Insights into Eye Health with Dr. Peter Tang

Eye problems, while often benign, can sometimes be the first sign of a serious health condition. Peter Tang, M.D., Ph.D., is an ophthalmologist at the MUSC Health Storm Eye Institute, where he specializes in retina surgery and ocular oncology, or cancer in and around the eye. In this episode, Dr. Tang discusses Storm Eye’s collaborative and holistic approach to eye care, the latest innovations in treating ocular oncology, and the connection between eye health and overall health.

“An annual eye exam is super important. You have to vocalize your concerns or issues that you found instead of minimizing them because that's the first step into getting you the care that you need.”

Peter Tang, M.D., Ph.D.
Ophthalmologist, MUSC Health Storm Eye Institute

Topics Covered in This Show

• The eyes can be “a window to a person’s health,” Dr. Tang says, because some of the earliest symptoms of the disease are sometimes first detected in eye issues. These symptoms include blurriness, dryness, and headache.
• Some of the most common diseases found through an eye exam are high blood pressure and diabetes, according to Dr. Tang. The most common and urgent issues for eye conditions, especially for aging or nearsighted patients, are newly occurring floaters, which often appear as squiggly lines or spots in one’s vision.
• The Storm Eye Institute at MUSC Health offers comprehensive care, which means highly trained specialists can treat a wide variety of eye issues, from basic vision correction to cataracts, to more serious issues such as eye cancer.
• While cancer within the eye is very rare, the most common type of eye cancer is ocular melanoma. Ocular melanoma can be deadly because it often has few symptoms and progresses faster than it can be detected.
• Sometimes eye cancer can metastasize and spread to other organs. Other times, lung cancer or breast cancer can travel to the eyes, which can be detected through imaging and monitoring your vision through regular eye exams.
• Dr. Tang explains that depending on the type of cancer, chemotherapy, targeted therapy, and/or radiation may be used. An MUSC care team will work one-on-one with every patient to determine a treatment plan that also considers quality of life, wellness, livelihood, and caretakers.
• One of the major advances in treating cancers of the eye is genetic testing from a tumor biopsy. Dr. Tang says this testing can help determine which treatment will be best for a patient’s cancer.
• If you have any eye issues, even as minor as needing glasses or contacts, Dr. Tang recommends an annual or every two years eye exam. This can be done at the Storm Eye Institute downtown or at the many MUSC satellite clinics in Nexton Summerville, West Ashley, Mount Pleasant, Clements Ferry, and other areas in the community.
• Dr. Tang advises that the best way to protect your vision and eye health is to prioritize your whole health and wellness. He urges listeners to develop good habits like exercising, eating well, and checking in regularly on how they’re feeling.

Read the Transcript

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. The health of your eyes can be a predictor of your overall health, according to the National Eye Institute. Here at MUSC Health, Dr. Peter Tang is an ophthalmologist who recently joined the Storm Eye Institute at MUSC as faculty practicing surgical retina and ocular oncology. He joins me today to talk about his specialty and why we should all be concerned about our eye health. Welcome to the show.

[00:00:43] Dr. Peter Tang: Thank you very much.

[00:00:44] Erin Spain, MS: Like I mentioned, it is said that eyes can be the window into your health. Tell me what that means and share with me your philosophy around eye health.

[00:00:53] Dr. Peter Tang: Oftentimes the eyes can become the first thing that a person experiences as soon as they wake up, they open their eyes. And the eyes themselves can tell you a lot about a person's health because if they're seeing well, oftentimes they're doing well. If they're not seeing well, they're not feeling well, it can certainly have a huge impact on their quality of life each day. It can be blurriness of the eyes, dryness and pain of the eyes, or even strain that can lead to headaches.

And because of that, the eyes oftentimes are the window to the person's health, because a lot of things can show up in your eyes first. And here we oftentimes do diagnose a lot of diseases and a lot of problems in patients when they come in for a very simple routine check, or when they come in for something that seems so minor, such as a scratchiness or a headache or straining, and then we discover that it is the prelude to a lot of other different diseases that they may be experiencing, without even knowing it.

[00:01:54] Erin Spain, MS: What are some of the common diseases that are found often through an eye exam?

[00:01:59] Dr. Peter Tang: So when we look at just something as simple as blurriness of the vision, let's say a patient who has noticed that maybe when they're driving that they are not able to see clearly the street signs or the freeway signs, it could be something that's very minor, like a change in the glasses prescription, or it could be something much more serious, such as bleeding in the eyes, which can be caused by very common but serious conditions like high blood pressure, diabetes. And these issues can go undiagnosed or untreated for a long time. When something so minor as blurriness brings the patient in and we see these very serious findings within the eye, it oftentimes leads to a much more extensive workup and a much more extensive treatment plan for these patients.

[00:02:49] Erin Spain, MS: So for someone who is experiencing any changes to their vision, what's your advice to them?

[00:02:55] Dr. Peter Tang: I would seek the care of an eye professional right away, whether it is your local friendly ophthalmologist at the Storm Eye Institute, or it could be somebody like an optometrist or even an optician at your local big box store, your local optometry clinic, eyeglasses clinic, because the most important thing is to be seen and examined.

And then oftentimes when there are more serious factors at play, these professionals involved in eye care that deal with these kind of conditions on a daily basis, if they themselves cannot correct or diagnose your problem, they triage you, which is to say they escalate and send you and refer you to the next person down the line with more focused and specialized expertise that can try to get to the bottom of why you're having changes in your vision. And ultimately, I mean we hopefully don't wish that upon anyone, but if you do have a serious condition, eventually you'll end up, one way or the other, in the office of an ophthalmologist. And that way we can try to treat and address some of these concerns that could be affecting your health.

[00:04:01] Erin Spain, MS: What are some of the most common eye diseases people face, and who are at risk of these conditions?

[00:04:07] Dr. Peter Tang: So in my world of retina, I think one of the more common urgent things that people face would be new floaters. So when you look at floaters, you see a black spot moving around, a squiggly line. I've heard it described as a spider web, like some kind of mist or fog in the vision. And for some folks, they have this for many years and it doesn't go away. But new floaters, or I would term acute floaters, so something that's new, that's very apparent, that's different, no matter how small, how insignificant, it at least warrants an examination of your eyes by a trained professional. Because a floater can be something that is an aging process to something that could be actually blood in your eye that can be from something more serious like a tear in your retina or a bleed from a blood vessel. And a lot of different diseases can show up initially as floaters.

And so with our aging population who are at a higher risk of having changes in the back of their eyes to folks with nearsightedness that may be at a higher risk for tears and detachments of the retina, it all begins with a floater. And so, when you come into the office and you get examined for a new floater, more often than not, it is fine, you'll be fine and life goes on. But for a small subset of people, that floater can lead to emergency surgery, emergency laser procedure, and it all begins with something so small as a floater.

[00:05:35] Erin Spain, MS: Tell me how the Storm Eye Institute at MUSC really offers comprehensive care when patients end up here. You're able to be connected to a lot of specialists to address these conditions. Tell me about this comprehensive approach.

[00:05:48] Dr. Peter Tang: Storm Eye itself, which is a part of the Department of Ophthalmology, we also work very collaboratively with many other departments, many other institutions within MUSC, such as the cancer center, such as Internal Medicine, rheumatologists or the Radiation Oncology folks. And so, we're kind of like the hub and spoke of eyes on the campus. And so we at Storm Eye have clinicians that specialize in just refractive, so correcting vision either through contact lenses, through eyeglasses, through surgical means like LASIK surgery. We have clinicians who specialize in treating cataracts. We have clinicians, like myself, who specialize in treating diseases of the back part of the eye. So it's things like the retina, the vitreous.

And also, my other clinical interest is oncology. So any kind of oncologic problems, any kind of cancers within the eye, around the eye, would be something that I would also see patients for. And so because we have a very team approach to these kinds of diseases, we are able to offer comprehensive care for the eyes and also offer access to address some of the more systemic problems. So things that affect the entire body that can show up within the eyes by referring our patients internally to our Medicine colleagues, Pediatrics colleagues, Radiation, you name it, we have it. And so therefore, we believe that we provide a very essential service to the low country population, to our patients here in the community, and I'm excited to be part of this team.

[00:07:22] Erin Spain, MS: Let's talk a little bit more about cancer in the eye. How rare is this and how are you able to detect it?

[00:07:29] Dr. Peter Tang: Thankfully, cancer within the eye is something that is rare, but when it is found, it can be very, very serious. It is something that can start just with a routine eye exam at your local optometrist or optical shop, and they may notice something funny, or it could be something that affects the patient first where they notice blurriness of their vision, a pressure sensation, anything like that. Again, it's very rare, with the most common cancer found in the eye are oftentimes what we call benign, so cancers that do not impact your overall health because they do not spread to other parts of the body. They're not what we would term as malignant. So benign cancers can be something as small as a skin tag around your eyelid. Maybe cosmetically does not look the best, maybe you don't even recognize it, and certainly it doesn't have a dramatic impact to your health, but other cancers, such as cancers that can spread to the eye, are actually the most common cause of malignant cancer that we find in the eye.

If you think about, as a general population, the most common cancers that are found in men in this country is lung cancer because of the prevalence of smoking and secondhand smoke and things like that. And so sometimes, rarely, but it does happen, cancers can travel from one location to the other. We term that as metastases. And so a cancer can metastasize from the lung to the eyes. And we can see that on the front end. For women, lung cancer is actually number two. Number one is breast cancer. And so you can also have breast cancer migrate from the breast tissue to the eye.

The most common cancer that develops within the eye in adults in this country would be a melanoma. And a melanoma is a cancer that develops from a freckle. Oftentimes when people think about freckles, they think about freckles on the skin. However, you can also have freckles in the eye itself And those freckles have a very rare but dangerous chance of turning into melanoma. And the way that we detect these things, aside from just looking at how well your vision is doing, is also using imaging, so taking photographs, doing scans of the back of the eye, to see whether there's any abnormalities as well as taking a look directly ourselves during the examination process.

[00:09:44] Erin Spain, MS: So tell me about some of the surgical procedures and treatments that you're able to perform to help people who may be diagnosed with one of these different types of eye cancer, either direct eye cancer or something that's metastasized from another common cancer.

[00:09:58] Dr. Peter Tang: A lot of times when we talk about treatment for cancers in the eye, it all depends on what kind of cancers we're dealing with. So when we have a cancer, such as breast cancer, that travels to the eye, usually those types of cancer respond well to whatever treatment that is delivered to treat the breast cancer.

Oftentimes now, thankfully, we have a lot of different types of medications that can be given, chemotherapy, targeted therapy, for these types of cancers because these therapies that they put into the patient's body travel throughout the body. And so not only does the breast tissue get treated by these drugs, the eye itself also gets treated. And we do see that these cancers over time just melt away and regress. and we can track that with images, photographs, scans and exams.

And we can also track how a patient's vision is doing from that. Other times when we have a very specific, localized type of cancer, other types of treatments can work, such as radiation treatment. And with radiation treatment, it's about delivering a pocket of energy, which in this case, radioactive energy, to a specific location within the body, and in this case that would be within the eye, in order to try to kill something, in this case would be to kill the tumor that is growing in there.

And so that is usually the treatment that we would provide if this was a cancer that originated from the eye, such as a melanoma, or if this was a cancer from another part of the body that was, for whatever reason, not responding well to chemotherapy, we would switch to radiation treatments for these patients. And then when you decide what type of treatment you'd pick, it's always a conversation amongst the team. And myself, as an ophthalmologist, is only one member of the team. We work very closely with the patient's oncologist, we work closely with their radiation therapist, radiation oncologist.

And we together develop a plan because each plan that we develop has to not only consider how effective these treatments are for the cancer, but it's also important to bring in the conversation about how this affects the patient's livelihood, the quality of life, as well as their wellness. What we've learned a lot over the last couple of years, it's to treat the entire patient, which is much more than just the disease. It is also their quality of life, it is also their expectations about what they would feel like or be able to do during the therapies as well as afterwards, as well as being able to bring in their family members too and their care team into the conversation because oftentimes it takes a village to help and treat these patients. And we certainly don't want to forget about their family members, the people who bring them to their appointments, the people who help them at home still stay independent and try to do things for themselves. And these are such critical members of the care team that are often neglected.

[00:12:53] Erin Spain, MS: Tell me about the survival rate and some of the advances and treatments that's helping these folks.

[00:12:58] Dr. Peter Tang: That's a great question. It is also a very difficult question to answer. And the reason is that with melanoma, it can be a very, what we call a sentinel disease, where it grows in the background and it does not show up in a patient's vision until it is very advanced, And so it's all about surveillance and it's all about early diagnosis.

When we are able to diagnose the patients, they do very well. And the reason why it's important is that with these melanomas, not only are they able to affect the patient's vision and cause serious problems within the eye, the bigger fear is that they actually migrate out of the eye to the rest of the body. And if that was to happen, more often than not, they would migrate to the lungs and to the liver, the liver specifically. And so, once the tumor has gotten out of the eye, the survival and quality of life and life expectancy becomes much more complicated than if the tumor stayed within the eye.

Because oftentimes these tumors are very resistant to chemotherapies, radiation to other parts of the body. We're looking at, potentially, a 50 to 60 percent mortality rate, which means that for folks with this disease that has spread out of the eye, more than half of those patients will pass away from this disease within the next three, five, ten years. And that's why there's been a lot of development within the realm of genetics of trying to test how some tumors become much more dangerous than other tumors.

When you look at two tumors from two different patients, why is it that one patient does better than the other? Presumably a much larger tumor has been growing for a longer period of time, and maybe that period of time means that there's more chances of it spreading to the rest of the body. However, what we've also found is that for some patients with large tumors, they do very well , and they don't spread, and after their eyes are treated, they live a very long, fulfilling life. Whereas other patients with much smaller tumors do show that they have early spread and they oftentimes don't do well.

And so there's been a push in the field to look at the genetics of these tumors and that will require a biopsy of the tumor, by a trained professional, like your local friendly ocular oncologist like myself. There is a process called a genetic expression profiling, GEP is the acronym for short, and it looks at 15 to 20 different types of genes And it uses artificial intelligence and machine learning to actually map out whether or not these genes indicate whether this tumor is something that is high-risk, intermediate-risk or low-risk for spread to other parts of the body.

And that in itself has changed a lot of our understanding of tumor mortality, survival and how well these patients do in the long-term. It has certainly changed how we approach our treatments because now not only are we looking at the size of the tumors, we're also looking at the amount of change over time, as well as family history, some of the more traditional things that we always looked at. But now with a biopsy it's very powerful because it allows us to better follow up with these patients, even after the treatment, because if we don't detect any spread on day one, it doesn't necessarily mean that they will stay clean, as we call it, free of spread, a month later, a year later, five years later. And so it's a very exciting time in ocular oncology because I think, with this information, we can start asking more specific questions and also develop ways to try to treat these patients on a more individual basis, instead of a one-size-fits-all strategy that we were confined to not that long ago.

[00:16:39] Erin Spain, MS: And this more personalized approach, or precision medicine, could also mean fewer side effects or procedures for patients as well.

[00:16:46] Dr. Peter Tang: Presumably. If a patient has a tumor that after a biopsy comes back as a low-risk tumor, there is probably less inclination to have them undergo systemic chemotherapy or as aggressively after their eye treatment as someone that comes back with a high-risk tumor And so that is, as you said, a developing field called precision medicine, where we try to cater the treatments and the algorithms to an individual patient based on factors that we detect from their body, in this case a biopsy that gives us a genetic profile of the tumor.

It is still a very fledgling state of medicine because it is so new. And of course, a lot more research is necessary in order to make this a more full-threaded approach, but it is exciting to be in the field. And my hope is that within the next five to 10 years, our way of practicing ocular oncology is going to look very different than what it currently is. And it already looks a lot different than what it was even five or 10 years ago. And so progress continues, and it marches onwards. And I'm happy and excited that Storm Eye and MUSC is going to be a part of that journey.

[00:17:53] Erin Spain, MS: Talking about all of this and how important it is to get an annual eye exam, it might not be something that's always on the top of people's list or it might not even be something they're thinking about as a possible cancer screening tool. Do you recommend that people go every year for an eye exam?

[00:18:10] Dr. Peter Tang: So if a person has an eye issue – whether it's something as small as they just need updated glasses or contact lenses, I think it's worthwhile to have a yearly or every-two-year exam, with your local optometrist, ophthalmologist, optician to get the care that you need, because those are also opportunities to check in and ask, How are you doing? How is your vision doing? How is it performing? Is it performing to your expectations? Have you noticed things that are off? I think if you don't have any eye issues of concern, good for you.

I'm happy for you. That's wonderful. But, from time to time, if you do notice changes, please do not write them off . Put yourself up on the list of things to think about and to care for. Because as we've learned more and more now, our own wellness is within our control, for the most part. And you do have to prioritize your own health and to seek help when you need it. And so, annual eye exam is super important. Doesn't have to be with us, but it has to be with someone.

And of course, we have not only our facilities at Storm Eye downtown, but we also have many satellite clinics within the community that can accommodate. And we're happy to see patients either in our Nexton Summerville area, in the West Ashley area. We also have a facility in Mount Pleasant, and we're, happy to inform our listeners that we will be opening up a new clinic up in the Clements Ferry area, and so therefore we are bringing the care to the community because, as we've learned, health is important, but convenience can be a huge catalyst to try to get folks the care that they need. That we're bringing the care to the patients instead of having the patients come to us.

[00:19:54] Erin Spain, MS: So the eye exam, very important if you're someone who has any eye issues, but as we wrap up today, is there anything else that people should be doing just on a daily basis to protect their eye health?

[00:20:07] Dr. Peter Tang: I think the biggest thing that people can do to promote their eye health is to just do all the things that you already kind of know that you need to do, but maybe are boring. Like, for example, eating right, exercising, because having a good cardiovascular system, having a good heart, having good blood pressure, controlling your diabetes, these are some of the biggest things that you can do to help with your overall health. Not just your vision, but everything.

And because your eyes are the windows to the body, helping the body will help the eyes. And so just keeping in mind that your health and your wellness is very important. And from time to time, making sure that you prioritize yourself and your own wellness, not just your health, but everything – your stress, your daily routine. Because your wellness leads to good habits, and good habits lead to good health, and good health leads to good eyes.

[00:20:59] Erin Spain, MS: Well, this is turning the tables a little bit, but this is a question that we ask everyone who comes on the show: What do you do to optimize your health and live well?

[00:21:07] Dr. Peter Tang: I think the biggest thing that I prioritize for my health is to make sure that no matter how busy life gets, no matter how chaotic the daily schedule can be, taking 10 minutes to myself, whether in the morning before everybody's awake or at night after everyone goes to bed, and run an almost like an internal checklist. How am I feeling?

Did I meet my hydration goals for the day? Did I eat well today? Can I do something better tomorrow? Set a plan so that you can meet your goals the next day or adjust it, for whatever chaos life throws at you that week. And it's not perfect and you have to allow yourself the grace of accepting that everything is not going to be perfect, everything is not going to go according to plan, but that if you do your best, that's okay, that's good enough.

[00:21:54] Erin Spain, MS: I think that's something we can all incorporate into our daily lives.

[00:21:57] Dr. Peter Tang: Thank you so much for all this valuable information today. I learned a lot. I think our listeners learned a lot as well, and we really enjoyed having you on the show. I appreciate it. Thank you for your time, and I look forward to seeing all of your audience in the clinic.

[00:22:10] Erin Spain, MS: For more information on this podcast, check out Advance.MUSCHealth.org.