Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model.
BACKGROUND
Choroidal naevomelanocytic lesions are often identified as an incidental finding by community optometrists and referred for expert evaluation in hospital eye units or specialist ocular oncology centres. Optimal management strategy is undecided and most centres err on the side of caution. Our aim was to test a virtual model of service delivery relying on interpretation of imaging test results by non-medically trained graders.


METHODS
Patients with naevomelanocytic lesions referred to Manchester Royal Eye Hospital and Moorfields Eye Hospital were retrospectively included in this study. All patients underwent imaging tests including optical coherence tomography and ultrasound and management was subsequently decided clinically. Images were anonymised and transferred to the Moorfields Eye Hospital Reading Centre and were reviewed by a trained, masked grader who reached a management decision on the basis of a specific grading protocol. Agreement between decisions made on the basis of clinical examination and imaging ('gold standard') by an expert ophthalmologist in the clinic was compared with the decisions made by a masked ophthalmologist and a masked non-medical grader based on imaging tests alone.


RESULTS
There were 102 consecutive patients included in this study. Agreement between gold-standard clinical management and decisions made by masked, non-medical grader and masked ophthalmologist on the basis of imaging test results alone was 96.1% (κ=0.97) and 100%, respectively.


CONCLUSIONS
In this pilot study, a streamlined, dedicated, virtual service for rapid assessment (within 2 weeks of referral) of choroidal naevomelanocytic lesions was shown to be feasible and safe. Such a model of service delivery may prove cost-efficient while optimising patient experience. Further prospective studies are required for formal validation of the proposed service model.
The Royal Eye Hospital, Manchester, UK Centre for Hearing and Vision Research, University of Manchester, Manchester, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK.
Konstantinos
K
Balaskas
The Royal Eye Hospital, Manchester, UK.
Jane
J
Gray
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK.
Peter
P
Blows
Department of Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Azita
A
Rajai
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK.
Deidre
D
Flaye
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK.
Tunde
T
Peto
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK.
Mandeep S
MS
Sagoo
D000328:Adult; D000465:Algorithms; D002830:Choroid Neoplasms / Q000175:diagnosis*; D003198:Computer Simulation; D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000175:diagnosis*; D009885:Ophthalmology / Q000592:standards*; D061848:Optical Imaging; D009907:Optometry / Q000592:standards*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014463:Ultrasonography; D014584:User-Computer Interface; D055815:Young Adult
Diagnostic tests/Investigation; Imaging; Neoplasia