Dr. Dan Gombos
INTRO: Dr. Dan Gombos is clinical co-director of the Retinoblastoma Center of Houston and Director of Clinical Operations for the Section of Ophthalmology. Dr. Gombos currently serves as an ocular oncologist for the Children’s Cancer Hospital and is Professor & Chief of the Section of Ophthalmology at The University of Texas MD Anderson Cancer Center. He is president of the American Association of Ophthalmic Oncology and Pathology (AAOOP).
His research interests include the management of retinoblastoma, uveal melanoma, and intraocular and conjunctival malignancies. In the following interview, Know The Glow® asked Dr. Gombos how his work in collaboration with top doctors is allowing the Retinoblastoma community to keep moving forward. While collaborating with other major leaders in the field, Dr. Gombos shares with us his current research examining vitreous seeds and the development of a consensus paper that is soon to be published.
You are currently in the process of publishing two papers, both of which are in collaboration with Children’s Hospital Los Angeles. What do you want those parents who are newly informed about Leukocoria to know about your research?
Paper #1: Vitreous Seeds
The first of our two collaborative papers was presented at the Association for Research and Vision in Ophthalmology, and has been accepted for publication. Our research is focused on vitreous seeds. Vitreous seeds in retinoblastoma (RB) are very significant because, historically, we have always known that vitreous seeds were one of the most challenging areas of therapy, and often in the past, led to treatment failures. Bigger, fluffier seeds were associated with the worst prognosis when treated with primary chemotherapy.
In the past 2-3 years there has been a revolution in the field – we are now able to inject chemotherapy directly into the eyes, which we never did before. This treatment has really helped to salvage many eyes that we would have likely removed in the past. This study is the first to look at the histopathology of these seeds.
I think that this research is going to help guide the management of vitreous seeds with chemotherapy, and is another step forward in our abilities to salvage eyes that we did not and could not salvage in the past.
Paper #2: Screening High Risk Patients
The second research paper is a consensus paper. The American Association of Ophthalmic Oncology and Pathology (AAOOP), for the first time, has released a consensus statement on screening patients at high risk for RB. Both the field and our societies are evolving and we created a consensus panel, which included Dr. Kim of CHLA, myself, and other leaders in the field such as Dr. Brenda Gallie, Dr. Brian Marr, and Dr. Chévez-Barrios, to see if we can come up with a general consensus on how frequently these patients should be screened. Most importantly, we are in the process of gaining support from not only AAOOP, but also from the American Academy of Ophthalmology, the American Association of Pediatrics, and the Association for Pediatric Ophthalmology and Strabismus. When it is all sorted out and we have received support from all of these organizations, it will be a pretty profound statement. It would have a significant impact on not only North America, but on countries around the world.
What I really love about both of these studies is that they bring about how different groups can come together. We all have different areas of expertise and leadership and we can all come together for the benefit of the community. We gain the biggest success together by collectively determining ways to help move the field forward.
Looking back at your collaboration with many other doctors throughout the years, how have other doctors influenced you and the RB community?
There are a few people I really try to emulate as a human being. Their moral compass is spot on and Linn Murphree is one of those people. He is so dedicated and early in my career was so supportive of me. I still remember when I first heard Linn Murphree’s name. I was a medical student with David Abramson in New York in 1993. He was telling me about research that’s going on in Los Angeles and I ask, “Who is she?” and his first statement to me was, “Linn… is a man.”
I think my job and the job of others is to remind those who didn’t get to know him what a profound and significant person he is in the field and how many of us stand on his shoulders as we look towards finding the cures of the future.
What goes on behind the scenes when you work with other doctors from different facilities?
RB is a complex area and one of the things we all recognize is the importance of keeping parents and their families updated about this disease. There is not always consensus about the best management of this approach. What I appreciate about the field is the collegiality where we can discuss differences of opinions and appreciate there are differences of approach, each with potential risk and results. Together, we can come up with an appropriate approach to treatment.
What I love about my job is I can work with America’s top cancer hospitals, top pediatric hospitals, and one of the best ocular pathology labs in the country, and we all get to bring our own perspectives. Cancer is not about one doctor, it is about the multidisciplinary aspect. And when you are dealing with cancer in children, it’s also very much about the families. RB is not a disease of children, it’s a disease of families and it impacts every aspect of family life.
How does your collaboration with other facilities allow you to advance in providing care to patients?
I was invited to give a talk in Brazil and was also asked to be a part of a conference in India. In both of those instances, the people who invited me felt that I would have the opportunity to give them some insight and knowledge on the treatments and approaches we have in North America. But in fact, in both those instances, it was I who learned a tremendous amount from my colleagues and how they manage this disease.
Some of our colleagues in Latin America, India, and Asia are absolutely amazing. They have limited resources, but they are truly saving kids’ lives and families’ lives. I came back from both meetings with enthusiasm, appreciation and humble respect for their approach to this disease and the tremendous strides they have made in curing children many of them with sight.
What is your number one hope for the future of preventing childhood blindness?
Knowledge is power. One of the best things we can do is continue to empower families and primary care providers about basic things in preventing childhood blindness. We’re not going to solve this problem overnight, but if you look at the initiatives Linn Murphree did years ago in screening and trying to get certain laws passed in the state of California and you look at the screening programs in the United Kingdom and Brazil, we know we are making small steps. What we’ve done is already huge but there’s still room to grow and there are still opportunities to grow.
Is there anything you share with your patients’ families that you would like all Glow families to know?
As difficult as this period is, know that the doctors profoundly care about your child and family. It is truly a doctor-patient relationship for which we are equally vested, and you have to trust us. We want you to know that we are constantly looking for better treatment options. You have people in the field that are very interested in working with each other for the betterment of children, and we’re finding ways that are not just limited to one center.
As difficult as this period is, try to be positive. How a family deals with RB will affect the development of that child. Regardless of the situation, a well supported child really does well. The children who receive support from their families turn out to be amazing adults with families of their own. Some of the bravest patients you meet are kids who went through RB and go on to be successful businessmen, lawyers and actors. I’m always about being positive and pragmatic and supporting Know The Glow® will certainly help someone out in the future.