Clinical Trial Summary
Choroidal nevomelanocytic lesions have a high prevalence affecting up to 7% of the entire
population and are increasingly incidentally identified during routine eye check- ups in
community optometry services. Given the tendency to err on the side of caution, there is
evidence of excessive referrals challenging service delivery in both tertiary eye units and
specialist ocular oncology services. Although previous studies have examined the natural
history and risk factors for growth of choroidal nevomelanocytic lesions, optimal delivery of
management remains uncertain. Management approaches display diversity with respect to the
number and type of baseline investigations, the duration and frequency of monitoring of
relevant patients. Utilisation of the skills of allied health professionals in appropriate
cases would allow streamlining service delivery in a socialised healthcare system, maximise
capacity, and allow community services to play an enhanced role. However, the evidence for
this model of delivery is lacking. Within existing models of care for these lesions, patients
are faced with delays, need for more than one attendances to the hospital and increased
anxiety around prognosis.
This project aims to answer the question of whether these low-risk, bland incidental findings
might possibly be managed by allied health professionals with the use of clinical imaging and
specific algorithms to make appropriate management decisions. We aim to validate a model of
service delivery on a virtual basis that will accommodate for capacity pressures to accept
all relevant referrals, while offering a safe service and optimising patient experience of
care. We will thus validate the setting up of a virtual choroidal nevomelanocytic clinic in
terms of safety and patient acceptability. More specifically, the degree of agreement between
management decisions made by non-medical graders on the basis of imaging data alone as
opposed to gold standard decisions (clinical and imaging tests combined) is examined. Health
economics analysis of the proposed service delivery model will be undertaken to demonstrate
cost-effectiveness.
