As miraculous an organ as it may be, the eye can be home to a remarkable array of conditions. Some of those conditions are just that—mere flaws, benign, not threatening to sight or health. Others, however, are more serious and can lead to blindness or even death. Spotting the difference between the two is the business of Zelia Correa, M.D., Ph.D.
Correa, who joined Wilmer in 2018, is one of just a handful of ophthalmologists nationwide who specializes in eye tumors and is able to do a biopsy on questionable tissues inside the eye.
Correa, the Tom Clancy Professor of Ophthalmology at Wilmer, uses long, extremely narrow-gauge, flexible needles that can reach deep inside the eye and collect small samples of cells to be analyzed by pathologists. She is quick to point out that she did not invent the procedure, but she has modified and perfected it.
“We’re going to put a needle in there. We’re going to get a tiny specimen. And we’re going to do it without harming the eye,” she says to patients. “And that’s what we did,” she says, noting that complications have occurred in less than 1 percent of the 1,000 or so procedures she’s done in the last 20 years.
Within the last decade, scientific advances in molecular and tumor evaluations have made it easier to achieve medical indication to justify doing a biopsy. “Knowing what you might be dealing with is important prior to testing any potential cancer and is key to yielding results that are helpful to patients,” says Correa.
She adds that she now performs biopsies for virtually all patients with any choroidal tumor that is likely to be a melanoma. Confirming a malignancy and characterizing the genetic makeup of the particular tumor make it possible to fine-tune treatment to the individual, potentially opening up the possibility of clinical trials using new therapies.
In addition, biopsies can be performed after a patient has completed cancer treatment and can be helpful to spot a recurrence, before it has spread and when it is still possible to treat locally.
As she points out, uveal melanoma carries a significant risk of metastasis.
The procedure is done on an outpatient basis and is “very minimally invasive,” Correa notes. The needles she currently uses are 27-gauge—just a few hundredths of an inch in diameter and extremely long. This makes them pliant and flexible, allowing Correa to steer the needle with great precision. The typical biopsy requires only a handful of cells for a diagnosis that could save a life.
“I think fine-needle biopsies are very important and necessary to 21st-century eye care,” Correa says.
In her newest endeavor, Correa is using artificial intelligence and machine learning to improve diagnosis. In these cutting-edge disciplines, computers scan biopsy images and teach themselves to recognize cancers. Often the computers make connections that even highly trained pathologists do not. These advances hold the promise of taking ocular oncology in exciting new directions.
“Being in the Hopkins environment, Wilmer has access to a robust infrastructure of artificial intelligence expertise and banks of supercomputers ready and able to do the math,” Correa says.
Soon, Correa will begin enrolling patients for studies looking at artificial intelligence to aid in detecting and predicting outcomes of eye tumors. Other studies on the horizon are a multicenter trial looking at biological hallmarks of metastasis and a single-institution trial to explore complications from radiation therapy in people treated for eye cancer.
Though still new to Wilmer, Correa says her transition has been very positive. She values the easy access to Wilmer’s worldclass research infrastructure and researchers. Collaboration with other labs at Johns Hopkins strengthens her own work. Each time she has a new idea, she says, it always seems there is another Johns Hopkins lab doing similar work, often in other parts of the body, that can yield insights for her work on the eye.
“The opportunity for multidisciplinary collaborations and the fundamental support for research is just tremendous here, and that has such a positive impact on patient care,” Correa says. “This is what brought me to Wilmer.”