Throwback Series: The eye that found a cancer

In celebration of Ophthalmology Times’ 50th anniversary, leaders revisit a memorable “throwback” case from earlier in their careers. In this special series, they reflect on how evolving knowledge, techniques, and technologies have transformed the way such cases are managed today. Join us as we look back at pivotal moments in their professional journeys — and explore how far the field has come.

This episode revisits a case in which a neuro-ophthalmic finding revealed a small cell lung carcinoma. Reflecting on the patient’s long-term survival, the ophthalmologist—Andrew G. Lee, MD—underscores how the value of broad diagnostic thinking can make the difference between vision saved and a life saved. Lee is chair of the Blanton Eye Institute at Houston Methodist Hospital and a professor of ophthalmology, neurology, and neurosurgery at the Weill Cornell Medical College, and host of the Ophthalmology Times NeuroOp Guru video series.

In 1997, Lee encountered the memorable case of paraneoplastic optic neuropathy (PON) in a 73-year-old woman. The patient presented with visual symptoms that ultimately led to the discovery of an underlying small cell carcinoma of the lung. As Lee recalled, “We found it using a chest X-ray, and it showed small cell carcinoma lung. It was resected, and she was treated with chemo [and] radiation.” The case was subsequently published in the Journal of Neuro-Ophthalmology in 1998.¹

The patient returned in 2010 with no visual complaints. “She said, ‘You don’t remember me, do you, Dr. Lee?’ … ‘I had lung cancer and you found it through my eye.’” As with the human dimension of neuro-ophthalmology, systemic disease can reveal itself through visual pathways. The patient’s long-term survival was extraordinary, as “the 5-year survival rate of small cell carcinoma in 1997 was only 9%.”

The patient’s survival made her “the longest known survivor of paraneoplastic optic neuropathy,” leading to a second publication on the same case.² When she returned again—this time for cataract extraction—her ongoing wellness offered an opportunity to reflect on evolving diagnostic approaches. Lee noted, “What would I do differently today? Probably I would have done a PET scan and paraneoplastic antibodies.”

This case underscores the importance of broad diagnostic thinking in ophthalmic practice. As Lee summarized, “The amazing thing is, being a doctor first; an ophthalmologist second; and neuro-ophthalmologist third saved this patient’s life.”

REFERENCES

1. Luiz JE, Lee AG, Keltner JL, Thirkill CE, Lai EC. Paraneoplastic optic neuropathy and autoantibody production in small-cell carcinoma of the lung. J Neuroophthalmol. 1998;18(3):178-181.

2. Pau D, Yalamanchili S, Lee AG. Long-term survivor of paraneoplastic optic neuropathy. J Neuroophthalmol. 2010;30(4):387. doi:10.1097/WNO.0b013e3181fd9435