Advances in primary eye care and ophthalmic imaging contribute to earlier detection of uveal melanoma.

Abstract

Purpose: To report how the evolving role of optometrists in primary eye care and advances in ophthalmic imaging have affected diagnosis and management of posterior uveal melanoma (UM).

Methods: Retrospective, single-centre cohort study of patients diagnosed with UM from 1993 to 2022 in Bergen, Norway.

Results: Four hundred nine patients were included, and comparisons were made between those diagnosed from 1993 to 2007 and from 2008 to 2022. The median tumour diameter decreased from 13.3 to 11.3 mm (p = 0.002), and the median tumour thickness decreased from 6.9 to 4.5 mm (p < 0.001). The median distance from the tumour border to the optic disc and to the foveola increased from 3.5 to 4.5 mm (p = 0.011), and from 3.0 to 4.0 mm (p < 0.001), respectively. Two hundred sixty-two patients (64%) experienced symptoms associated with UM, with a median duration of 152.5 and 81 days in the first and second half of the study period, respectively (p < 0.001). The median best corrected visual acuity at diagnosis improved from 0.5 logMAR (Snellen equivalent, 6/19) in the first half to 0.2 logMAR (Snellen equivalent, 6/9.5) in the second half of the period (p < 0.001). The proportion of asymptomatic patients was 23.5% in the first and 41.9% in the second half of the period (p < 0.001). The proportion of UMs incidentally detected by optometrists increased from 3.0% to 18.1% (p = 0.009), and the proportion of UMs incidentally detected by fundus photography increased from 1.5% to 18.1% (p < 0.001).

Conclusions: The temporal changes in patient and tumour characteristics suggest that UMs are now being diagnosed at an earlier stage. This may in part be attributed to the introduction of widefield fundus cameras and increased opportunistic screening of asymptomatic patients.