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

Abstract

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.

The MOLES System for Planning Management of Melanocytic Choroidal Tumors: Is It Safe?

“…Tele-oncology platforms for monitoring choroidal and iris nevi have been previously reported [28]. Given that the MOLES scores in this study were purely based on a review of patient imaging, the results are generalizable to tele-ophthalmology platforms.…”

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

“…Ultrasonography requires specialized equipment and an experienced operator and, as such, is often a limited resource in community settings. As a result, even when ocular oncology care is delivered via telemedicine platforms, patients are required to travel to centralized hubs where ultrasonography is available [ 6 , 7 ]. The omission of ultrasonography from the monitoring of choroidal nevi may aid in the implementation of tele-oncology programs, maximizing benefit to patients by decreasing both the time and cost associated with travel.…”

“…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.…”

“…This mnemonic refers to thickness > 2 mm, fluid under the retina, symptoms, orange pigment, melanoma hollow on ultrasonography, and diameter > 5 mm; however, in many instances access to US remains limited in the community. Unlike fundus photography, AF and OCT, ultrasonography requires a highly skilled operator and, as such, many tele-oncology programs still require patients to travel to a central location where the imaging equipment and expertise are available [ 6 ]. The incentive to identify early progression of choroidal melanocytic tumors while minimizing unnecessary patient travel to larger centers has perhaps never been as great as it is in the current COVID-19 era.…”

Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak

“…Telemedicine-assisted informed consent meetings prior to laser vision correction and refractive lens exchange procedures were found to be generally preferred among patients, who reported an equal satisfaction rate as those who had an in-person meeting with their surgeon [77]. A validation study of 99 patients demonstrated that telemedicine can offer a sensitive and specific monitoring modality for following the growth of choroidal and iris nevi in an ophthalmic oncology setting [78]. A similar retrospective observational pilot study on 71 patients exhibited 100% sensitivity and negative predictive value in growth detection when an examination was carried out by trained ultrasound technicians and remotely reviewed by an ophthalmologist [79].…”