PT  - JOURNAL ARTICLE
AU  - Lamis Al Harby
AU  - Zaria Ali
AU  - Azita Rajai
AU  - Stephen A Roberts
AU  - Tunde Peto
AU  - Irene Leung
AU  - Jane Gray
AU  - Gordon Hay
AU  - Amit K Arora
AU  - Pearse A Keane
AU  - Victoria M L Cohen
AU  - Mandeep Sagoo
AU  - Konstantinos Balaskas
TI  - Prospective validation of a virtual clinic pathway in the management of choroidal naevi: the NAEVUS study Report no. 1: safety assessment
AID  - 10.1136/bjophthalmol-2020-317371
DP  - 2022 Jan 01
TA  - British Journal of Ophthalmology
PG  - 128--134
VI  - 106
IP  - 1
4099  - http://bjo.bmj.com/content/106/1/128.short
4100  - http://bjo.bmj.com/content/106/1/128.full
SO  - Br J Ophthalmol2022 Jan 01; 106
AB  - Background Choroidal naevi are a common incidental finding prompting specialist referrals to ocular oncology. Rarely, such lesions have sufficient suspicious features to diagnose a small melanoma. The aim of the study is to show that ‘virtual’ imaging-based pathways are a safe and efficient option to manage such referrals.Methods A prospective cohort study at the Manchester Royal Eye Hospital and Moorfields Eye Hospital between June 2016 and July 2017 of the management decision of 400 patients reviewed by an ophthalmologist in a face-to-face consultation (gold standard) supported by fundus photography, optical coherence tomography, autofluorescence (AF) and B-mode ultrasound. The images were also read independently by blinded graders (non-medical) and blinded ophthalmologists, and a management decision was made based on image review alone (virtual pathway). The two pathways were compared for safety.Results The agreement for management decisions between face-to-face and virtual pathways was 83.1% (non-medical) and 82.6% (medical). There were more over-referrals in the virtual pathway (non-medical 24.3%, medical 23.3% of gold standard discharge) and only two under-referrals (10.5% of gold standard referrals), both borderline cases with minimal clinical risk. The agreement for risk factors of growth (orange pigment, subretinal fluid, hyper-AF) ranged between 82.3% and 97.3%.Conclusions We prospectively validated a virtual clinic model for the safe management of choroidal naevi. Such a model of care is feasible with low rate of under-referral. An over-referral rate of almost 24% from the vitrual pathway needs to be factored into designing such pathways in conjunction with evidence on their cost-effectiveness.