Here is a message from Vijayalakshmi Kamala (Miss Vijay), consultant ophthalmologist at Queens Hospital Burton, concerning best practice for Choroidal naevi referrals sent into the Treatment Centre at Queens Hospital Burton
FAO all Optical Contractors and Performers, East Staffs and SE Staffs.
At the Treatment centre Eye department at Burton, we run a dedicated Ultrasound clinic for Choroidal Nevi /Melanomas , Optic Disc Drusen (calcium deposits on the optic Nerve) etc .
In recent months there has been a surge of referrals of choroidal Nevi from the opticians from Burton, Tamworth ,Lichfield and some out of the catchment area too . There are not many DGH’s which offer a dedicated Ultrasound Service .
At present the referral letters from the optician comes in for Triaging and through our patient admin system (V6) the Doctors triage them and book them into the appropriate clinics .The triage letter is not accompanied by any clinical photograph for the Nevi at present and hence when the referral is for a Nevus (birthmarks at back of Eye) it automatically gets triaged into the Ultrasound clinic . The Triaging Doctor is not able to assess the size of the lesion or any other relevant features based on a letter alone.
Some of the referred Nevi are very flat with no suspicious features and do not actually need an ultrasound . They would need to be seen in a general clinic, photographs taken and if no suspicious features they can be discharged back to the optician for regular monitoring. A copy of the Nevus photograph will be given to the patient (it is already in practice at the time of discharge ). The suspicious lesions will be routed in to the Ultrasound clinic for further management. The increased number of referrals is putting a lot of pressure on already full clinics.
Following a recent audit on the Nevi one recommendation was that the opticians could attach a copy of the photograph of the nevus along with the first New referral to help us triage the referral letters appropriately in to the correct clinics and also address capacity issues in the ultrasound clinic.
If this was possible the Trust can then re-audit this activity in due course and reassess the effectiveness, and I would be grateful if photographs could accompany referrals of choroidal nevi by all optical practices in East Staffs and SE Staffs, and it would be helpful for the audit which I propose to start in October/November .