Preventable delays in the treatment of intraocular melanoma in the UK

Intraocular melanoma should be treated urgently to improve the chances of survival and of conserving the eye and vision. The aims of this study were to determine the mode of presentation of intraocular melanoma in the United Kingdom and to identify any preventable causes of delay in treatment. A total of 112 patients were included and questioned about their initial symptoms, the type of practitioner consulted and their subsequent management. Thirty per cent of patients were asymptomatic and detected on routine ophthalmoscopy. Symptomatic patients presented with blurred vision (52%), photopsia (26%), visual field loss (9%) and miscellaneous symptoms (13%). Patients presented to an optometrist in 66 cases (59%), to a general practitioner in 30 cases (27%) and to an ophthalmologist in 16 cases (14%). The tumour was misdiagnosed in 12% of patients presenting to an optometrist and in 27% of cases presenting to a GP. The period from the time of onset of symptoms or detection of an abnormality to the time when the patient was referred to the Ocular Oncology Service averaged 6 months (range 0-36 months). Patients waited an average of 4 months if referred urgently as compared with 7.7 months if referred non-urgently (Mann-Whitney U-test, p = 0.0003). Patients were likely to be treated sooner if they were referred directly to the ophthalmologist rather than via the GP (7.8 months vs 4.8 months; Mann-Whitney U-test, p = 0.02).