To investigate the accuracy of diagnosis in patients referred with suspected uveal melanoma from a multispecialty ophthalmology department to a specialist ocular oncology centre and the efficiency of the referral pathway for these patients according to national standards.


A retrospective study was performed on 68 patients who were referred for suspected uveal melanoma from the University Hospitals of Coventry and Warwickshire (UHCW) to the Liverpool Ocular Oncology Centre (LOOC), between December 2008 and December 2014. Main outcome measures were the accuracy of the clinical diagnosis made by UHCW and the delay at each stage of the referral process according to national standards. These standards state that review should occur within two weeks of referral to the hospital eye services, subsequent referral should occur within 24 hours to the specialist ocular oncology services and subsequent specialist review of the patient should occur within two weeks. Presenting symptoms and the sources of referral to UHCW were also collected.


Of the total 68 patients, 36 patients (52.9%) were found to have a suspicious uveal lesion by a community optometrist, 13 (19.1%) by an eye casualty doctor at UHCW and 10 (14.7%) by an Ophthalmologist in subspecialty clinics at UHCW. Other source of referrals to UHCW included family doctors (3 patients; 4.4%), the diabetic retinal screening program (3 patients; 4.4%), neighbouring trusts (2 patients; 2.9%) and the general medical team at UHCW (1 patient; 1.5%). On review at UHCW, 37 patients (54.4%) were asymptomatic. In symptomatic patients, presenting symptoms included flashes and/or floaters (14 patients; 20.6%), blurred vision (9 patients; 13.2%) and a visual field defect (4 patients; 5.9%). Of the 44 patients who were referred to UHCW with suspected uveal melanoma, delays greater than 2 weeks occurred in 20 patients (45.5%) before review at UHCW. Of the 68 patients reviewed at UHCW, once the diagnosis was made of a suspicious uveal lesion, delays greater than 24 hours occurred in 30 patients (44.1%) before referral to LOOC. Of the 68 patients referred from UHCW, delays greater than 2 weeks occurred in 24 patients (35.3%) before review at LOOC. Based on the LOOC review, 45 out of the 68 patients (66.2%) referred from UHCW had a correct initial diagnosis made at UHCW.


Delays occurred at all stages of the referral pathway, but primarily these were internal delays, between the patient’s referral to UHCW and review at UHCW. We suggest that ophthalmology departments should audit their ocular oncology pathways to identify any unnecessary delays and streamline the referral process. We also suggest that departments should set clear guidelines on when to refer patients with suspected uveal melanoma to tertiary oncology centres, in order to minimise inappropriate referrals. Moreover as the majority of cases were identified in the community, ophthalmology departments should communicate with their referring primary care services to ensure that any delays in obtaining a specialist opinion are minimised.

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Amun Sachdev