 56:35
  normal
• 56:36
  now.
• 56:36
  In
• 56:36
  the olden
• 56:37
  days,
• 56:37
  we used to say
• 56:38
  if
• 56:38
  the tumor
• 56:39
  comes
• 56:39
  back,
• 56:39
  we have to
• 56:39
  take out
• 56:40
  the eye.
• 56:40
  But,
• 56:41
  you know,
• 56:41
  we would
• 56:41
  we would
• 56:42
  take out
• 56:42
  the eye
• 56:42
  if
• 56:42
  there was
• 56:43
  really
• 56:43
  no vision.
• 56:44
  But
• 56:44
  if there's
• 56:45
  vision
• 56:46
  and it's
• 56:47
  very
• 56:47
  treatable,
• 56:47
  it's
• 56:48
  you know,
• 56:49
  what
• 56:49
  I've learned
• 56:49
  is that
• 56:50
  the eye
• 56:50
  does not
• 56:51
  completely
• 56:52
  fall
• 56:52
  apart
• 56:53
  with a
• 56:53
  second
• 56:53
  dose of
• 56:53
  radiation.
• 56:55
  there's
• 56:55
  this
• 56:55
  notion
• 56:56
  still.
• 56:56
  I mean,
• 56:56
  we were
• 56:56
  very
• 56:57
  first,
• 56:57
  the
• 56:57
  very first time
• 56:58
  I remember
• 56:59
  doing a
• 56:59
  second
• 56:59
  plaque.
• 57:00
  Our
• 57:00
  radiation
• 57:00
  team was
• 57:01
  like,
• 57:01
  well,
• 57:01
  we can't do
• 57:02
  that.
• 57:02
  We
• 57:02
  can't do
• 57:02
  that.
• 57:03
  I said,
• 57:03
  well,
• 57:03
  what's
• 57:03
  the option
• 57:04
  if
• 57:04
  we're going
• 57:05
  to take
• 57:05
  the eye
• 57:05
  out?
• 57:05
  So, so
• 57:06
  we, we
• 57:07
  everyone
• 57:07
  was very
• 57:07
  surprised
• 57:08
  that the
• 57:08
  patient
• 57:09
  tolerated
• 57:09
  it
• 57:09
  very well.
• 57:10
  And you
• 57:10
  know, now
• 57:11
  when
• 57:11
  we do see
• 57:12
  a
• 57:12
  recurrence
• 57:13
  and the
• 57:13
  vision is
• 57:13
  good,
• 57:13
  most
• 57:14
  people
• 57:14
  tend to
• 57:14
  maintain
• 57:15
  their vision.
• 57:17
  so
• 57:17
  a second
• 57:18
  dose of
• 57:18
  radiation
• 57:19
  is not a,
• 57:19
  not a,
• 57:20
  not
• 57:20
  necessarily
• 57:21
  a vision
• 57:22
  threatening
• 57:22
  sentence.
• 57:23
  So,
• 57:23
  you know,
• 57:24
  make
• 57:24
  sure
• 57:24
  you get
• 57:24
  followed
• 57:25
  up,
• 57:25
  make sure
• 57:25
  you
• 57:26
  monitor
• 57:26
  the eye.
• 57:27
  And the
• 57:28
  other
• 57:28
  thing to
• 57:29
  when
• 57:29
  you're
• 57:29
  getting
• 57:30
  these eye
• 57:30
  evaluations,
• 57:31
  not don't
• 57:32
  just
• 57:32
  focus
• 57:32
  on the
• 57:33
  melanoma
• 57:33
  eye, but
• 57:34
  make sure
• 57:35
  that the
• 57:35
  ophthalmologist
• 57:36
  is
• 57:36
  looking
• 57:36
  carefully
• 57:37
  at your
• 57:37
  other eye.
• 57:38
  Because
• 57:39
  there are
• 57:39
  so many
• 57:40
  conditions
• 57:41
  of
• 57:41
  the eye
• 57:41
  that
• 57:42
  are far
• 57:42
  more
• 57:42
  common
• 57:43
  than
• 57:43
  ocular
• 57:43
  melanoma,
• 57:44
  that are
• 57:45
  so
• 57:45
  treatable.
• 57:46
  And,
• 57:46
  you know,
• 57:47
  number
• 57:47
  one is
• 57:48
  cataract.
• 57:49
  and then
• 57:49
  glaucoma.
• 57:51
  And then
• 57:52
  there's
• 57:52
  a host
• 57:52
  of
• 57:52
  various
• 57:53
  retinal
• 57:53
  conditions.
• 57:54
  But even
• 57:55
  just
• 57:55
  because
• 57:56
  your eye
• 57:56
  had a
• 57:56
  melanoma
• 57:57
  in it,
• 57:57
  and
• 57:58
  if you
• 57:58
  develop
• 57:58
  like a
• 57:58
  macular
• 57:59
  hole or
• 57:59
  something
• 58:00
  different,
• 58:00
  you can have
• 58:01
  the treatment
• 58:02
  that
• 58:02
  everybody
• 58:02
  else has.
• 58:03
  sometimes
• 58:04
  I hear
• 58:05
  that, oh,
• 58:05
  this is a
• 58:06
  melanoma.
• 58:06
  I don't
• 58:07
  touch it.
• 58:07
  Just
• 58:07
  leave it.
• 58:08
  You know,
• 58:09
  it's been
• 58:09
  through a lot.
• 58:10
  But
• 58:10
  if there's
• 58:11
  a way
• 58:11
  to
• 58:11
  make your
• 58:11
  vision
• 58:12
  better
• 58:13
  because
• 58:13
  that
• 58:13
  eye has
• 58:14
  a condition
• 58:15
  that is more common
• 58:16
  and that
• 58:17
  we know
• 58:17
  how to
• 58:17
  fix, then
• 58:18
  you
• 58:18
  should
• 58:18
  definitely
• 58:19
  have
• 58:19
  surgery.
• 58:20
  And
• 58:20
  the other thing
• 58:21
  is,
• 58:21
  you know,
• 58:22
  cataract.
• 58:23
  I often
• 58:23
  find
• 58:24
  people
• 58:24
  saying,
• 58:24
  oh, my
• 58:25
  doctor
• 58:25
  told me
• 58:25
  that
• 58:26
  I should
• 58:26
  I should
• 58:26
  wait
• 58:27
  as long
• 58:27
  as
• 58:27
  possible
• 58:28
  to have
• 58:28
  cataract
• 58:28
  in
• 58:29
  my good
• 58:29
  eye
• 58:29
  and maybe
• 58:30
  never
• 58:30
  have
• 58:30
  cataract
• 58:31
  surgery,
• 58:31
  because
• 58:32
  what if
• 58:32
  something
• 58:32
  happened
• 58:33
  to my my,
• 58:35
  my good
• 58:35
  eye?
• 58:35
  And I
• 58:36
  just
• 58:36
  think
• 58:36
  that's
• 58:36
  just I
• 58:37
  would
• 58:37
  flip it
• 58:38
  around
• 58:38
  and say
• 58:38
  that in
• 58:39
  order
• 58:39
  for you
• 58:39
  to
• 58:39
  function
• 58:40
  well,
• 58:41
  if you do
• 58:41
  start
• 58:42
  to have
• 58:42
  a vision
• 58:43
  degrading
• 58:43
  condition
• 58:44
  that's
• 58:44
  happening
• 58:45
  in your
• 58:45
  better
• 58:45
  eye,
• 58:46
  you need
• 58:47
  to be
• 58:47
  all the
• 58:48
  more
• 58:48
  proactive
• 58:49
  about
• 58:49
  getting
• 58:49
  it
• 58:49
  treated
• 58:50
  so that
• 58:50
  you can
• 58:51
  continue
• 58:51
  and do
• 58:52
  well.
• 58:52
  Because,
• 58:53
  you know,
• 58:53
  this is
• 58:54
  cataract
• 58:54
  is such a
• 58:55
  such a
• 58:56
  common
• 58:56
  and
• 58:56
  highly
• 58:57
  successful
• 58:57
  surgery
• 58:59
  that to
• 58:59
  to
• 58:59
  sort of
• 59:00
  not to
• 59:00
  deny
• 59:01
  people
• 59:01
  to have
• 59:01
  cataract
• 59:02
  surgery.
• 59:03
  just
• 59:03
  because
• 59:04
  there
• 59:04
  might
• 59:04
  be a
• 59:04
  remote
• 59:05
  risk that
• 59:06
  something
• 59:06
  might
• 59:06
  happen,
• 59:07
  is
• 59:07
  just not
• 59:08
  appropriate,
• 59:09
  in
• 59:09
  my opinion.
• 59:09
  And
• 59:10
  I think
• 59:10
  it's
• 59:10
  really
• 59:10
  outdated
• 59:11
  to tell
• 59:11
  people
• 59:12
  not to
• 59:12
  have
• 59:12
  surgery
• 59:13
  that
• 59:13
  we're so
• 59:13
  good at,
• 59:15
  because
• 59:15
  of this
• 59:16
  rare
• 59:16
  risk.
• 59:17
  And,
• 59:17
  and I
• 59:17
  and I try
• 59:17
  to
• 59:18
  talk to
• 59:18
  people
• 59:18
  about it
• 59:18
  and
• 59:18
  those people
• 59:19
  who just
• 59:19
  don't
• 59:20
  want
• 59:20
  anything
• 59:20
  done.
• 59:20
  And,
• 59:21
  you know,
• 59:21
  it's
• 59:21
  completely
• 59:22
  your choice.
• 59:23
  But it's
• 59:24
  important
• 59:24
  not to
• 59:25
  necessarily
• 59:25
  have the
• 59:26
  fears
• 59:27
  of your
• 59:27
  ophthalmology
• 59:28
  team.
• 59:29
  You know,
• 59:30
  trickle
• 59:31
  on to you
• 59:31
  if it's
• 59:31
  going to
• 59:32
  be result
• 59:33
  in
• 59:33
  impaired
• 59:33
  vision.
• 59:34
  So
• 59:34
  there's
• 59:35
  a lot
• 59:35
  of things
• 59:35
  you can
• 59:35
  do.
• 59:36
  And the
• 59:36
  other
• 59:36
  thing
• 59:36
  I'd
• 59:37
  mention
• 59:37
  is
• 59:37
  glaucoma.
• 59:38
  there's about
• 59:39
  8 to
• 59:40
  9% of
• 59:41
  everybody
• 59:41
  who gets
• 59:42
  a break.
• 59:42
  A therapy
• 59:42
  plaque
• 59:43
  will
• 59:43
  develop a
• 59:43
  pressure
• 59:44
  issue
• 59:44
  with
• 59:44
  their eye
• 59:45
  down
• 59:45
  the road
• 59:46
  at
• 59:46
  some point.
• 59:47
  and I
• 59:47
  find that
• 59:47
  a lot
• 59:48
  of people
• 59:48
  are
• 59:48
  scared
• 59:49
  to treat
• 59:49
  glaucoma
• 59:50
  in a
• 59:50
  melanoma
• 59:51
  eye.
• 59:52
  And
• 59:52
  unfortunately,
• 59:53
  I've seen
• 59:53
  people
• 59:53
  who've
• 59:53
  lost
• 59:54
  a lot of vision
• 59:55
  because
• 59:55
  their
• 59:56
  ophthalmologist
• 59:56
  was too
• 59:57
  afraid
• 59:57
  to do
• 59:58
  the
• 59:58
  standard
• 59:58
  glaucoma
• 59:59
  surgeries
• 1:00:00
  in a
• 1:00:00
  melanoma
• 1:00:01
  eye.
• 1:00:02
  And
• 1:00:02
  I think
• 1:00:02
  that's
• 1:00:02
  just
• 1:00:03
  really
• 1:00:03
  unfortunate.
• 1:00:04
  But, you
• 1:00:05
  know,
• 1:00:06
  again,
• 1:00:07
  if if
• 1:00:08
  when
• 1:00:08
  I see
• 1:00:08
  people
• 1:00:09
  regularly
• 1:00:09
  always
• 1:00:09
  ask about
• 1:00:10
  what else
• 1:00:10
  is
• 1:00:10
  happening
• 1:00:11
  in their
• 1:00:11
  eye care,
• 1:00:11
  who's
• 1:00:12
  checking
• 1:00:12
  this,
• 1:00:12
  who's
• 1:00:13
  doing
• 1:00:13
  that, and
• 1:00:13
  sometimes
• 1:00:14
  I have
• 1:00:14
  to get
• 1:00:14
  on the phone
• 1:00:15
  and call
• 1:00:15
  their
• 1:00:15
  ophthalmologist
• 1:00:16
  and say,
• 1:00:16
  hey, you
• 1:00:16
  know,
• 1:00:17
  it's
• 1:00:17
  completely
• 1:00:17
  safe.
• 1:00:18
  This
• 1:00:18
  tumor
• 1:00:18
  is dead.
• 1:00:19
  You know,
• 1:00:19
  please,
• 1:00:19
  do you
• 1:00:20
  know,
• 1:00:21
  glaucoma
• 1:00:21
  surgery.
• 1:00:21
  So
• 1:00:22
  the vision,
• 1:00:22
  we're
• 1:00:23
  not
• 1:00:23
  going to
• 1:00:23
  lose
• 1:00:23
  vision
• 1:00:24
  from
• 1:00:24
  something
• 1:00:25
  else.
• 1:00:25
  So
• 1:00:26
  I
• 1:00:26
  encourage
• 1:00:27
  people to
• 1:00:28
  know,
• 1:00:29
  ask
• 1:00:29
  questions
• 1:00:30
  not just
• 1:00:30
  about the
• 1:00:31
  cancer
• 1:00:31
  part,
• 1:00:31
  but
• 1:00:32
  about everything
• 1:00:32
  in their
• 1:00:33
  eye
• 1:00:33
  health.
• 1:00:35
  Yeah,
• 1:00:35
  I mean,
• 1:00:36
  that
• 1:00:36
  makes
• 1:00:36
  sense.
• 1:00:36
  You want to
• 1:00:37
  preserve
• 1:00:37
  any
• 1:00:37
  vision
• 1:00:38
  you have.
• 1:00:38
  So yeah,
• 1:00:39
  I mean,
• 1:00:40
  I think
• 1:00:41
  that
• 1:00:41
  that's
• 1:00:41
  wonderful
• 1:00:42
  that
• 1:00:43
  everything
• 1:00:43
  is
• 1:00:43
  progressing
• 1:00:44
  the way it is
• 1:00:44
  and
• 1:00:45
  they're
• 1:00:45
  starting
• 1:00:45
  to see
• 1:00:45
  that
• 1:00:46
  they can
• 1:00:46
  save
• 1:00:46
  the vision.
• 1:00:47
  I mean,
• 1:00:47
  that's
• 1:00:49
  the
• 1:00:49
  ultimate
• 1:00:50
  thing is,
• 1:00:51
  you know,
• 1:00:51
  obviously
• 1:00:53
  getting
• 1:00:53
  the
• 1:00:53
  cancer
• 1:00:54
  to be,
• 1:00:56
  what's
• 1:00:56
  the word.
• 1:00:56
  Not
• 1:00:58
  not cure.
• 1:00:59
  Cure
• 1:01:00
  killed
• 1:01:01
  kill the
• 1:01:01
  melanoma.
• 1:01:03
  You
• 1:01:03
  just kill
• 1:01:04
  it.
• 1:01:04
  I don't
• 1:01:04
  I don't
• 1:01:05
  there's
• 1:01:05
  no fancy.
• 1:01:05
  Words
• 1:01:06
  like
• 1:01:07
  there.
• 1:01:08
  That
• 1:01:08
  dead.
• 1:01:09
  Yes.
• 1:01:10
  Yeah.
• 1:01:10
  To kill
• 1:01:11
  the cancer.
• 1:01:11
  But then
• 1:01:12
  we also
• 1:01:12
  need to
• 1:01:12
  preserve
• 1:01:13
  quality
• 1:01:13
  of life
• 1:01:14
  and vision.
• 1:01:14
  And so
• 1:01:15
  you don't
• 1:01:15
  just
• 1:01:16
  want to
• 1:01:16
  stop there.
• 1:01:17
  So
• 1:01:17
  I think
• 1:01:18
  that's
• 1:01:18
  great.
• 1:01:18
  And that,
• 1:01:19
  you know,
• 1:01:20
  technology
• 1:01:20
  is
• 1:01:21
  progressing
• 1:01:21
  enough
• 1:01:22
  that
• 1:01:22
  they can
• 1:01:22
  do more
• 1:01:23
  and more.
• 1:01:23
  It's
• 1:01:24
  really
• 1:01:24
  just
• 1:01:24
  fascinating.
• 1:01:25
  And I
• 1:01:26
  mean,
• 1:01:26
  what
• 1:01:27
  a time
• 1:01:27
  to be
• 1:01:27
  alive.
• 1:01:27
  Like the
• 1:01:28
  technology
• 1:01:29
  is to
• 1:01:29
  explore.
• 1:01:31
  Yeah.
• 1:01:31
  And then
• 1:01:31
  there's
• 1:01:31
  so much,
• 1:01:32
  so much
• 1:01:32
  happening
• 1:01:33
  and you
• 1:01:34
  know,
• 1:01:34
  repair of
• 1:01:35
  I mean,
• 1:01:35
  I think,
• 1:01:36
  I think
• 1:01:36
  in the
• 1:01:36
  field
• 1:01:37
  of
• 1:01:37
  retinal
• 1:01:37
  detachment
• 1:01:38
  even and
• 1:01:38
  sometimes
• 1:01:39
  eyes with
• 1:01:40
  the
• 1:01:40
  melanoma
• 1:01:40
  right
• 1:01:41
  after
• 1:01:41
  treatment,
• 1:01:42
  sometimes
• 1:01:42
  you can
• 1:01:43
  get a
• 1:01:43
  retinal detachment.
• 1:01:44
  And I
• 1:01:44
  find that
• 1:01:45
  a lot
• 1:01:45
  of times
• 1:01:45
  doctors
• 1:01:46
  don't
• 1:01:46
  really
• 1:01:46
  want to
• 1:01:46
  treat it.
• 1:01:48
  And,
• 1:01:48
  and I
• 1:01:48
  that
• 1:01:48
  really
• 1:01:49
  bugs me
• 1:01:49
  because
• 1:01:49
  we,
• 1:01:50
  we know
• 1:01:50
  how to
• 1:01:50
  fix
• 1:01:51
  retinas.
• 1:01:52
  and so,
• 1:01:53
  so if you
• 1:01:53
  find
• 1:01:54
  that,
• 1:01:54
  you know,
• 1:01:54
  your
• 1:01:54
  vision
• 1:01:55
  is down
• 1:01:55
  and you,
• 1:01:55
  you're asking,
• 1:01:56
  why
• 1:01:56
  am I not
• 1:01:57
  seeing?
• 1:01:57
  And then
• 1:01:58
  you hear
• 1:01:58
  that
• 1:01:58
  there's a
• 1:01:59
  retinal detachment,
• 1:02:00
  you can
• 1:02:00
  say,
• 1:02:00
  well,
• 1:02:00
  how about
• 1:02:01
  how about
• 1:02:01
  we fix
• 1:02:01
  the retina
• 1:02:02
  because,
• 1:02:03
  you know,
• 1:02:03
  people do
• 1:02:04
  that.
• 1:02:04
  That's a
• 1:02:04
  normal
• 1:02:05
  thing.
• 1:02:06
  and I
• 1:02:06
  find that
• 1:02:06
  people
• 1:02:06
  are
• 1:02:06
  always
• 1:02:07
  reluctant
• 1:02:08
  to do
• 1:02:08
  that. So.
• 1:02:09
  So I
• 1:02:09
  encourage
• 1:02:10
  people
• 1:02:11
  to,
• 1:02:11
  you know,
• 1:02:11
  ask
• 1:02:12
  specifically
• 1:02:13
  like,
• 1:02:13
  why is my vision
• 1:02:14
  decreased
• 1:02:15
  if it is
• 1:02:16
  or why
• 1:02:17
  am I
• 1:02:17
  seeing
• 1:02:18
  this?
• 1:02:18
  And once
• 1:02:18
  you
• 1:02:18
  understand
• 1:02:19
  what
• 1:02:19
  it is
• 1:02:19
  like,
• 1:02:19
  ask,
• 1:02:20
  what are we going
• 1:02:21
  to do
• 1:02:21
  about it?
• 1:02:21
  You know,
• 1:02:22
  we're
• 1:02:22
  going
• 1:02:22
  to just
• 1:02:22
  leave it
• 1:02:22
  there or,
• 1:02:23
  you know,
• 1:02:24
  do
• 1:02:24
  I have to
• 1:02:24
  live
• 1:02:24
  with this
• 1:02:25
  or can
• 1:02:25
  this be
• 1:02:25
  fixed?
• 1:02:26
  And
• 1:02:27
  I just
• 1:02:28
  I find
• 1:02:28
  that
• 1:02:28
  a lot
• 1:02:29
  of still,
• 1:02:29
  there has
• 1:02:29
  to be
• 1:02:30
  a lot
• 1:02:30
  of work
• 1:02:30
  amongst
• 1:02:31
  the
• 1:02:32
  ophthalmology
• 1:02:32
  community
• 1:02:33
  to let
• 1:02:34
  people
• 1:02:35
  know.
• 1:02:35
  And,
• 1:02:36
  you know,
• 1:02:36
  lot of times
• 1:02:36
  I give
• 1:02:37
  talks
• 1:02:37
  in our
• 1:02:38
  annual
• 1:02:38
  meetings
• 1:02:39
  and
• 1:02:39
  things
• 1:02:39
  about all
• 1:02:40
  the
• 1:02:40
  different
• 1:02:40
  things
• 1:02:40
  that
• 1:02:40
  we have
• 1:02:41
  to make
• 1:02:43
  better
• 1:02:43
  vision.
• 1:02:43
  And then
• 1:02:44
  ocular
• 1:02:44
  melanoma
• 1:02:45
  eyes,
• 1:02:45
  because
• 1:02:45
  we have
• 1:02:46
  so many
• 1:02:47
  incredible
• 1:02:48
  techniques.
• 1:02:48
  As you
• 1:02:49
  say,
• 1:02:49
  there are
• 1:02:49
  so many
• 1:02:50
  advances.
• 1:02:50
  It
• 1:02:50
  doesn't
• 1:02:51
  have
• 1:02:51
  to be
• 1:02:51
  an
• 1:02:51
  advancement
• 1:02:52
  in eye
• 1:02:52
  cancer,
• 1:02:53
  but an
• 1:02:54
  an
• 1:02:54
  advancement
• 1:02:55
  in any
• 1:02:55
  type of
• 1:02:56
  eye care
• 1:02:57
  is is
• 1:02:58
  translatable
• 1:02:58
  to an eye
• 1:02:59
  with a
• 1:02:59
  melanoma.
• 1:03:00
  You know,
• 1:03:00
  there's
• 1:03:00
  so much
• 1:03:01
  that
• 1:03:01
  people
• 1:03:01
  can
• 1:03:01
  benefit
• 1:03:02
  from.
• 1:03:02
  but
• 1:03:03
  I also
• 1:03:04
  often
• 1:03:04
  find that
• 1:03:04
  it's hard
• 1:03:05
  to get
• 1:03:05
  the eye
• 1:03:06
  doctors
• 1:03:06
  to be
• 1:03:06
  open
• 1:03:07
  about it,
• 1:03:07
  because I
• 1:03:08
  feel
• 1:03:08
  like,
• 1:03:08
  honestly,
• 1:03:09
  you know,
• 1:03:10
  an eye
• 1:03:10
  with a
• 1:03:10
  melanoma
• 1:03:11
  is a
• 1:03:11
  little
• 1:03:11
  second
• 1:03:12
  class
• 1:03:12
  citizen
• 1:03:12
  eye.
• 1:03:13
  And and
• 1:03:14
  we have
• 1:03:14
  to
• 1:03:14
  just let
• 1:03:14
  people
• 1:03:15
  know
• 1:03:15
  that it's
• 1:03:16
  we have to
• 1:03:16
  do
• 1:03:16
  we have to
• 1:03:17
  fix that.
• 1:03:17
  If
• 1:03:17
  you have
• 1:03:17
  macular
• 1:03:18
  degeneration,
• 1:03:19
  you get
• 1:03:20
  macular
• 1:03:20
  degeneration.
• 1:03:21
  And I
• 1:03:21
  with a
• 1:03:21
  melanoma
• 1:03:22
  will
• 1:03:22
  treat
• 1:03:22
  that.
• 1:03:22
  You know,
• 1:03:23
  we're not
• 1:03:23
  just
• 1:03:23
  going to
• 1:03:23
  leave it.
• 1:03:24
  Of course
• 1:03:24
  I mean
• 1:03:25
  we have
• 1:03:25
  like
• 1:03:26
  that.
• 1:03:26
  I think
• 1:03:26
  that's
• 1:03:26
  the area
• 1:03:27
  we have.
• 1:03:27
  The
• 1:03:27
  incredible
• 1:03:28
  progress
• 1:03:28
  in the
• 1:03:29
  last few
• 1:03:29
  years is
• 1:03:30
  the
• 1:03:30
  treatments
• 1:03:30
  we have
• 1:03:31
  for age
• 1:03:31
  related
• 1:03:31
  macular
• 1:03:32
  degeneration,
• 1:03:33
  where
• 1:03:33
  we can
• 1:03:33
  improve
• 1:03:34
  vision
• 1:03:34
  and
• 1:03:34
  people
• 1:03:35
  are
• 1:03:35
  driving
• 1:03:36
  as they
• 1:03:36
  get older
• 1:03:37
  with
• 1:03:37
  these
• 1:03:37
  diseases.
• 1:03:38
  I mean,
• 1:03:38
  those diseases
• 1:03:39
  are
• 1:03:39
  fairly
• 1:03:40
  common
• 1:03:40
  and
• 1:03:40
  they can happen
• 1:03:41
  if you have
• 1:03:41
  a
• 1:03:41
  melanoma
• 1:03:42
  and and
• 1:03:43
  you got
• 1:03:43
  to get
• 1:03:43
  that
• 1:03:43
  treated.
• 1:03:44
  And so,
• 1:03:45
  so
• 1:03:45
  just, you
• 1:03:46
  know,
• 1:03:46
  again,
• 1:03:46
  I think
• 1:03:47
  a lot of
• 1:03:47
  it is
• 1:03:48
  just for
• 1:03:48
  the
• 1:03:48
  audience
• 1:03:49
  is to ask
• 1:03:50
  questions.
• 1:03:51
  If
• 1:03:51
  something
• 1:03:51
  is
• 1:03:52
  changing
• 1:03:52
  in
• 1:03:52
  your vision,
• 1:03:52
  you want to know
• 1:03:53
  why,
• 1:03:54
  you know,
• 1:03:54
  if
• 1:03:54
  something
• 1:03:55
  is
• 1:03:55
  a little
• 1:03:55
  worse.
• 1:03:56
  Your ophthalmologist
• 1:03:57
  needs to
• 1:03:57
  tell you
• 1:03:58
  why and
• 1:03:59
  what
• 1:03:59
  you're
• 1:03:59
  going
• 1:03:59
  to do about it
• 1:04:01
  if you can.
• 1:04:01
  Because
• 1:04:02
  yes,
• 1:04:02
  there are
• 1:04:02
  some things
• 1:04:03
  we don't
• 1:04:03
  have
• 1:04:03
  treatments
• 1:04:04
  for, but
• 1:04:05
  there are
• 1:04:05
  so many
• 1:04:05
  things
• 1:04:06
  that are
• 1:04:06
  treatable.
• 1:04:07
  So if you
• 1:04:08
  have a
• 1:04:08
  treatable
• 1:04:08
  condition,
• 1:04:09
  you have
• 1:04:10
  to push
• 1:04:10
  to get
• 1:04:11
  the treatment.
• 1:04:11
  And
• 1:04:12
  if your doctor
• 1:04:12
  is
• 1:04:13
  reluctant
• 1:04:13
  again,
• 1:04:14
  get
• 1:04:14
  a second
• 1:04:15
  opinion,
• 1:04:15
  you know,
• 1:04:15
  see
• 1:04:16
  someone
• 1:04:16
  who, who
• 1:04:17
  has the
• 1:04:17
  ability
• 1:04:18
  and
• 1:04:19
  willingness
• 1:04:19
  to help
• 1:04:20
  you see
• 1:04:20
  your best.
• 1:04:21
  And
• 1:04:21
  that's
• 1:04:21
  really
• 1:04:21
  what it's
• 1:04:22
  all about,
• 1:04:22
  as you
• 1:04:23
  say, it's
• 1:04:23
  just
• 1:04:23
  really,
• 1:04:24
  you know,
• 1:04:24
  making
• 1:04:24
  use
• 1:04:25
  of all
• 1:04:25
  the
• 1:04:25
  advances
• 1:04:26
  that
• 1:04:26
  we have
• 1:04:26
  and
• 1:04:27
  making
• 1:04:27
  sure
• 1:04:27
  that they
• 1:04:28
  apply to
• 1:04:28
  your eye
• 1:04:29
  health.
• 1:04:30
  And we
• 1:04:30
  talk a
• 1:04:31
  lot about
• 1:04:31
  advocating
• 1:04:32
  for yourself
• 1:04:32
  that
• 1:04:33
  you're
• 1:04:33
  your best
• 1:04:33
  advocate.
• 1:04:34
  And
• 1:04:34
  this is,
• 1:04:35
  excuse
• 1:04:35
  me,
• 1:04:35
  this is one
• 1:04:36
  of those
• 1:04:36
  situations
• 1:04:37
  where
• 1:04:37
  if you
• 1:04:37
  don't go
• 1:04:38
  ask those
• 1:04:38
  questions
• 1:04:39
  and you
• 1:04:39
  don't
• 1:04:39
  advocate
• 1:04:40
  for yourself,
• 1:04:40
  no
• 1:04:41
  one else
• 1:04:41
  is going
• 1:04:41
  to do it.
• 1:04:43
  That's
• 1:04:43
  absolutely
• 1:04:44
  right.
• 1:04:44
  Yeah.
• 1:04:45
  And
• 1:04:45
  you have
• 1:04:45
  to feel
• 1:04:45
  really
• 1:04:46
  comfortable
• 1:04:46
  doing
• 1:04:46
  that.
• 1:04:47
  You have
• 1:04:47
  to think
• 1:04:47
  this is
• 1:04:47
  for you.
• 1:04:48
  You know,
• 1:04:48
  this is,
• 1:04:49
  you know,
• 1:04:50
  it's
• 1:04:50
  your eye
• 1:04:50
  and
• 1:04:51
  your life
• 1:04:51
  and
• 1:04:53
  you have to be
• 1:04:54
  you have to
• 1:04:55
  be
• 1:04:55
  comfortable
• 1:04:55
  just speaking
• 1:04:56
  up for
• 1:04:56
  yourself
• 1:04:57
  and, and,
• 1:04:59
  you know,
• 1:05:00
  talk to
• 1:05:00
  people.
• 1:05:01
  You know,
• 1:05:01
  I always
• 1:05:01
  recommend
• 1:05:02
  people
• 1:05:02
  bring
• 1:05:02
  somebody
• 1:05:03
  to their
• 1:05:03
  appointment
• 1:05:04
  because,
• 1:05:04
  you know,
• 1:05:05
  even,
• 1:05:05
  you know,
• 1:05:05
  I've been
• 1:05:05
  a patient
• 1:05:06
  before,
• 1:05:06
  and
• 1:05:06
  I often
• 1:05:07
  find that
• 1:05:08
  when
• 1:05:08
  something
• 1:05:08
  is
• 1:05:09
  happening
• 1:05:09
  to you,
• 1:05:10
  you
• 1:05:10
  kind of
• 1:05:10
  you kind
• 1:05:11
  of lose
• 1:05:11
  a little
• 1:05:11
  bit, you
• 1:05:12
  lose
• 1:05:12
  your voice
• 1:05:12
  a little bit.
• 1:05:13
  So bring
• 1:05:14
  someone
• 1:05:14
  with you,
• 1:05:15
  a good
• 1:05:15
  friend,
• 1:05:15
  a family
• 1:05:16
  member or
• 1:05:16
  partner
• 1:05:17
  and
• 1:05:18
  have them
• 1:05:19
  there
• 1:05:19
  together
• 1:05:19
  with you
• 1:05:20
  to make
• 1:05:21
  sure that
• 1:05:21
  you got
• 1:05:22
  through
• 1:05:22
  all the
• 1:05:22
  questions
• 1:05:23
  on your list
• 1:05:23
  or that
• 1:05:24
  you know
• 1:05:24
  the
• 1:05:25
  person
• 1:05:25
  coming
• 1:05:25
  with you
• 1:05:26
  is
• 1:05:27
  you got a
• 1:05:27
  two sets
• 1:05:28
  of brains
• 1:05:28
  there
• 1:05:28
  that are
• 1:05:29
  analyzing
• 1:05:30
  the information
• 1:05:30
  you're getting,
• 1:05:31
  and
• 1:05:31
  they can ask
• 1:05:32
  questions
• 1:05:32
  too.
• 1:05:33
  So
• 1:05:33
  I think
• 1:05:33
  that's
• 1:05:34
  very helpful
• 1:05:35
  because
• 1:05:35
  sometimes
• 1:05:37
  if you're
• 1:05:37
  just by
• 1:05:37
  yourself,
• 1:05:38
  you might
• 1:05:38
  you might
• 1:05:39
  not feel
• 1:05:39
  strong
• 1:05:40
  enough.
• 1:05:41
  But
• 1:05:41
  when you
• 1:05:41
  have
• 1:05:41
  someone
• 1:05:41
  with you,
• 1:05:42
  I
• 1:05:43
  find that
• 1:05:43
  if I
• 1:05:43
  ever come
• 1:05:44
  with
• 1:05:44
  someone
• 1:05:44
  to a
• 1:05:45
  medical
• 1:05:45
  examination,
• 1:05:47
  I, I'm
• 1:05:47
  right
• 1:05:47
  there,
• 1:05:48
  ready to
• 1:05:49
  interrogate
• 1:05:50
  and
• 1:05:50
  find out
• 1:05:50
  everything.
• 1:05:51
  So
• 1:05:51
  bring a
• 1:05:52
  close
• 1:05:52
  friend.
• 1:05:52
  I think
• 1:05:53
  that's
• 1:05:53
  a tip
• 1:05:53
  I'd
• 1:05:53
  recommend.
• 1:05:55
  Yeah,
• 1:05:55
  and even
• 1:05:55
  if they
• 1:05:56
  can't go
• 1:05:56
  in
• 1:05:56
  person,
• 1:05:56
  you can always
• 1:05:57
  put them
• 1:05:57
  on
• 1:05:57
  FaceTime
• 1:05:58
  on your phone
• 1:05:58
  and
• 1:05:59
  have them
• 1:05:59
  not be
• 1:06:00
  right
• 1:06:00
  there
• 1:06:00
  with you
• 1:06:00
  on your
• 1:06:01
  phone.
• 1:06:02
  Exactly.
• 1:06:02
  That's
• 1:06:02
  a great thing
• 1:06:03
  to bring.
• 1:06:05
  Bring
• 1:06:05
  people
• 1:06:05
  by
• 1:06:05
  FaceTime
• 1:06:06
  in
• 1:06:07
  person.
• 1:06:07
  It's,
• 1:06:08
  you know,
• 1:06:08
  there's
• 1:06:08
  so much
• 1:06:09
  you can
• 1:06:09
  do, and
• 1:06:10
  I
• 1:06:10
  encourage
• 1:06:10
  everyone
• 1:06:11
  to try
• 1:06:11
  to do
• 1:06:12
  the most
• 1:06:12
  they can
• 1:06:13
  to really
• 1:06:14
  engage.
• 1:06:15
  You know,
• 1:06:15
  it's all
• 1:06:15
  about
• 1:06:16
  your eye
• 1:06:16
  and
• 1:06:16
  your health
• 1:06:17
  and so
• 1:06:18
  much
• 1:06:18
  people
• 1:06:18
  can do.
• 1:06:19
  And
• 1:06:20
  in this
• 1:06:20
  experience,
• 1:06:21
  not not
• 1:06:22
  only in
• 1:06:22
  the very
• 1:06:22
  beginning,
• 1:06:23
  but,
• 1:06:24
  you know,
• 1:06:24
  even
• 1:06:24
  like a
• 1:06:25
  decade
• 1:06:25
  later,
• 1:06:25
  if
• 1:06:26
  there's
• 1:06:26
  more
• 1:06:26
  information
• 1:06:27
  or more
• 1:06:27
  knowledge,
• 1:06:27
  it's it's
• 1:06:29
  I find
• 1:06:29
  that it's
• 1:06:30
  it's
• 1:06:30
  really
• 1:06:31
  it really
• 1:06:31
  is
• 1:06:32
  important
• 1:06:32
  for
• 1:06:32
  people
• 1:06:32
  to keep
• 1:06:33
  learning,
• 1:06:33
  even
• 1:06:34
  if you
• 1:06:34
  think
• 1:06:34
  you're
• 1:06:35
  your
• 1:06:35
  old hat.
• 1:06:35
  I mean,
• 1:06:36
  there's
• 1:06:36
  always
• 1:06:36
  something
• 1:06:37
  else.
• 1:06:38
  Right?
• 1:06:38
  You know.
• 1:06:39
  Absolutely.
• 1:06:40
  That's
• 1:06:40
  100%
• 1:06:41
  true.
• 1:06:42
  I think
• 1:06:42
  a lot of
• 1:06:43
  people
• 1:06:43
  like,
• 1:06:43
  it's
• 1:06:43
  really
• 1:06:44
  hard to
• 1:06:44
  get that
• 1:06:44
  kind of
• 1:06:44
  information
• 1:06:45
  in your
• 1:06:46
  eye
• 1:06:46
  appointments.
• 1:06:47
  yeah.
• 1:06:47
  I feel like
• 1:06:48
  there's
• 1:06:48
  little
• 1:06:49
  pieces
• 1:06:49
  that
• 1:06:49
  I talk
• 1:06:50
  to people
• 1:06:50
  about,
• 1:06:50
  but just
• 1:06:51
  sort of
• 1:06:51
  really
• 1:06:52
  focusing
• 1:06:52
  on all
• 1:06:52
  the
• 1:06:53
  things
• 1:06:53
  you can
• 1:06:53
  do, like
• 1:06:54
  literally
• 1:06:55
  like mind
• 1:06:56
  and body
• 1:06:56
  and
• 1:06:57
  physical
• 1:06:57
  health
• 1:06:58
  and so
• 1:06:59
  many
• 1:06:59
  things
• 1:06:59
  that
• 1:06:59
  relate
• 1:07:00
  to people
• 1:07:00
  doing
• 1:07:00
  better.
• 1:07:01
  So I
• 1:07:01
  so appreciate
• 1:07:02
  that.
• 1:07:02
  I just
• 1:07:03
  really,
• 1:07:04
  you know,
• 1:07:04
  I'm
• 1:07:04
  excited
• 1:07:05
  to
• 1:07:05
  reach out
• 1:07:06
  to people
• 1:07:07
  and be
• 1:07:07
  a resource,
• 1:07:08
  and I'm
• 1:07:08
  happy to
• 1:07:08
  if a
• 1:07:09
  topic
• 1:07:09
  comes up
• 1:07:09
  that
• 1:07:10
  you need
• 1:07:10
  any
• 1:07:10
  help on
• 1:07:11
  or I can
• 1:07:12
  speak
• 1:07:12
  about,
• 1:07:13
  please
• 1:07:13
  don't
• 1:07:13
  hesitate
• 1:07:14
  to ask
• 1:07:14
  me.
• 1:07:14
  I feel like
• 1:07:15
  I
• 1:07:16
  really
• 1:07:16
  want to
• 1:07:16
  share
• 1:07:17
  everything
• 1:07:17
  that I've
• 1:07:17
  learned
• 1:07:18
  and
• 1:07:18
  and what
• 1:07:18
  I think
• 1:07:19
  would
• 1:07:20
  help
• 1:07:20
  people
• 1:07:20
  who are
• 1:07:21
  going
• 1:07:21
  through
• 1:07:21
  this just
• 1:07:22
  to do
• 1:07:22
  their
• 1:07:22
  very just
• 1:07:23
  to have a
• 1:07:23
  make this
• 1:07:24
  something
• 1:07:25
  really,
• 1:07:26
  you know,
• 1:07:26
  like an
• 1:07:27
  opportunity
• 1:07:28
  to learn
• 1:07:28
  new
• 1:07:28
  things
• 1:07:29
  and to
• 1:07:29
  just,
• 1:07:30
  you know,
• 1:07:31
  really
• 1:07:31
  engage.
• 1:07:31
  I think
• 1:07:32
  that's,
• 1:07:32
  that's
• 1:07:32
  really
• 1:07:33
  my,
• 1:07:33
  my
• 1:07:34
  mission.
• 1:07:34
  I feel
• 1:07:34
  it's
• 1:07:34
  important
• 1:07:35
  that we,
• 1:07:35
  we do
• 1:07:36
  all
• 1:07:36
  we can.
• 1:07:36
  And,
• 1:07:36
  I mean,
• 1:07:37
  I,
• 1:07:37
  I've
• 1:07:37
  just
• 1:07:37
  been
• 1:07:38
  in this
• 1:07:38
  so long,
• 1:07:38
  I feel like
• 1:07:39
  it's
• 1:07:39
  I need to
• 1:07:40
  figure
• 1:07:40
  out a way
• 1:07:40
  to share
• 1:07:41
  as much
• 1:07:42
  as
• 1:07:42
  possible.
• 1:07:43
  I
• 1:07:43
  so
• 1:07:43
  appreciate
• 1:07:44
  it.
• 1:07:44
  Megan.
• 1:07:44
  Thank you
• 1:07:45
  all
• 1:07:45
  so
• 1:07:45
  much for
• 1:07:45
  tuning
• 1:07:46
  in.
• 1:07:46
  And
• 1:07:46
  thank you
• 1:07:46
  to Doctor
• 1:07:47
  macannel
• 1:07:47
  for all
• 1:07:48
  of your
• 1:07:48
  great
• 1:07:48
  information.
• 1:07:49
  We have
• 1:07:49
  loved
• 1:07:49
  having
• 1:07:50
  you and
• 1:07:50
  all
• 1:07:50
  of this
• 1:07:51
  great
• 1:07:51
  information.
• 1:07:51
  I know
• 1:07:52
  it's
• 1:07:52
  going to
• 1:07:52
  really
• 1:07:52
  benefit
• 1:07:53
  our
• 1:07:53
  entire
• 1:07:54
  om
• 1:07:54
  community.
• 1:07:56
  Thank you
• 1:07:56
  so much.
• 1:07:57
  It's a
• 1:07:57
  really honor
• 1:07:57
  to speak
• 1:07:58
  and I
• 1:07:58
  really
• 1:07:58
  appreciate
• 1:07:59
  the
• 1:07:59
  opportunity.
• 1:08:00
  Absolutely.
• 1:08:01
  Hopefully
• 1:08:02
  we'll have you
• 1:08:02
  back
• 1:08:02
  soon.
• 1:08:03
  And
• 1:08:03
  we just
• 1:08:04
  want to
• 1:08:04
  thank our
• 1:08:04
  sponsors,
• 1:08:05
  Castle
• 1:08:05
  Bioscience,
• 1:08:06
  for
• 1:08:07
  helping
• 1:08:08
  make this
• 1:08:08
  podcast
• 1:08:09
  possible.
• 1:08:09
  And to
• 1:08:10
  all of
• 1:08:10
  our
• 1:08:10
  viewers
• 1:08:11
  for
• 1:08:11
  watching,
• 1:08:12
  liking,
• 1:08:12
  subscribing,
• 1:08:13
  everything
• 1:08:13
  that
• 1:08:13
  you're doing
• 1:08:14
  is also
• 1:08:14
  making
• 1:08:15
  this
• 1:08:15
  possible.
• 1:08:16
  So
• 1:08:16
  if you've
• 1:08:16
  not
• 1:08:16
  subscribed
• 1:08:17
  to our
• 1:08:17
  YouTube
• 1:08:18
  channel,
• 1:08:18
  please
• 1:08:19
  do that.
• 1:08:19
  You can also
• 1:08:20
  follow us
• 1:08:21
  on Apple.
• 1:08:22
  Spotify.
• 1:08:22
  Anywhere
• 1:08:23
  that
• 1:08:23
  you get
• 1:08:23
  your
• 1:08:23
  podcast,
• 1:08:24
  and
• 1:08:25
  please
• 1:08:25
  follow
• 1:08:25
  our
• 1:08:25
  social
• 1:08:26
  media
• 1:08:26
  as well.
• 1:08:27
  You can also
• 1:08:28
  sign up
• 1:08:28
  for our
• 1:08:28
  newsletter
• 1:08:29
  @acureinsight.org.
• 1:08:30
  There's a
• 1:08:31
  little
• 1:08:31
  button
• 1:08:31
  at the
• 1:08:31
  top
• 1:08:32
  to get
• 1:08:32
  the
• 1:08:32
  newsletter,
• 1:08:33
  and then
• 1:08:34
  we'll
• 1:08:34
  send you
• 1:08:34
  some
• 1:08:34
  great
• 1:08:35
  information
• 1:08:35
  every
• 1:08:36
  month and
• 1:08:37
  keep you,
• 1:08:38
  in
• 1:08:38
  the loop
• 1:08:38
  on all
• 1:08:38
  the
• 1:08:39
  things
• 1:08:39
  that are
• 1:08:39
  going on
• 1:08:39
  in the community.
• 1:08:41
  And
• 1:08:41
  that is all
• 1:08:42
  for me.
• 1:08:42
  So
• 1:08:43
  thank you
• 1:08:43
  everyone
• 1:08:44
  so
• 1:08:44
  much for
• 1:08:44
  tuning
• 1:08:45
  in.
• 1:08:45
  We will
• 1:08:45
  see you
• 1:08:46
  guys next
• 1:08:46
  time.