How Multidisciplinary Care and Molecular Diagnostics Are Redefining Ocular Oncology

The management of ocular malignancies has historically straddled a fine line between ophthalmology and systemic oncology, occasionally falling into institutional silos that fragment patient care. With the recent appointment of ocular oncologist Miguel A. Materin, MD, to lead the adult and pediatric ocular oncology programs at Northwell Health, the institution is positioning itself to dismantle these barriers. By establishing an integrated network of medical oncologists, pediatric oncologists, radiation oncologists, pathologists, interventional neuroradiologists, and other oncology specialties, the program aims to streamline complex treatment pathways and improve outcomes for rare, high-stakes ocular cancers.

Materin, system head of Ocular Oncology at the Northwell Cancer Institute, spoke with CancerNetwork® regarding his new appointment, and highlighted the ocular oncology space and the advancements that have been changing the landscape.

A Vision Realized: Transitioning to Northwell Health

For Materin, the decision to join Northwell Health was driven by the opportunity to design a comprehensive, multidisciplinary infrastructure from the ground up. Ocular oncology inherently demands collaboration, given its intersection with multiple subspecialties. Rather than forcing patients to navigate these complex clinical systems, Materin’s model establishes pre-coordinated, disease-specific teams.

The initial phase of this initiative has focused on standardizing care pipelines for the most prevalent adult and pediatric ocular malignancies: uveal melanoma and retinoblastoma.

"Ocular oncology is a specialty that interacts with all specialties in ophthalmology and in oncology, so building the teams for each one of the conditions is key, and what we want is to make this journey as smooth as possible for patients,” Materin said.

Bridging the Gap: The Clinical Reality of Ocular Metastases

The necessity of a multidisciplinary framework is perhaps most visible in the management of secondary ocular tumors. Ocular metastases can be the first sign of a known or unknown systemic cancer.

Also, due to significant advancements in systemic targeted therapies and immunotherapies, patients with advanced lung, breast, gastrointestinal, and genitourinary cancers are living substantially longer than they did 2 decades ago. A secondary consequence of this extended survival is an increased clinical incidence of ocular adverse effects from systemic treatments, which is why siloed care is a model that is no longer feasible.

Materin noted that managing these cases requires seamless communication between the patient’s primary medical oncologist and the ocular oncologist to balance systemic therapeutic efficacy with local vision preservation.

Clinical Trials and Paradigms: Evolving Management in Uveal Melanoma

The treatment landscape for uveal melanoma, the most common primary intraocular malignancy in adults, is undergoing a profound shift.¹ Historically, therapeutic success was measured strictly by local tumor control and patient survival. Today, the preservation of visual acuity has become a critical tertiary end point.

“When we see [and] 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,” Materin said

Vision-Preserving Paradigms

Radiation retinopathy remains a major driver of long-term vision loss after treatment with plaque brachytherapy or particle therapy.

According to Materin, to mitigate potential vision loss, current clinical approaches incorporate routine intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. Recent studies have shown that by reducing the total radiation dose to treat these tumors, we are also reducing the delivered dose to the adjacent ocular structures, improving visual acuity outcomes.

"By the combination of reducing the radiation dose and by performing intraocular injections, we see patients are preserving better vision, not perfectly, but better than in the past,” Materin noted.

Managing Systemic and Metastatic Disease

While primary ocular tumors can often be controlled locally, metastatic uveal melanoma has historically carried a dismal prognosis due to its resistance to conventional systemic chemotherapies. However, the therapeutic landscape fundamentally shifted with the 2022 FDA approval of tebentafusp-tebn (Kimmtrak), a bispecific gp100 peptide-HLA-directed T-cell receptor engager that demonstrated a significant overall survival (OS) benefit in HLA-A*02:01-positive patients.² Data from the 5-year update on the phase 3 IMCgp100-202 trial (NCT03070392) showed an OS of 21.6 months (95% CI, 12.9-24.3) in the tebentafusp arm vs 16.9 months (95% CI, 12.9-19.5) in the investigator’s choice of therapy arm (HR, 0.67; 95% CI, 0.54-0.85).³

Materin emphasizes that having multiple FDA-approved treatment avenues for metastatic disease has fundamentally injected hope into a challenging clinical space.

“Since 2022 we have 2 approved FDA approved treatment for metastatic disease, and that is an ongoing process that it's helping us and is helping the patients and gives us a lot of hope.”

The Promise of Liquid Biopsies

Accurate risk stratification is critical for determining which patients require aggressive systemic surveillance. Materin highlighted the emerging role of liquid biopsies in reshaping diagnostic accuracy.

Rather than relying solely on invasive fine-needle aspiration biopsies of the choroid, researchers are investigating less invasive methods. This includes analyzing DNA, circulating tumor DNA (ctDNA), and proteomic biomarkers derived from micro-samples of the eye’s anterior chamber fluid. These biomarkers help identify high-risk genomic mutations (such as BAP1 loss) that predispose patients to rapid systemic dissemination.

One such method is TEARDROP (Tear Enrichment using Advanced Recovery via Deep Resolution of Proteins).⁴ A series of biochemical steps will occur to extract and retrieve tear proteins, which will allow clinicians to detect and treatment potential diseases earlier.

Artificial Intelligence in Ocular Imaging

While deep learning algorithms and artificial intelligence (AI)-driven imaging have generated significant interest for differentiating benign nevi from early-stage choroidal melanomas, Materin urges clinical caution.

At present, AI tools serve as a valuable triage mechanism for community optometrists and ophthalmologists to determine when a patient should be referred to a tertiary center. However, they do not replace the diagnostic accuracy of an experienced ocular oncologist.

“There will be a role for AI, no doubt. We know that medicine is going to use more of AI. At this point [in] 2026 it’s not perfect [it can be a useful tool for referring clinicians or established ocular oncologists], but I am not sure we are there yet.”

The Next Frontier: Survivorship and Patient-Centered Continuity

In pediatric ocular oncology retinoblastoma is the most common primary intraocular malignancy. In US more than 95% of patients survive the primary disease.⁵ Patients with bilateral disease carry the germline mutation for this retinoblastoma, carry a lifetime risk of developing secondary and tertiary malignancies, such as osteosarcomas and soft-tissue sarcomas. To address this, Materin highlighted the critical role of dedicated survivorship programs that provide rigorous, long-term oncological surveillance as these pediatric patients transition into adulthood.

Ultimately, whether managing a pediatric retinoblastoma survivor or an adult with metastatic uveal melanoma, Materin maintained that transparent communication regarding prognosis, treatment limits, and realistic expectations is the true cornerstone of effective oncological care.

“We’re 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. By building the right teams, communicating with patients for what they need to know, and the possibilities that we can provide, both in support, treatment, prognosis, [and] diagnosis, we’re going down the right path,” Materin concluded.

References

1. What is uveal melanoma? Harvard Medical School Department of Ophthalmology. Accessed June 10, 2026. https://tinyurl.com/mr299bwr
2. Immunocore announces FDA approval of KIMMTRAK® (tebentafusp-tebn) for the treatment of unresectable or metastatic uveal melanoma. News release. Immunocore. January 26, 2022. Accessed June 10, 2026. https://tinyurl.com/5hdd9yu9
3. Nathan P, Piperno-Neumann S, Hassel JC, et al. Five-year survival with tebentafusp in previously untreated metastatic uveal melanoma in a phase 3 trial. Abstract presented at: American Association for Cancer Research Annual Meeting 2026; April 17-22, 2026; San Diego, CA. Abstract CT029.
4. TEARDROP – A proteomics protocol for human tears. News release. Stanford Medicine. October 27, 2025. Accessed June 10, 2026. https://tinyurl.com/m47mcjtp
5. Kaur K, Patel BC. Retinoblastoma. National Library of Medicine. Updated February 17, 2025. Accessed July 6, 2026. https://tinyurl.com/mtmhvafw