RETINA REFLECTIONS

David H. Abramson, MD, FACS

David H. Abramson, MD, FACS, is the first chief of ophthalmic oncology at Memorial Sloan Kettering Cancer Center in New York City, where he is a tenured professor in surgery, pediatrics, and radiation oncology; he is also a professor of ophthalmology at Weill Cornell Medical College.

Dr. Abramson is a clinician-scientist who has published more than 800 articles and books and delivered more than 500 lectures around the world. He has served on the medical school faculties at Harvard, Columbia, and Weill Cornell, and has been a visiting professor at many universities including Yale, the University of Pennsylvania, the State University of New York, and Washington University in St. Louis.  

Among Dr. Abramson’s numerous honors are the American Academy of Ophthalmology Lifetime Achievement Award, the Association for Research in Vision and Ophthalmology Weisenfeld Award, the Alcon Institute Research Award, the Stallard Medal from Cambridge University and the International Society of Ocular Oncology, the Bjerrum Medal from the Danish Ophthalmological Society, the Franceschetti Medal from the International Society for Genetic Eye Diseases, the Dunnington Medal from the National Society to Prevent Blindness, and the Hobart Lerner Award from the New York State Ophthalmological Society. For more than 25 years he has been listed as one of the “Best Doctors” in New York, USA in both Ophthalmology and Cancer.

Dr. Abramson is also a charter member of the Retina Hall of Fame. He has been a member of many medical societies and served as president of the New York Academy of Medicine’s Section of Ophthalmology, the Manhattan Ophthalmological Society, and the Laser and Imaging Society.

He has collaborated and published with more than 375 fellow scientists and clinicians in the United States and throughout the world. Many of Dr. Abramson’s papers are considered landmarks in ophthalmic oncology and in many cases, he and his collaborators have been responsible for changing the way patients are managed worldwide.

Until 1970, surgical removal of the eye (enucleation) was the standard of care for ocular cancers in children and adults. Much of Dr. Abramson’s life has been spent developing techniques to cure ocular cancer without enucleation.

Dr. Abramson’s list of “firsts” is long; he introduced pre-implantation genetic diagnosis (PGD) for eye cancers, diopexy for retinoblastoma, and chemotherapy delivery via periocular injection for retinoblastoma.

In the 1970s, Dr. Abramson’s work eliminated the mutilating eye surgery once performed for orbital rhabdomyosarcoma and changed its management worldwide to radiation and chemotherapy—saving more lives and eyes without devastating surgery.

Also in the 1970s—before the retinoblastoma gene had been cloned—Dr. Abramson proposed that there was a critical gene on chromosome 13 that led to cancer development in humans. It was subsequently cloned 10 years later, confirming his hypothesis.

Throughout the 1980’s, he and his collaborators decoded the complex story of second cancers in retinoblastoma survivors, clarifying the influence of the gene, environment, radiation and chemotherapy, and the child’s age on the development of these cancers.

And in 2006, in perhaps his most triumphant accomplishment, Dr. Abramson introduced ophthalmic artery chemosurgery for retinoblastoma. This technique—a painless outpatient procedure—has revolutionized eye cancer management, resulting in a cure rate of more than 99% in children while retaining 95% of their eyes; 90% of the children maintain 20/20 vision. The technique is now used in more than 60 countries, with thousands of lives saved.

Dr. Abramson was a principal investigator of the nationwide Collaborative Ocular Melanoma Study (COMS). This 20-year National Institute of Health-sponsored study set the standard for melanoma management worldwide. Dr. Abramson and his collaborators at Memorial Sloan Kettering remain committed to improving ocular and patient survival with safer, more effective, and less-toxic techniques.

He began his specialization in ophthalmic oncology with advanced training at the Armed Forces Institute of Pathology and fellowship training at Columbia in addition to receiving a license in radiation oncology. Previously, Dr. Abramson completed medical school and a medical internship at Albert Einstein College of Medicine and his residency at the Edward S. Harkness Eye Institute at Columbia University Medical Center (then Columbia Presbyterian).

Dr. Abramson, a native New Yorker, graduated from Brooklyn Technical High School where he received the “All-TECH medal’ given to the outstanding student athlete and years later was inducted into the TECH Hall of Fame. He then attended Harvard College, where he majored in biology. At Harvard, he captained the swimming team, set university records in 6 events as well as 4 NCAA records, and was later inducted into the Harvard Varsity Club Hall of Fame. At Harvard he was elected “First Marshal’- the equivalent of Class president, a position he has held for more than 55 years. Dr. Abramson represented the United States in the Fifth World Maccabiah Games in Israel in 1961, where he won 3 gold medals and was an alternate on the 1960 US Olympic team.

Here, Dr. Abramson shares his retina reflections.

Please share a defining moment that shaped your career.

In 2006, an infant patient had retinoblastoma with total retinal detachment and a tumor filling more than 75% of the eye; we scheduled the baby for enucleation.

Then our institutional review board protocol for intra-arterial retinoblastoma chemotherapy was approved (in humans) and we told the family there was now another option—one that might be able to save the eye.

We had not yet tried this option on any other human—or animal. Neither the efficacy or toxicity was known. The patient’s parents signed on and we did the procedure in May.

I held my breath for 6 weeks. Then, I examined the baby. Almost all of the tumor was gone; a calcified remnant was left, and the retina was totally in place. I knew the world of retinoblastoma had changed forever.

What career accomplishment provides you with the greatest sense of satisfaction?

I consider making retinoblastoma the most cured of all human pediatric cancers my greatest career accomplishment.

What do you feel is the most significant development or change in the practice of ocular oncology or retina?

For sure, the most significant development was intra-arterial chemotherapy for retinoblastoma. In 10 years, we went from removing 95% of eyes to saving 95% of eyes.

How will the practice of ocular oncology or retina change by 2040?

Retina, and ocular oncology, will build on what we now know and will be totally different. Artificial intelligence (AI), machine learning, targeted molecules, less surgery, individualized (rather than protocol-based) treatments, the insinuation of molecular data for diagnosis, and differential diagnosis and management decisions will require ophthalmologists to be schooled in oncology.

Understanding what you don’t know will let you lead the pack. You will need to be an expert in fields outside ophthalmology—computer learning, AI, molecular biology, and more. Without that knowledge, you will be just an eye doctor treating patients with cancer. With that knowledge, you can change the world for patients, families, and medicine.

Our thanks to Dr. Abramson for sharing his reflections.

(Retina Reflection published 2024)

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