Validation of an online referral guide for melanocytic fundus lesions

Hemmerdinger, Christopher M; Beech, Michael; Groenewald, Carl; Damato, Bertil

doi:10.1111/j.1475-1313.2011.00830.x

Cited by 7 publications

(6 citation statements)

References 8 publications

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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%

“…Overall, the additional information gleaned from ancillary imaging of pigmented fundus lesions (either accessed in house or through referral to services such as CFEH) might be difficult to acquire using ophthalmoscopy or fundus photography alone and may subsequently be usefully applied to clinical management decisions. The management of pigmented lesions might, in addition, benefit from referral refinement or audit schemes such has been performed in conditions like glaucoma, repeat‐measure schemes, validated referral guides, facilities associated with a large, specialist centres and open‐source clinical resources . A tele‐consultation or “virtual clinic” approach (both synchronous and asynchronous) may also be helpful …”

Section: Discussionmentioning

confidence: 99%

“…CFEH diagnoses were also determined by clinical examination and imaging, and not confirmed by histopathology. Despite the two clinician CFEH report review system, misdiagnoses are still possible and the effect of identifying subtle clinical signs such as lipofuscin was also beyond the scope of this study. Finally, the patients with pigmented lesions are not managed at CFEH and remain the responsibility of the referring professional.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nivison‐Smith

Hennessy

et al. 2017

Ophthalmic Physiologic Optic

View full text Add to dashboard Cite

show abstract

“…One of the most important roles of the optometrist is the detection of sight and life‐threatening ocular tumours and Hemmerdinger and colleagues 35 assessed an online referral guide for melanocytic fundus lesions. They sent images of 400 different melanocytic lesions to 55 optometrists, most of whom were in community optometric practice (there was a bias with a disproportionate number in independent practice) 35 . There was substantial agreement between optometrists and an ocular oncologist, and indeed between different optometrists.…”

Section: Disease Detection In Community Optometric Practicementioning

confidence: 99%

“…Some studies are collaborations between community optometrists and research‐trained collaborators, 13–15 sometimes with the community optometrists providing data from their practice records 2 . Other approaches are for community optometrists to allow data to be gathered in their practices, 16–24 to collect normative data for clinical tests, 9,12 to allow additional services to be offered from their practices, 25,26 or to collaborate with questionnaires or surveys 27–35 . The College of Optometrists’ initiative in setting up iPRO (Innovation in Practice‐based Research for Optometrists) 36 is a welcome development to encourage in‐practice optometric research.…”

Section: Introductionmentioning

confidence: 99%