Advancing Ocular Oncology: Liquid Biopsies and Vision-Preserving Innovations

In an interview with CancerNetwork®, Miguel A. Materin, MD, discussed his new role as system head of Ocular Oncology at the Northwell Cancer Institute. Ocular oncology represents a highly specialized field at the intersection of ophthalmology and diverse oncological disciplines. Materin shared his clinical vision for replacing traditionally siloed care models with fully integrated, multidisciplinary teams.

Throughout the conversation, Materin highlighted pioneering advancements transforming the field, including the rise of liquid biopsies for tumor risk assessment, the utility and limitations of intra-arterial chemotherapy for pediatric retinoblastoma, and modern vision-preserving techniques for uveal melanoma. He also provided a pragmatic overview of artificial intelligence’s (AI) current role in diagnostic imaging, the shifting paradigm of survivorship and secondary cancer prevention, and the evolving therapeutic landscape for metastatic disease.

CancerNetwork: You recently joined Northwell Health to lead the adult and pediatric ocular oncology programs. How does your vision for a multidisciplinary team integrating radiation oncology, medical oncology, and pathology specifically improve outcomes compared with traditional siloed care?

Materin: In my opinion, multidisciplinary teams provide the best care for the patients with better outcomes. Ocular oncology is a specialty that interacts with all specialties in ophthalmology and many specialties in oncology, so building the teams for each one of the conditions is key. What we want is to make this journey as smooth as possible for patients. You mentioned some of the interactions with medical oncology, radiation oncology, pediatric oncology, and neuro-oncology. We see patients [who] have metastasis from lung cancer, breast cancer, [gastrointestinal], [genitourinary], you name it, and we will probably see them.

Our goal is to [better integrate teams] as soon as we can, and we have been working even before I came on board building those teams. We started with the most common conditions, probably uveal melanoma and retinoblastoma, and we have our teams already built and ready to go. I started to see patients last month, and the process and collaboration have been great.

What ongoing research in the ocular oncology space is worth noting or highlighting?

There are different areas and topics, whether we include ocular oncology in general or other specialties in oncology. When we talk about uveal melanoma and retinoblastoma, we want to be right there. The hot topics these days are liquid biopsies. There are different sources of markers or DNA in the blood that we can get information from, and Northwell has been great to be on board for all of these, which will put the program right where we want to be. We want to inform the patients about the risk for other conditions for the tumors they may have, and use the most cutting edge technologies to monitor tumors, and to work for them and with them.

Looking at intra-arterial chemotherapy, which has revolutionized retinoblastoma treatment, what are some current limitations of this technique, and are there new delivery methods on the horizon that could further reduce systemic toxicity?

Retinoblastoma is a very interesting topic because, no.1, the vast majority of patients survive the retinoblastoma. Less than 3% or 4% of patients die from retinoblastoma, and we have good treatments. Intra-arterial chemotherapy is one of them, and if you go all around the world about when to use intra-arterial chemotherapy, you may have different opinions.

For limitations, I would say that the main limitation is how early we diagnose the retinoblastoma in a baby. The younger the baby is, the more challenging it is for the interventional neuro-radiologists to treat that [patient], but it can be done during a second phase of treatment when the baby has grown a bit. Regarding limitations, if we can provide access to patients to see the team, the [patient] and the family will be evaluated, will be treated promptly, and we will decide the treatment individually after we discuss with the rest of the team what we think is best for that patient.

For hereditary retinoblastoma, how is the role of the ocular oncologist shifting from long-term survivorship to looking at secondary cancer prevention?

That is honestly a good place to be because that means that the baby is not a baby anymore and survived the condition. When it comes to germline retinoblastoma, patients are at risk for second cancers and third cancers because of the germline mutation. At Northwell, we have that team already in place for what is called survivorship. That team starts at Cohen’s Children’s Medical Center and continues with other places at Northwell that will continue monitoring those patients all throughout their lives.

What are some of the most promising vision-preserving surgical techniques that are currently being utilized in uveal melanoma?

When we see patients and we treat patients with uveal melanoma, we first focus on life, second on the eye, and third on vision. Meaning that if we are discussing vision, we are good with the other 2. Everything started many years ago, and I would say that a big milestone was the Collaborative Ocular Melanoma Study, and that was done in the '80s. I would say that since then to now, there are 2 big factors that are helping us improve vision, or at least the chances to preserve vision.

One is the anti-vascular growth factor injections that we have available, which years ago,15 to 20 years ago, we did not have. We can use those medications intraocularly to preserve the best possible vision. The second topic, which is under discussion, is that there is a trend trying to reduce the radiation dose. By the combination of reducing the radiation dose and utilizing intraocular injections, patients are seeing better—not perfectly, but better than in the past.

Vision loss often occurs post-treatment due to radiation retinopathy. Are there new pharmacological interventions that show promise in mitigating this damage?

Yes, and that is what I meant by the anti-vascular growth factors. It is interesting because those medicines are getting better too, and we have different options. We can provide those injections and starting with one medicine and going to another one, I have seen that some patients respond to some medications differently than others. We have those drugs right now, and we know there is more research going into working on those drugs to get even better.

AI is a very hot topic across all oncology spaces. How are you integrating AI-driven imaging and deep learning algorithms to better differentiate between benign nevi and early-stage choroidal melanomas?

Any answer I can give is debatable, so I will give you my opinion. In terms of this topic, there is and there will be a role for AI, no doubt. We know that medicine is going to use more AI. At the same time, we need to be careful because at this point in 2026, it is not perfect. It is worth it to help referring doctors in terms of looking at an image and determining what the chances are that it could be a uveal melanoma or not, and when to refer the patient; then, yes.

At the same time, on the other side of the spectrum, you have the ocular oncologist who has seen many of these patients, and we clinically have a very high percentage of being accurate about the diagnosis. In the future it will be a combination of both. As we get better, or as the AI gets better and more useful, there will be a role, but I am not sure we are there yet.

What is the missing link in research to prevent the dormant spread of metastatic uveal melanoma?

That takes us a bit into the markers in blood and mutations. That is what I mentioned about the liquid biopsies. As an example, there is research going on about taking a few drops from the anterior part of the eye and analyzing the DNA or even proteomics to tell us if it is a melanoma or not. As research gets better with these liquid biopsies, we will know better.

The "dormant" melanoma, is more a description from the past and not the present. I will say that today we can categorize a lesion or a tumor like, "Okay, this is benign, this is malignant, this is a nevus, this is a melanoma," and there are some indeterminate lesions. That is what you may be referring to as dormant melanoma. For those suspicious lesions, that is what I think about for the future—not the near future, but the far future—where we will be able to analyze those tumors and make a more accurate diagnosis. At this point, they are called indeterminate lesions, and each patient and each decision should be made when we are with the patient.

Looking towards the future, where is the ocular oncology field headed?

All the above, everything I said. It depends on what condition we are talking about and let me give you an example. We spoke about uveal melanoma and we spoke about retinoblastoma. What about metastasis to the eye? In the past, and I am talking about 20 years ago, patients would die within 3 or 6 months from stage IV lung cancer, breast cancer, etc. We are seeing those patients living much longer, and that is thanks to the improvement of identifying the markers, the genes, the mutations, and target therapy, immunotherapy, etc.

When it comes to uveal melanoma, there is research, and Northwell is part of it, about treating large uveal melanomas with an oral medication that can shrink the tumor, and we can say probably will save the eye. We can provide a lesser amount of radiation to the patient, but that is ongoing research. We can talk about how I see things in 5 years, or in 10 years, or 15 years, and we will have different answers. The liquid biopsies, identifying the ctDNA, and any markers we can find in these patients will help us to treat these patients early.

Second, when it comes to uveal melanoma, years ago we did not have any treatment for metastatic uveal melanoma. Now, since 2022, we have 2 FDA-approved treatments for metastatic disease, and that is an ongoing process that is helping us, helping the patients, and giving us a lot of hope. My way of seeing this is to understand where we are––we need to know where we are coming from. If we talk about the ‘80s, the ‘90s, or even the early 2000s, we did not know which patients were at higher risk to develop metastasis. That is clearer now, and we have some medicines that in some patients work or show some improvement. The path is showing us where we are going, and I am very optimistic that we are going down the right path, identifying high-risk patients and treating them early with more appropriate and accurate treatment than in the past.

We touched on a wide range of topics today. Is there anything else that you want to highlight or maybe expand on?

In everything that we are discussing, communication is key, and communication is above all. Understanding what the expectations from the patients is important; they need to be realistic, and we want to help them to do that. We are building large teams and finding the key players who can coordinate the care for these patients. We cannot forget that eye cancer is a rare disease. It is more common for us because we have been seeing thousands of patients, and by building the right teams, communicating what patients need to know about where we are at, and the possibilities that we can provide both in support, treatment, prognosis, and diagnosis, we are going down the right path.