Life, Uninterrupted

An ocular melanoma diagnosis with a happy ending

Janet Thompson and Dr. Prithvi Mruthyunjaya (left) stand with Thompson's family at the Lookin' for a Cure 5K fundraiser for ocular melanoma at Byers.


JANET THOMPSON KNOWS better than most the value of a healthy lifestyle and preventative care to fend off disease, but she also knows first-hand that sometimes illness sneaks up on you anyway. 

Thompson has spent her entire working life in the healthcare field. She earned a degree from the Family Nurse Practitioner program at the University of California, Davis, before spending decades in women’s general healthcare clinics in the Sacramento area. She’s prided herself on keeping a healthy weight, lipid levels, and blood pressure. After retiring in 2014, Thompson would ride her bike on 25- to 30-mile journeys three days a week, take long walks, and play pickleball with her husband, a retired veterinarian. 

All of that seemed like it was working to help her avoid serious illness, until 2019, when a routine eye exam turned into a recommendation for a second opinion, which turned into a surprising ocular melanoma diagnosis that almost took her eye. 

Thompson sought an expert to treat her condition and found Prithvi Mruthyunjaya, MD, MHS, professor of ophthalmology and, by courtesy, associate professor of radiation oncology at Stanford. Mruthyunjaya is also the director of Ocular Oncology at the Byers Eye Institute. 


A second opinion

Thompson’s saga started six years before her appointment with Mruthyunjaya, when her optometrist initially discovered a large, flat freckle on her eye. Her optometrist said the freckle needed a second opinion, even though freckles like hers “hardly ever turned into anything.” Still, the optometrist would check in with an ophthalmologist and, hopefully, come back with good news. 

Her news wasn’t good. That freckle was ocular melanoma—a cancer with the possibility to or spread. 

The first ophthalmologist Thompson saw informed her that the melanoma was affecting her optic nerve, the critical connection at the back of the eye that allows visual information to reach the brain for processing. He recommended an enucleation—to remove her eye.

Thompson and her husband Dennis researched options. A family member recommended the Byers Eye Institute. 

“I am so darn lucky,” she said. “You know, Dr. Mruthyunjaya is a busy guy, but somehow, it was just two weeks later that I got in.” She didn’t know at the time that no matter the backlog, the Byers Eye Institute always works to get urgent patients into their doctors.

The Thompsons met with Mruthyunjaya in July of 2019, and his assessment wasn’t quite as dire. He found that the tumor wasn’t growing into Thompson’s optic nerve, but overhanging it, meaning she would only need radiation, not enucleation.

Mruthyunjaya offered another treatment plan, called radiation plaque brachytherapy, in which he would place a disc with radioactive “seeds,” or pieces of metal smaller than a grain of rice, into the eye to target radiation to the site of the melanoma. The seeds stay at the back of the eye for five to six days to help the cancer shrink. 

The procedure still came with risks. “Even if the treatment were successful, two to three years later, she could have been close to legally blind,” Mruthyunjaya said. “But Janet was willing to save her eye if at all possible.”


From worry to results

Thompson returned to Byers Eye Institute for her radiation surgery in August 2019, about a month after that first meeting. The surgery went smoothly, but she wasn’t out of the woods yet. She returned to Mruthyunjaya every three to four months for monitoring and for injections of Bevacizumab, a drug used to protect the retina by blocking the protein that triggers blood vessels to form, known as vascular endothelial growth factor. 

Today, Thompson sees Mruthyunjaya every six weeks for the injections. “Janet’s an incredibly classy, kind, warm personality,” Mruthyunjaya said. “She’s the kind of person you’d want as your friend and neighbor, and it’s really been such a pleasure to know her.” 

Thompson’s sight is now nearly 20/20 with her glasses. She, her husband Dennis, their two sons, daughter-in-law, and grandchildren joined in the Ocular Melanoma 5K benefit hosted at the Byers Eye Institute in July, beaming with gratitude for how much Stanford has changed their lives. Thompson credits Mruthyunjaya specifically for her unlikely success story.

“He’s so good, not just his expertise, but he’s so compassionate—he cares, and that comes across,” she said.

Mruthyunjaya was inspired by Thompson’s case to push forward a large clinical trial that is now being conducted across multiple universities and clinics to prevent radiation retinopathy, a major cause of vision loss after radiation treatment for ocular melanoma. 

“It was the response of patients like Janet Thompson that motivated me to move this first-of-its-kind clinical trial forward,” Mruthyunjaya said. “Results of this study may increase access to these drugs for more patients.” 

Thompson and her family are continuing that tradition through their giving to the Byers Eye Institute at Stanford, funding work that will help others who might find, like she did, that sometimes illness catches up to us. 

“It was a whirlwind, but things fell into place—it was meant to be,” she said. “I was meant to be at Stanford.”

Grace is a freelance writer for the Byers Eye Institute at Stanford.