Choroidal nevus candidacy for monitoring in a virtual photoscreening pathway

Abstract

Purpose

To evaluate the proportion of patients with choroidal nevus in an ocular oncology practice who would be suitable candidates for monitoring via a virtual photoscreening model, wherein imaging is asynchronously reviewed and longitudinally managed by an ocular oncologist.

Methods

Data were abstracted from the Prospective Ocular Tumor Study Database for all patients diagnosed with choroidal nevus from July 2019-October 2024. A stratification model for identification of virtual pathway candidates was defined and implemented as follows: good virtual pathway candidates included those with posteriorly located lesions for adequate photographic capture and no more than two high-risk features. Risk factors, outlined by the TFSOM-DIM acronym, included thickness >2 mm, presence of subretinal fluid, visual acuity 20/50 or worse, presence of orange pigment, low internal reflectivity, and basal diameter >5 mm. Of posteriorly located lesions, those with 0–2 risk factors were defined as good virtual pathway candidates, 3 risk factors as acceptable in select cases, and 4 or more as poor candidates.

Results

There were 614 choroidal nevi in 586 patients diagnosed during the study period. Mean patient age at initial visit was 63.5 years old (median 66.1, range 5.8–94.8), with 59.4% female and 98.8% white. Analysis identified 436 (71%) nevi in 408 (69.6%) patients as good virtual pathway candidates, 53 (8.6%) nevi in 53 (9%) patients as potential candidates in select cases, and 125 (20.4%) nevi in 125 (21.3%) patients as poor candidates.

Conclusion

Nearly 70% of patients with choroidal nevi followed by Mayo Clinic Ocular Oncology were identified as good candidates for follow-up via virtual photoscreening. This highlights the potential for improved clinical efficiency through virtual frameworks in ocular oncology.