Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model

Balaskas, Konstantinos; Gray, Jane; Blows, Peter; Rajai, Azita; Flaye, Deidre; Sagoo, Mandeep S.

doi:10.1136/bjophthalmol-2015-307168

Cited by 17 publications

(21 citation statements)

References 13 publications

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“…The last decade has seen advances in multimodal ocular imaging and in telemedicine platforms, allowing innovative delivery of care in several ophthalmic sub-specialties [ 1 , 2 , 3 , 4 , 5 ], including oncology [ 6 , 7 , 8 ]. This technology enhances opportunities for the remote monitoring of melanocytic choroidal tumors of uncertain malignancy.…”

Section: Introductionmentioning

confidence: 99%

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Roelofs

O’Day

Harby

et al. 2020

Cancers

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Purpose: To determine if ultrasonography is necessary to detect progression of choroidal melanocytic tumors undergoing sequential multi-modal imaging with color photography, autofluorescence (AF) and optical coherence tomography (OCT). Methods: All patients with choroidal melanoma undergoing treatment at Moorfields Eye Hospital between January 2016 and March 2020 were reviewed to identify those with treatment deferred by ≥ 2 months. Tumors that showed progression prior to treatment, defined as an increase in (a) basal dimensions (b) thickness (c) orange pigment and/or (d) sub-retinal fluid, were included. Mushroom shape, Orange pigment, Large size, Enlargement and Sub-retinal fluid (MOLES) scores were assigned to all tumors at earliest date and date of treatment. Results: A total of 99 patients with a mean age of 66 years (range: 26–90) were included. The initial MOLES score was 1 in 2 cases, 2 in 23 cases, and ≥ 3 in 74 cases. Progression was detected with sequential color photography alone in 100% of MOLES 1/2 and 97% of lesions with a MOLES score of ≥ 3. When findings on AF and OCT were included, sensitivity for detecting subtle change without ultrasonography improved to 100% for MOLES 3 and 97% for MOLES 4/5. Only one patient included in this study had an isolated increase in thickness that may have been missed had sequential ultrasonography not been performed. Overall, the sensitivity for detecting progression with color photographs alone was 97% (95% CI 93–100%) and increased to 99% (95% CI 97–100%) by including autofluorescence and OCT. Conclusions: Monitoring of choroidal nevi, particularly those classified as MOLES 1 or 2 (i.e., low-risk or high-risk naevi), can be accomplished safely without the need for ultrasonography. The findings of this study may remove barriers to the implementation of tele-oncology clinics for the monitoring of choroidal melanocytic tumors.

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Section: Introductionmentioning

confidence: 99%

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Roelofs

O’Day

Harby

et al. 2020

Cancers

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“…This represents a high level of lesion awareness, appropriate detection and referral practices and improved diagnostic techniques among the practising clinicians utilising the centre . Similarly, substantial agreement in the clinical management decisions regarding melanocytic fundus lesions by optometrists compared with ophthalmological opinion has been reported elsewhere …”

Section: Discussionmentioning

confidence: 85%

The advantages of intermediate‐tier, inter‐optometric referral of low risk pigmented lesions

Nivison‐Smith

Hennessy

et al. 2017

Ophthalmic Physiologic Optic

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Purpose: Pigmented ocular lesions are commonly encountered by eye-care professionals, and range from benign to sight or life-threatening. After identifying a lesion, the primary care professional must establish the likely diagnosis and decide either to reassure, to monitor or to refer. The increasing use of ocular imaging technologies has contributed to an increase in the detection rate of pigmented lesions and a higher number of referrals, which may challenge existing pathways of health-care delivery. Specialist services may be over-burdened by referring all patients with pigmented lesions for an opinion, while inter-optometric referrals are underutilised. The aim of this study was to describe the referral patterns of pigmented lesions to an optometry led intermediate-tier collaborative care clinic. Methods: We performed a retrospective review of patient records using the list of patients examined at Centre for Eye Health (CFEH) for an initial or follow up pigmented lesion assessment between the 1/7/2013 and the 30/6/2016. Analysis was performed on: patient demographic characteristics, the referrer's tentative diagnosis, CFEH diagnosis and recommended management plan. Results: Across 182 patient records, the primary lesion prompting referral was usually located in the posterior segment: choroidal naevus (105/182, 58%), congenital hypertrophy of the retinal pigment epithelium (CHRPE; 11/182, 6%), chorioretinal scarring (10/182, 5%) or not specified (52/182, 29%). Referrals described a specific request for ocular imaging in 25 instances (14%). The number of cases with a non-specific diagnosis was reduced after intermediate-tier care assessment (from 29% to 10%), while the number of diagnoses with less common conditions rose (from 2% to 21%). There was a 2% false positive referral rate to intermediatetier care and a first visit discharge rate of 35%. A minority required on-referral to an ophthalmologist (22/182, 12%), either for unrelated incidental ocular findings, or suspicious choroidal naevi. Conditions most amenable to optometric follow up included: 1) chorioretinal scarring, 2) choroidal naevus, and 3) CHRPE. Conclusions: Intermediate-tier optometric eye-care in pigmented lesions (following opportunistic primary care screening) has the potential to reduce the number of cases with non-specific diagnoses and to increase those with less common diagnoses. The majority of cases seen under this intermediate-tier model required only ongoing optometric surveillance.

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“…One other group has previously utilized teleophthalmology as a virtual platform to assess new referrals for melanocytic lesions. Balaskas et al [10] evaluated a virtual service for rapid assessment of these patients and concluded that this platform may be feasible, safe, and cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Tele-Oncology: A Validation Study of Choroidal and Iris Nevi

Roelofs

Weis

2018

Ocul Oncol Pathol

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Background/Aims: To evaluate teleophthalmological assessment of choroidal and iris nevi (tele-oncology) compared to traditional in-person clinical evaluation for detection of either axial or basal growth. Methods: This is a validation study. All 97 eyes of 99 patients were evaluated with an in-person ocular oncology visit utilizing standard testing, and subsequently had a tele-oncology evaluation with the standardized tests. The tele-oncology reviewer was blinded to the in-person examination findings. The primary study outcome was detection of nevus growth on tele-oncology compared to in-person clinical examination. Results: Patients had a mean age of 61 years and the majority had nevi located in the choroid (n = 87; 88%). The most common diagnosis was a low-risk nevus (n = 38; 44%). By tele-oncology assessment, 11 eyes showed growth. Ten of these patients had growth confirmed on in-person clinical examination. Resultantly, tele-oncology assessment of choroidal and iris nevi growth had a sensitivity of 100%, specificity of 99%, positive predictive value (PPV) of 91%, and negative predictive value (NPV) of 100%. Conclusions: The results of this study suggest that tele-oncology is a safe platform for monitoring choroidal and iris nevi for growth, with excellent sensitivity, specificity, PPV, and NPV.

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Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model

Cited by 17 publications

References 13 publications

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary?

The advantages of intermediate‐tier, inter‐optometric referral of low risk pigmented lesions

Tele-Oncology: A Validation Study of Choroidal and Iris Nevi

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