An image-based eyelid lesion management service-evaluation of a pilot

Abstract

Background/aims: Oculoplastics is a predominantly visual specialty and many of the pathologies can be diagnosed based on external appearance. An image-based eyelid lesion management service was piloted to reduce the number of patients who would require outpatient clinic review. The aim of this study was to determine its accuracy and feasibility, both as a hospital-based and community optometrist-based service. If successful, the service was envisaged to significantly reduce the number of patients that require face-to-face (F2F) review, in accordance with current post-COVID-19 principles of social distancing.

Methods: Patients with lid lesions attending an oculoplastics clinic were assessed by consultant oculoplastic surgeons in an F2F consultation (Arm A). The lesions were photographed by a professional clinical photographer (Arm B) and by an optometrist with a handheld digital camera (Arm C). These images were reviewed by independent consultants masked to the outcome of the F2F clinical encounter. Data were collected prospectively including patient demographics, diagnosis, suspicion of malignancy and management. The image-based clinic results were compared to the F2F clinic results.

Results: Ninety-five patients were included. Clinical diagnoses were compared for intra-observer variability and substantial agreement was demonstrated between gold-standard F2F clinic visit (Arm A) and Arm B (Ƙ = 0.708) and C (Ƙ = 0.776). There was no statistically significant difference in the rate of discharge and all cases of malignancy were either identified or flagged for F2F review in the image-based arms.

Conclusion: This pilot demonstrated substantial diagnostic agreement of image-based diagnoses with F2F consultation and image review alone did not miss any cases of malignancy.

Fig. 1. Outline of methodology and outcomes.

Clinical pathway and outcomes for patients attending eyelid lesion management service.

Fig. 2. Images taken by clinical photographers and optometrists.

A True positive—basal cell carcinoma; images from clinical photographer (A1) and optometrist (A2). A diagnosis of BCC was made by clinicians reviewing images in both arms. This was in agreement with the F2F consultation and was subsequently confirmed by pathology. B False-positive—cyst of Moll; images from clinical photographer (B1) and optometrist (B2). The clinicians reviewing images in both arms felt that they were unable to exclude a BCC and therefore F2F review was recommended. A diagnosis of Cyst of Moll was made at F2F consultation and the patient discharged.