June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
An observational population-based study of uveal melanoma in England: The impact of route to diagnosis on tumour management and survival
Author Affiliations & Notes
  • Gavin Reynolds
    Bristol Medical School, University of Bristol, Bristol, Bristol, United Kingdom
    Bristol Eye Hospital, Bristol, Bristol, United Kingdom
  • Beth Stuart
    Queen Mary University of London Faculty of Medicine and Dentistry, London, London, United Kingdom
  • sandro Fasolo
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Mandeep sagoo
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Denize Atan
    Bristol Medical School, University of Bristol, Bristol, Bristol, United Kingdom
    Bristol Eye Hospital, Bristol, Bristol, United Kingdom
  • Footnotes
    Commercial Relationships   Gavin Reynolds None; Beth Stuart None; sandro Fasolo None; Mandeep sagoo None; Denize Atan None
  • Footnotes
    Support   NIHR ACF-2020-25-010
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 909. doi:
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      Gavin Reynolds, Beth Stuart, sandro Fasolo, Mandeep sagoo, Denize Atan; An observational population-based study of uveal melanoma in England: The impact of route to diagnosis on tumour management and survival. Invest. Ophthalmol. Vis. Sci. 2023;64(8):909.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Uveal melanoma is a rare but potentially life-threatening intraocular malignancy. Treatment outcomes are more likely to be favourable if asymptomatic tumours are detected earlier in the community. Prompted by the rapid and substantial changes in community eyecare service delivery in England over the last 10 years, we conducted an observational population-based study to determine whether these changes had resulted in earlier detection, referral and better outcomes for people affected by uveal melanoma.

Methods : We analysed Public Health England data from the National Cancer Registration and Analysis service for all patients diagnosed with uveal melanoma between 2013 and 2018. Survival data was available until April 2019. Using Cox proportional hazard models with age, sex, tumour site and deprivation index as covariates, we determined how route to diagnosis from the community to hospital eye specialist and referral waiting times affected uveal tumour management and survival.

Results : There were 3415 people diagnosed with uveal melanoma in the study period, from which data were available on referral source, referral waiting times and tumour location from 2203 individuals (65%). Compared with people who self-presented to the emergency department, those who were referred to hospital eye specialists via community eye practitioners were less likely to undergo enucleation than local tumour management, e.g., brachytherapy, (35% vs 43%, p<0.01) and had better survival at 3- and 5-years (p=0.03, Figure 1) despite being significantly older (65 vs 59 years, p=0.001). Intraocular tumour locations were choroidal (81.9%), ciliary body (11.9%), and unspecified (6.2%) and there were no differences in tumour location between groups (p=0.3). Referral times were shorter in areas of England that had commissioned community eye care schemes, like the Minor Eye Condition Service (17 vs 8 days, p<0.01), but there was no impact on uveal tumour management and survival.

Conclusions : This study highlights the important role of community eye practitioners to detect asymptomatic intraocular uveal melanomas, since those who presented to emergency departments, presumably because their tumours were larger and symptomatic, had worse prognosis. Our study supports the value of eye health screening programs that recommend people to have regular eye tests in the community.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

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