An image-based eyelid lesion management service—evaluation of a pilot

Abstract

BACKGROUND/AIMS: Oculoplastics is a predominantly visual specialty and many of the pathologies can be diagnosed based on external appearance. An image-based eyelid lesion management service was piloted to reduce the number of patients who would require outpatient clinic review. The aim of this study was to determine its accuracy and feasibility, both as a hospital-based and community optometrist-based service. If successful, the service was envisaged to significantly reduce the number of patients that require face-to-face (F2F) review, in accordance with current post-COVID-19 principles of social distancing. METHODS: Patients with lid lesions attending an oculoplastics clinic were assessed by consultant oculoplastic surgeons in an F2F consultation (Arm A). The lesions were photographed by a professional clinical photographer (Arm B) and by an optometrist with a handheld digital camera (Arm C). These images were reviewed by independent consultants masked to the outcome of the F2F clinical encounter. Data were collected prospectively including patient demographics, diagnosis, suspicion of malignancy and management. The image-based clinic results were compared to the F2F clinic results. RESULTS: Ninety-five patients were included. Clinical diagnoses were compared for intra-observer variability and substantial agreement was demonstrated between gold-standard F2F clinic visit (Arm A) and Arm B (Ƙ = 0.708) and C (Ƙ = 0.776). There was no statistically significant difference in the rate of discharge and all cases of malignancy were either identified or flagged for F2F review in the image-based arms. CONCLUSION: This pilot demonstrated substantial diagnostic agreement of image-based diagnoses with F2F consultation and image review alone did not miss any cases of malignancy.

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

“…The successful upscaling of the virtual clinical capacity for glaucoma patients at Moorfields Eye Hospital now means that all new routinely referred patients (around 5000 per annum) can be seen virtually 67 . In a pilot clinic design, a recent study reported substantial agreement between the diagnosis reached by clinicians reviewing patients with suspected lid lesions face to face than when photographs of the lesion were reviewed by consultants 68 …”

“…Another study reported that 40% of patients were discharged without intervention from a clinic assessing eyelid lesions, whereas discharge was recommended in 51.6% for the same set of patients when reviewed virtually. Of note, the virtual reviews were performed by a separate consultant ophthalmologist in the latter study 68 . In relation to the sustainability of these systems, no information about cost was reported and it was unclear from the literature how acceptable these systems were to the stakeholders using them.…”

Video consultations in oculoplastic service: a continuing role post-pandemic?

“…Oculoplastic VCs have proved successful, partly due to emphasis on visual recognition [ 2 ]. A comparison of face-to-face consultations (F2FC) with photographs assessed independently showed 100% detection rate for extraocular malignancy [ 3 ]. Previous studies on VC uptake were done during a period when concerns of catching Covid-19 in hospitals ran high, possibly influencing patient and clinician responses [ 2 ].…”

“…Next, we will conduct VCs for non-emergency new referrals, follow-up for investigation results and after minor procedures. For cases necessitating detailed examination, an asynchronous approach whereby photographs are submitted by patients or community optometrists beforehand could be used [ 3 ]. We did not directly compare outcomes with F2FCs, however other peer-reviewed studies show comparable results [ 3 ].…”

“…For cases necessitating detailed examination, an asynchronous approach whereby photographs are submitted by patients or community optometrists beforehand could be used [ 3 ]. We did not directly compare outcomes with F2FCs, however other peer-reviewed studies show comparable results [ 3 ]. Covid-19 introduced a change which is advantageous to service provision.…”