When to refer patients with choroidal nevi
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ATLANTA – Clinicians should evaluate choroidal nevi for five factors when deciding to refer or follow the patient, according to Steven Ferrucci, OD, FAAO, here at SECO.
He recommended using a pneumonic devised by Carol L. Shields, MD, and Jerry A. Shields, MD, of Wills Eye Hospital, To Find Small Ocular Melanomas:
- Thickness: Lesions greater than 2 mm;
- Fluid: Signs of subretinal fluid suggestive of retinal detachment;
- Symptoms: Symptoms of photopsia or vision loss;
- Orange pigment: Lipofuscin is a marker for cell destruction in the retina; and
- Margins: Margins touching the optic nerve head.
“If you see a nevus that has some of these factors, especially thickness, which was found to be the No. 1 factor, you want a retinal consultation,” Ferrucci told Healio/Primary Care Optometry News. “If none, follow with serial photos and frequent monitoring.”
In his presentation, he said that patients with none of these factors carry a 3% risk of the nevus converting to melanoma in 5 years. Those with one factor have an 8% risk, and those with two or more have a 50% risk.
Ferrucci discussed several other retinal conditions that require referral.
In the case of a retinal detachment, “macula on is a true emergency in the optometric setting that mitigates a same-day call to a retinal specialist,” he said. “Most will want to see them that day.
“Macula off is urgent, but a little less so, because, in a way, the damage has already been done,” he added.
“Horseshoe tears are a high urgency referral to a retinal specialist, whereas an operculated hole does not necessitate a referral at all and can be seen safely in an optometric practice,” Ferrucci said.
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Ferrucci S. Refer or relax retina. Presented at: SECO; Atlanta, Georgia; April 28-May 2, 2021.
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