Article Text

Download PDFPDF
Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model
  1. Konstantinos Balaskas1,2,3,
  2. Jane Gray1,
  3. Peter Blows3,
  4. Azita Rajai4,
  5. Deidre Flaye3,
  6. Tunde Peto3,
  7. Mandeep S Sagoo3
  1. 1The Royal Eye Hospital, Manchester, UK
  2. 2Centre for Hearing and Vision Research, University of Manchester, Manchester, UK
  3. 3NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
  4. 4Department of Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Konstantinos Balaskas, Manchester Royal Eye Hospital, Oxford Road, Manchester M139WL, UK; Konstantinos.Balaskas{at}{at}


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.

  • Diagnostic tests/Investigation
  • Imaging
  • Neoplasia

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost Jonas