Survey of Australian primary eyecare management of choroidal naevus patients

Abstract Background: Choroidal naevus is a benign, relatively common ocular tumour. Discerning common naevi from rare primary eye melanoma and managing these patients using an evidence-based approach remains an ongoing clinical challenge. We surveyed primary eyecare practitioners on their current management and use of imaging for choroidal naevus patients. Methods: A random sample of 1,130 optometrists and ophthalmologists registered to practice in Australia were surveyed using a purpose-designed questionnaire containing demographics, imaging techniques used, and knowledge (K), attitude (A), and practice (P) questions. Results: 93 optometrists and 82 ophthalmologists responded. More than 50% practised independently, most in metropolitan centres (n=113/175). Imaging techniques were often used to detect and monitor choroidal naevus, with 72% of practitioners using optical coherence tomography and colour fundus photography. KAP scores indicated moderate knowledge (mean=5.2/9, SD=1.8). Recent mnemonics for risk of naevus-to-melanoma transformation were underutilised being used by less than 50% of practitioners. Scores indicated very positive attitude (mean=6.5/8, SD=1.2) but moderate practice (mean=13.9/25, SD=2.9) in this area. A significant difference between optometrists and ophthalmologists was found for knowledge, but not attitude or practice scores. Choroid naevus patients were referred to a specialist ophthalmologist by a third of all practitioners. Conclusion: Many eyecare practitioners utilised several imaging techniques to detect and monitor choroidal naevi. Gaps in knowledge were found associated with choroidal naevus growth. Findings align with recent studies highlighting eyecare pathways for choroidal naevus patients that provide diligent screening and review, timely referral for signs of potential melanoma-related risk, and that encourage multi-disciplinary care.