Dear Doctor: Our neighbor was diagnosed with cancer in his right eye. It’s called ocular melanoma. I don’t want to bother him or his wife with a lot of questions, but I’d like to know more about the disease. Can you explain about risk factors and symptoms? How common is it? I thought melanoma was a skin cancer.

Dear Reader: Ocular melanoma is what is known as a primary intraocular cancer. That means that the disease begins within the eye itself. It’s a rare type of cancer that occurs most often in adults, and it affects only 5 or 6 out of every 1 million people each year. It can occur at any age and in people of all races, but it tends to be more common in those with lighter skin and eye color.

You’re correct that we’re most accustomed to hearing about melanoma in connection to skin cancer. However, the root of the word derives from melanocytes, which are cells that produce and contain the pigment known as melanin. These cells are found both in the skin and the eyes and, depending on their density and distribution, lend each their specific color. The word “oma” denotes swelling, tumor or other abnormal growth. Melanoma, therefore, refers to cancers that begin in the melanocytes.

Ocular melanoma usually arises in the uvea, which is the middle of the three layers of the eye. The positioning makes it difficult to see, and this type of cancer causes few, if any, symptoms. When symptoms do occur, they can include a dark spot that is visible on the iris, a change to the shape of the pupil, visual distortion or a blind spot in the peripheral vision, the perception of flashing lights or the sensation of pressure within the eye. Most often, ocular melanoma is identified when the eyes are dilated in the course of a routine exam. Ultrasound and a range of scans may then be used to confirm a diagnosis.

In addition to lighter eye color, risk factors for this type of cancer include exposure to sunlight or UV light, increased pigmentation on the uvea, having a mole in or on the surface of the eye, older age and being of Caucasian descent.

This is an aggressive type of cancer that can potentially spread to other areas of the body, most often to the liver. Immediate treatment is often necessary. The approach depends on the size and placement of the tumor, and the stage at which it is found. The two most common treatments are radiation therapy and surgery. Depending on the size and placement of the tumor, vision may be preserved. In advanced cases, aggressive treatment may be necessary, and vision is lost.

When an eye must be removed, patients can opt for reconstructive surgery, including the use of an artificial eye, or prosthesis. When tumors are small, they can sometimes be removed with laser treatment, which heats and destroys the cells. Investigative therapies that have shown promise include cryosurgery, which involves freezing the affected cells, immunotherapy and drugs that target proteins involved in tumor growth.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I hate switching to and from daylight saving time every year. My husband says it’s just a nuisance, but it messes up my sleep, and I think it’s affecting my health. Haven’t there been some studies about that? We’re both interested in your answer.

Dear Reader: You’re far from alone in your feelings about being forced to either lose or gain an hour as daylight saving time begins and ends each year. The energy-saving origins of the idea have since been disproven, as studies show that the drop in lighting demands is offset by air conditioning use during the longer summer days. Meanwhile, as you are experiencing, the practice has been shown to lead to widespread sleep disruptions. Numerous studies have linked the time shift to increases in workplace and automobile accidents, heart attacks, depression and sleep disorders. Considering all that we continue to learn about the close link between the functioning of our bodies, and the daily cycle of light and dark, these findings don’t come as a complete surprise.

A large new study into the health effects of daylight saving time, published last June, analyzed health data from 150 million patients in the United States and 9 million patients in Sweden. In addition to the ill effects we already mentioned, the researchers reported that the semi-annual time shift also played a role in increases in digestive disorders such as noninfective enteritis and colitis, complications related to pregnancy and childbirth, and autoimmune and inflammatory disease. Some of these showed a modest uptick of about 3%, while others, such as car accidents that resulted in injury, spiked up to 30% on the day of the shift into daylight saving time.

It’s important to note that, depending on your personal work and life schedules, daylight saving time affects everyone differently. People who have to be at work at an early hour suddenly find themselves waking up and commuting in the dark. Younger kids are being sent to bed while the sun is still in the sky. Location plays a role, as well, with people living farther south less affected by the time shift. And while it’s true that we do adapt, the research continues to suggest that even just a 60-minute realignment can have real repercussions.

Meanwhile, unless you live in Hawaii or Arizona, which don’t switch their clocks, there are a few steps you can take to try to reduce the degree of disruption. Sleep specialists suggest planning ahead. Several weeks before daylight saving time begins, start going to bed a few minutes earlier each night and waking up a few minutes earlier each morning. This helps ease you into the one-hour loss of time. Then, make it a point to expose yourself to early morning daylight when the sun does rise, which can help your body clock to adjust. Keep the rest of your schedule as regular as possible, including exercise and mealtimes, so your body isn’t dealing with additional change and stress. These won’t erase the challenges caused by that lost hour, but they may make adjusting a bit easier.

Remember to change your clocks this Sunday, March 14, the start of daylight saving time.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I have a question I’m sure is on the minds of others, as well -- where is the flu this year? All we are hearing about is COVID-19. Did the flu vaccine they gave work that well? Is no one getting the flu anymore?

Dear Reader: You’ve asked an excellent question with a somewhat complex answer. The short version is that, yes, incidence of influenza infection has been markedly lower for the flu season thus far. We’re seeing that in our own practices. As of the middle of February, we have not had a single case of influenza. To say that’s unusual is an understatement.

Our experience is reflected in the numbers that the Centers for Disease Control and Prevention use to track the course of influenza infection in the United States. In the last week of 2020, for example, only 1% of samples tested positive for influenza. Typical results at that time of year are in the 20% to 30% range. Global tracking data also mirror this trend.

A number of factors are playing a role in this year’s surprising flu season numbers. An important one is the many mitigation measures we’re all taking in the fight against COVID-19. These include social distancing, wearing a mask, vigilant hand-washing and cleaning high-touch surfaces. Environments that act as natural petri dishes for the spread of respiratory infections, such as offices and classrooms, are either severely restricted or completely shut down. Ditto for group activities such as concerts, sporting events, travel, dining, bars and other recreational activities. In physically protecting ourselves and limiting our potential exposure to the airborne coronavirus, we’re also shielding ourselves from the coughs and sneezes and surface contamination that spread the flu. The influenza virus, less transmissible than the coronavirus, is proving no match for these multiple layers of precautions.

The differences in tracking methods for COVID-19 and the flu are playing a role. With the coronavirus, the goal is to count every possible case in order to understand the trajectory of the pandemic. To that end, many millions of coronavirus tests have been administered, and all of the resulting data collected and logged. Statistics about the number of cases each flu season, by contrast, are estimates. These are arrived at by analyzing testing data collected from designated public health and clinical laboratories, and from a network of medical practices and hospitals.

It’s also important to note that people aren’t visiting the doctor as much as in pre-pandemic days. When they do seek medical care, the respiratory illness they’re most concerned with is COVID-19, so that’s the test they’re most interested in getting. There’s evidence that a number of people are opting to treat suspected flu-related illnesses at home, which also lowers the reported influenza numbers. However, influenza-related hospitalization rates, with just 155 lab-confirmed admissions from Oct. 1, 2020, to Jan. 30, 2021, bolster the idea that this year’s flu season is unusually mild.

If mask-wearing and other physical precautions continue after the epidemic, then we may continue to see lower influenza rates in the future.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)