A Clear Vision

Renelle Lim, MD, faced a dilemma. During residency training at State University of New York-Downstate Medical Center, Dr. Lim found herself drawn equally to two areas of ophthalmology: cancers of the eye and oculoplastic & reconstructive surgery. Instead of choosing one specialty over the other, Dr. Lim embarked on fellowship trainings in both ocular oncology and oculoplastic surgery. Dr. Lim underwent intense training at the premier Wills Eye Hospital in Philadelphia. She completed two fellowships, one in oculoplastic surgery and another in ocular oncology where she studied under Carol Shields, MD, and Jerry Shields, MD, “the leading ocular tumor specialists in the world,” she said. “Their mega practice allowed me to see rare ocular tumors routinely. While most ophthalmologists see one or two ocular tumors during their entire career, we treated several hundred patients with ocular tumors each year.” In addition to her surgical skills, Dr. Lim honed a vision of her practice through both the instruction and examples set by her mentors. “One of the most valuable lessons learned from my fellowship training is to always strive for the highest quality of care,” Dr. Lim said. As the new director of Smilow Cancer Hospital’s Ocular Oncology Program, Dr. Lim draws on her dual specialties to treat patients with both common and rare malignancies of the eye, eyelid, and orbit. Her multidisciplinary approach mirrors that of the program. As one of the few programs in the nation with a dedicated full time ocular oncologist in a cancer hospital, the Smilow Ocular Oncology Program draws on the wealth of experience and expertise across all specialties at Smilow Cancer Hospital. “The Smilow Ocular Oncology program does not stand alone,” Dr. Lim explained. “A tremendous advantage of our location within Smilow Cancer Hospital is that we can collaborate with many specialists—neurosurgeons, ENTs, dermatologists, plastic surgeons, radiation oncologists, and others—to provide comprehensive treatment for ocular and periocular cancers.” Indeed, Smilow’s Ocular Oncology Program uses state-of-the art technology and the newest techniques to provide cutting-edge treatments to patients with all disorders involving cancer in the eye and periocular region. A prime example is plaque brachytherapy, in which a small disc-shaped plaque containing radioactive material is sutured to the surface of the eye over a tumor. Used for uveal melanoma—the most common primary intraocular cancer—and other types of tumors, plaque brachytherapy can deliver radiation directly to the affected area with minimal side effects. Dr. Lim collaborates with radiation oncologists and physicists, who custom design the plaque using advanced computer models and CT simulation so that it provides the optimal dosage of radiation while limiting potential damage to nearby healthy tissues.

Dr. Lim’s training in oculoplastics enables her to not only excise ocular tumors but also to reconstruct the eyelid afterward. “I am humbled to be able to provide these services to my patients,” Dr. Lim said. “Having such extensive training uniquely benefits my patients.” Patients also benefit from genetic sequencing of tumors, which in some cases can open the door to targeted therapies for their cancer. “The future of cancer treatment is targeted therapy,” Dr. Lim explained. “We have the ability to test tumors for gene mutations and to alter treatment options based on the results.” Genetic counselors help patients—and their families— understand the results, and the Smilow nursing staff and social workers support them throughout treatment. “At Smilow, we understand that we are not just treating the patients but their families as well,” Dr. Lim said. As other cutting-edge cancer treatments progress through Yale’s research pipeline, Dr. Lim looks forward to adopting them for her own patients as she leads the Ocular Oncology Program in its critical mission: to conserve the life, eye, and sight of each of her patients.