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Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 2-3

Diamonds are forever… and so are case reports

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University; Support provided in part by the Eye Tumor Research Foundation, Philadelphia, PA, USA

Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Carol L Shields
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University; Support provided in part by the Eye Tumor Research Foundation, Philadelphia, PA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_3737_20

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How to cite this article:
Shields CL, Shields JA. Diamonds are forever… and so are case reports. Indian J Ophthalmol Case Rep 2021;1:2-3

How to cite this URL:
Shields CL, Shields JA. Diamonds are forever… and so are case reports. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 14];1:2-3. Available from: https://www.ijoreports.in/text.asp?2021/1/1/2/305525

We have all heard the catchphrase of “diamonds are forever.” This phrase was coined in Philadelphia in 1947 to boost sales of diamonds. This subsequently was adapted to the James Bond spy film, “Diamonds are Forever,” in which Bond impersonated a diamond smuggler to break up a smuggling ring.

Diamonds are generally regarded as everlasting, and even the word “diamond,” is derived from the Greek word “adamas,” which means indestructible or invincible. However, is it true that diamonds last forever? Maybe we should more accurately state “nearly forever,” as many diamonds can reside in the Earth for millions of years; however, heat and pressure can change the internal crystal planes, leading to deformation into graphite. Nevertheless, generally speaking, “diamonds are forever” and you can count on them lasting far beyond your lifetime and that of your great, great, grandchildren.

Case reports are forever, too. Case reports are the building blocks for major scientific discovery. The first block is a single observation or relationship that is documented in the published literature. Soon thereafter, others recollect similar cases and a small case series is penned, and then a retrospective study of factors leading up to this observation subsequently blossoms into major scientific contribution—all emanating from the cornerstone of a single case report.

In the field of ophthalmology, the “posterior uveal bleeding syndrome” is a perfect example of a unique observation in a few cases that lead to the description of an entirely new disease. Kleiner et al. in 1990 wrote on the “posterior uveal bleeding syndrome” in eight patients, mostly black females who developed varying degrees of vitreous hemorrhage, retinal hemorrhage, and subretinal fluid and exudation.[1] Later, Yannuzzi et al. renamed this condition to “polypoidal choroidal vasculopathy”[2] and since then there have been 1,311 published reports on PubMed (accessed December 11, 2020) from all corners of the world.

In the world of ocular oncology, single case reports have caused us to query relationships, such as the underlying genetic abnormality that led to the development of both retinoblastoma and uveal melanoma in a single patient 50 years apart,[3] or the first case documenting an environmental relationship of heavy electronic cigarette vaping with the development of corneal squamous cell carcinoma in a young man, published last year in the Indian Journal of Ophthalmology.[4]

Small case series are enormously impactful, too. Recall the sentinel report by Shields et al. in 1983 of 12 eyes with an unusual retinal vascular tumor, termed “presumed acquired retinal hemangioma,”[5] that later was documented in 334 cases and renamed as “acquired vasoproliferative tumor.”[6] This led to a flurry of subsequent publications and a PubMed review (accessed December 11, 2020) noted 212 publications under the keywords <vasoproliferative tumor>, and additionally, further interesting associations of vasoproliferative tumor with Waardenburg syndrome,[7] multiple sclerosis,[8] and ocular albinism,[9] as well as other conditions. Lastly, Honavar proposed a new classification for this previously rare, and now more commonly-recognized disease.[10] All of this emanated from the clever recognition of key features similar in a few cases.

Beyond ophthalmology, Tureci and Sahin are not yet household names, but they soon will be. Their careers began decades ago with the study of immune surveillance of cancer and the consideration of mRNA vaccines for cancer immunotherapy.[11] However, in 2020, they took a sharp turn and refocused on an mRNA vaccine for coronavirus and won the approval of the first available vaccine. Decades of study led from small to the enormous understanding of this technology, and a potential cure for a world viral pandemic.

Back to diamonds again. Did you know that diamonds come in a gradient of colors from the most popular colorless, icy-clear diamond to the less expensive near-colorless or yellow-gold diamond? However, color is not always a degrading feature as some of the most precious diamonds are pink, yellow, blue, or purple. Only 1 in 10,000 diamonds have natural color, and, in some cases, the more intense the color, the rarer the stone, the more precious the gem.[12] Like a case report, small nuances in a single disease entity can increase the educational value of the publication.

The magnificent Oppenheimer blue diamond ranks among the most precious jewels in the world, setting an all-time record at a Swiss auction of over 50 million US dollars.[13] Similarly, many scientific discoveries are prized, especially those that move medicine forward. Yes, these typically originate through a novel single observation, like the innocent case report.

So, let the case reports live on forever. These rare gem observations can potentially morph into a small case series, and like those of Tureci and Sahin, lead to an innovative scientific principle and change the world.

About the authors

Drs. Carol and Jerry Shields, Ocular Oncology Service, Wills Eye Hospital, Philadelphia, USA

Carol L. Shields, M.D.

Dr. Carol Shields completed her ophthalmology training at Wills Eye Hospital in Philadelphia and fellowship training in ocular oncology and ophthalmic pathology. She is currently Director of the Oncology Service, Wills Eye Hospital, and Professor of Ophthalmol at Thomas Jefferson University in Philadelphia, PA, USA.

She has authored or coauthored 11 textbooks, 337 chapters in edited textbooks, over 1900 articles in major peer-reviewed journals, and given nearly 1000 lectureships.

The five most prestigious awards that have honored her include:

  • The American Academy of Ophthalmology Life Achievement Honor Award (2011) for contributions to the field of ophthalmology.
  • Induction into the Academic All-American Hall of Fame (2011) for lifetime success in athletics and career.
  • President of the International Society of Ocular Oncology (2013-2015) – the largest international society of ocular oncology.
  • Ophthalmology Power List 2014, 2016, 2018, 2020 – Nominated by peers as one of the top 100 leaders in the field. In 2020, Dr. Carol Shields was listed as #1 in the Ophthalmology Power List.
  • The Donders Award (2003) by the Netherlands Ophthalmological Society every 5 years. She was the first woman to receive this award.

Jerry A. Shields, M.D.

Dr. Jerry Shields completed his ophthalmology training at Wills Eye Hospital in Philadelphia and fellowship training in retina and ophthalmic pathology. He is Director Emeritus of the Oncology Service, Wills Eye Hospital, and Professor of Ophthalmology at Thomas Jefferson University in Philadelphia, PA, USA.

He has authored or coauthored 13 textbooks including the popular  Atlas More Details of Intraocular Tumors and the Atlas of Eyelid, Conjunctiva, and Orbital Tumors. In addition, he has published over 1800 articles in peer-reviewed journals and over 350 textbook chapters. He has delivered 82 prestigious named lectures.

The five most prestigious awards that have honored him include:

  • The establishment of the annual Jerry A. Shields Lecture at the Asian Pacific Society of Ophthalmology (2012).
  • The prestigious National Physician of the Year Award (named the top doctor in America) for Clinical Excellence by Castle Connolly Medical LTD, NY, NY (2013)
  • The Laureate Award at the American Academy of Ophthalmology (AAO), a top prestigious honor given to an ophthalmologist annually (2014).
  • President of the International Society of Ocular Oncology.
  • President of the Macula Society.

Together, they have managed over 600 new patients each year with uveal melanoma, retinoblastoma, and hundreds of other intraocular, orbital, and conjunctival tumors from the United States and abroad. They are the proud parents of 7 children, ranging in age from 20 to 32 years.

  References Top

Kleiner RC, Brucker AJ, Johnston RL. The posterior uveal bleeding syndrome. Retina 1990;10:9-17.  Back to cited text no. 1
Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy. Retina 1990;10:1-8.  Back to cited text no. 2
Singh AD, Shields CL, Shields JA, Sternberg P. Occurrence of retinoblastoma and uveal melanoma in the same patient. Retina 2000;20:305-6.  Back to cited text no. 3
Shields CL, Kim M, Lally SE, Chevez-Barrios P, Shields JA. Eye cancer in a young male with vaping history. Indian J Ophthalmol 2020;68:1699-701.  Back to cited text no. 4
[PUBMED]  [Full text]  
Shields JA, Decker WL, Sanborn GE, Augsburger JJ, Goldberg RE. Presumed acquired retinal hemangiomas. Ophthalmology 1983;90:1292-300.  Back to cited text no. 5
Shields CL, Kaliki S, Al-Daamash S, Shukla S, Reilly B, Shields JA. Retinal vasoproliferative tumors . Comparative clinical features of primary versus secondary tumors in 334 cases. JAMA Ophthalmol 2013;;131:328-34.  Back to cited text no. 6
Rundle P, Shields JA, Shields CL, Singh AD, Peairs R . Vasoproliferative tumor of the ocular fundus associated with Waardenburg's syndrome . Eye 2000;14:105-6.  Back to cited text no. 7
Özalp O, Atalay E, Bilgeç MD, Erol N, Yıldırım N. The relationship between vasoproliferative tumor and uveitis in a multiple sclerosis patient: A case report and review of the literature . Turk J Ophthalmol 2019;49:364-6.  Back to cited text no. 8
Alsakran WA, Almadhi NH, Alshamrani AA, Alzahrani YA. Retinal vasoproliferative tumor in ocular albinism. Am J Case Rep 2020;21:e925926. doi: 10.12659/AJCR.925926.  Back to cited text no. 9
Honavar SG. Retinal vasoproliferative tumor – A proposal for classification. Indian J Ophthalmol 2018;66:185-6.  Back to cited text no. 10
[PUBMED]  [Full text]  
Morris L. Their coronavirus vaccine candidate has made them billionaires. This modest German Turkish couple doesn't own a car. The Washington Post. 2020 (November 12).  Back to cited text no. 11
Duncan P, Allen P. The world's most expensive diamonds - size isn't everything. The Guardian. 21 May 2016. Retrieved 2020 Dec 09. Available from: www.theguardian.com.  Back to cited text no. 12
Oppenheimer Blue diamond sells for world record at auction. The Guardian. 18 May 2016. Retrieved 2016 May 18. Available from: www.theguardian.com.  Back to cited text no. 13


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