Routine eye exam leads to liver cancer diagnosis

November 8, 2022
Edward Melman, O.D., knew his patient’s health history, personality and energy level. Rafael Melendez had been seeing Dr. Melman at his Voorhees, New Jersey, office for regular comprehensive eye exams for more than 20 years. In the past decade, he had been seeing Dr. Melman more often, after cataract surgery and for ongoing glaucoma treatment.
Rafael and Luz Melendez

When Rafael "Ray" Melendez, now age 70, showed up for his regular appointment in fall 2021, Edward Melman, O.D., knew something was off. “I knew that Ray’s health had been gradually changing over the years, but he always had an abundance of energy and was physically fit. And in this case, he just was not,” Dr. Melman explained.

He noticed that Melendez was a bit slow in his responses and didn’t seem to have much energy. “If he was a brand-new patient, I would have noticed he was lacking energy and would have had a discussion with him about whether this was normal for him,” Dr. Melman said. “But for somebody who I had known for years, it was immediately obvious to me that something was not right. I can certainly say that he was not himself.”

Dr. Melman asked Melendez if he had noticed any differences in his health.

“Looking at it, I can see the signs where I was not as ‘up’ as I normally was,” Melendez recalled. “But until he had mentioned it, I had not really given it much, if any, thought.”

Dr. Melman knew Melendez had been diagnosed with type 2 diabetes about 15 years earlier, and he recommended that he make an appointment with his primary care physician (PCP) for an exam and to discuss his current medications.

Melendez took Dr. Melman’s advice, which began a health journey that led to him being diagnosed with liver cancer and learning he didn’t have diabetes after all.

“Dr. Melman, in my humble estimation, saved my life.” -Rafael Melendez

Melendez’s PCP suggested he stop taking his diabetes medication temporarily to see if he truly needed it. Then, Melendez decided to see an endocrinologist, who surprised him by telling him that he didn’t have diabetes. “She told me to discontinue all my medications.”

Melendez knew he had a fatty liver—which might have led to the earlier diabetes diagnosis. He soon saw a gastroenterologist—a doctor who treats disorders of the digestive tract, including stomach and intestines—and a hepatologist—who focuses on the liver, gallbladder, pancreas and bile ducts.

“Through a lot of testing, they determined that my liver was diseased. That’s what started it all—all because of Dr. Melman, who had put me on the right path.”

Melendez was placed on a liver transplant list, but when it came time for his transplant, the surgeon discovered Melendez had cancer cells in his liver. They couldn’t go through with the transplant because there was a risk the cells would invade the new healthy liver.

Instead, he had an ablation procedure to destroy the cancer cells, and he now undergoes an MRI on his liver every three months. He continues to wait for a chance at another liver transplant.

Dr. Melman stressed that this story shows the importance of having continuity with your doctors. A comprehensive eye exam with a doctor of optometry every year is important to catch vision problems early, but it can also help detect health issues in other areas of the body.

“More can be gleaned from an eye examination than simply getting a new pair of glasses,” Dr. Melman explained.

Melendez continues to marvel that Dr. Melman picked up on subtle changes in his energy and personality that eventually led to a proper diagnosis of liver disease and cancer removal.

“That’s what people don’t realize—that a good optometrist looks at so much more. They are doctors, and they look at other things, not just our eyes.” -Rafael Melendez

He continued: “I told Dr. Melman he saved my life, quite frankly. I really feel that way.”

Edward Melman, O.D.

Edward Melman, O.D.

Dr. Melman is a leader in New Jersey optometry and an administrator for Vision Source, the nation's largest association of independent practitioners. He has served as the president of the West Jersey Optometric Society for many years. In 2016 he was awarded Optometrist of the Year by the New Jersey Society of Optometric Physicians. Dr. Melman has given continuing education lectures on eye disease, diabetes and dry eye conditions. He sees patients with low vision  for the Commission for the Blind and Visually Impaired.

Dr. Melman's office specializes in the diagnosis and treatment of a wide array of eye diseases and conditions including specialty contact lenses for keratoconus, orthokeratology lenses for myopia management, early assessment of macular degeneration and night vision, and low-vision evaluations for those with subnormal vision. They are equipped to provide Zeiss aberration correcting lenses which enhance night vision. Recently they have added test lenses which help the color blind enhance their deficient color perception. This can be tried in the office.

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