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Featured Services
Dr. Finger's Ocular, Orbital and Systemic Imaging Techniques:
These services allow for the most complete office evaluations of ocular and orbital tumors that are possible.
Dr. Finger's New Surgical Techniques:
Dr. Finger has invented numerous new surgical techniques and instruments specifically for patients with eye cancer. Over the years he pioneered the use of microwave hyperthermia, palladium-103 plaque radiation therapy, Finger-tip Cryotherapy Applicators, the Finger Iridectomy Technique, and Finger's Slotted Plaques.
Ophthalmic Ultrasound Imaging
Dr. Finger has broken new ground with the use of new diagnostic imaging techniques, including high frequency and 3D ultrasound for imaging tumors on and in the front of the eye. Specifically, Dr. Finger and his associates first described the use of 3D ultrasound for measurement of choroidal melanomas, to document proper radioactive plaque placement and for extrascleral tumor extension. He now recommends the use of high-resolution 20 Mhz B-scan in movie-mode to measure most intraocular tumors. He also recommends the use of 3D ultrasound in cases where there is no ophthalmoscopic view into the eye.
Dr. Finger and his colleagues have pioneered the use of computerized coronal C-scan ultrasound sections to measure the orbital portion of the optic nerve, to detect optic nerve sheath meningiomas and invasion of retinoblastoma into the optic nerve.
Dr. Finger has established the use of high-frequency ultrasound for anterior segment tumors. He has written on the use of this technique for the diagnosis of conjunctival (squamous, oncocytoma, sarcoma) and eyelid tumors. He has shown how high frequency ultrasound can be used to detect retinoblastoma that are hidden behind the iris, invasion of conjunctival tumors into the eye, for measurement of iris and ciliary body tumors and to allow for plaque radiation therapy. Movie mode allows him to replay and show patients their tumors and how he measures them.
High-Definition (HD) Digital Photography
Dr. Finger currently uses specialized 11-megapixel High Definition digital photography (TopCon) to document and compare eye tumors to monitor for growth, patterns of circulation and response to treatment. Dr. Finger believes there is no substitute for side-by-side comparative photography to detect small changes on or around tumors of the eye. In addition, Dr. Finger has shown that early detection and treatment of radiation eye damage offers the best chance to maintain vision and use of the eye.
OCT Imaging
Dr. Finger has obtained a state-of-the-art OCT/SLO (Scanning Laser Ophthalmoscope) imaging system. He uses it to monitor patient response to treatment and new vision-sparing ant-VEGF treatments (for radiation retinopathy and optic neuropathy).
Spectral OCT and
Scanning Laser Ophthalmoscope (SLO) system
Spectral OCT/SLO is able to generate a
3-dimensional retinal thickness map.
Below are photos taken with SLO/OCT of patients with choroidal melanoma (Patient 1 and 2), choroidal hemangioma (Patient 3), and cystoid macular edema (Patient 4).
(click on the images below to enlarge)
Patient 1:
Patient 2:
Patient 3:
Patient 4:
Total Body FDG PET/CT Imaging
Dr. Finger led a group of scientists to determine the efficacy of total body 18 FDG PET/CT imaging for choroidal melanoma. This is because he recognized that what had been the standard metastatic work up was inadequate. In contrast, positron emission tomography allowed for a physiologic assessment of the tumor's metabolism, while computed tomography (CT) allowed us to measure its size, shape and relationship to normal anatomic structures. For the first time, PET/CT puts form and function on the same diagnostic page. Dr. Finger's group found that intraocular melanomas had different metabolic intensities, further that metastatic melanoma was also found at greater frequency outside the liver (primarily bone and skin) and that even with FDG PET/CT, microscopic metastasis may not be found. However, since bone was the second most common site of metastasis and only a total body scan can detect bone metastasis, any other tests may come up short. Since that time, Dr. Finger and co-workers have used this technique to diagnose patients with metastatic sebaceous carcinoma, conjunctival melanoma and orbital lymphoma.
Most recently, Dr. Finger has performed a study to compare the metabolism of choroidal melanomas as measured by PET/CT against epidemiologic, anatomic, ultrasonographic and histopathologic risk factors for the development of metastatic choroidal melanoma.This study suggests that a high metabolic rate as measured by PET - SUV may be a biomarker (indicator) for the risk of metastasis.
