Virtual Pigmented Ocular Lesions Clinic

Swansea Bay University Health Board

Richard Waters, Senior Clinical Photographer

Douglas Neil, HoD Medical Illustration

This project will enable the establishment of a inventive re-imagining of the patient pathway, to improve the Referral Time to Treat (RTT) for many patients. Thereby reducing waiting lists, waiting times and giving our patients a better outcome and experience.

Pigmented ocular lesions are commonly encountered by Primary (eye)-care professionals, and range from benign (having a prevalence in adult eyes of between 10-30%) to sight or life-threatening. Whilst most are benign, some are not. In addition, for some lesions there is a small risk of transformation into malignant neoplasm (melanoma), with potential for ocular damage from the disease or its treatment, and also life-threatening metastasis. This situation generates a number of referrals, to specialist hospital services, which may challenge existing pathways of eye-care delivery.

Specialist services may be over-burdened by referring all patients with pigmented lesions for an opinion. Clinical recognition and detection of small melanoma is key to prevention of eye damage and metastasis and ultimately death.

This project is to help streamline to a more patient focused pathway by creating a innovative clinic concentrating on patients with Pigmented Ocular Lesions.

The increasing use of ocular imaging technologies has contributed to an increase in the identification and classification of these lesions, enabling, the identification of the likely diagnosis from the imaging directly and decide either to reassure, monitor and discharge to primary care, or to treat.

The provision of such a service is within the remit of ophthalmic photographers who are equipped with the knowledge, experience and skill set required for producing high quality diagnostically meaningful images.

This project will enable the establishment of an inventive re-imagining of the patient pathway, utilising the resources of the Multi-Disciplinary Team (MDT) effectively to improve the Referral Time to Treat (RTT) for many patients. The imaging will include colour fundus photography, Optical Coherence Tomography (OCT) scans, and Ultrasound scans, all taking place before consultant review, allowing the reviewer to quickly and accurately diagnose patients “virtually” therefore making efficient use of their time.

By using this virtual pathway for these patients, we will be able to screen, image, review and
refer appropriately.

Our objectives are:

  • Provide high quality images for more accurate triage and diagnosis
  • Effective use of entire MDT skill set
  • Reduce waiting lists
  • Reduced RTT
  • Better patient experience
  • Better patient outcomes
  • Improved patient safety
    by ensuring patients are assessed quickly
    by ensuring appropriate and equitable assess to screening
    baseline imaging of benign lesions
  • Earlier detection and treatment of ophthalmic melanoma
  • Effective use of resources will reduced RTT
    – reducing inappropriate referrals to specialist services
    -enabling rapid specialist review of lesions of concern
  • Free up specialist resources for more urgent patient treatments
  • Provide professional and personal development opportunities
  • Provide an improved outcome through digital enablement