A smartphone lens attachment improves the quality of referrals to eye casualty.

BACKGROUND/OBJECTIVES: In recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty. SUBJECTS/METHODS: Fifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire ('History'), and the questionnaire with the photo ('History with Image'), as well as rate their clinical confidence on a 1-5 scale. RESULTS: Diagnostic accuracy was significantly higher in "History with Image" (98.2%), when compared to "History" only (48.2%). "History with Image" prevented significantly more appointments when compared to "History" alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between 'History with Image' and 'Clinic' appointments was similar. Clinical'Confidence was significantly higher at 4.5 with 'History with Image' when compared to 2.37 with 'History Only'. CONCLUSION: A low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.

Intraepidermal carcinoma of the eyelid.

PURPOSE: To examine the clinical and pathological features and treatment outcomes of cutaneous squamous intraepidermal carcinoma of the eyelid in order to determine its behaviour, its relationship to squamous cell carcinoma and appropriate management. METHODS: All patients from the practice of one of the authors with a histological diagnosis of squamous intraepidermal carcinoma were included. Retrospective chart review was performed, and pathology re-examined. All patients were recalled for examination. Histological diagnosis of periocular intraepidermal carcinoma, lesion characteristics, outcome of surgical excision, local recurrence, and occurrence of metastasis were assessed as main outcome measures. RESULTS: Thirty-one white, usually fair-haired patients had a total of 37 lesions. Most had a history of occupational or recreational sun exposure. Other predisposing factors included exposure to arsenic, petroleum by-products and epidermodysplasia verruciformis. All except one had other solar keratoses and non-melanoma skin cancers. All had surgical excision. Six cases (16%) had evidence of progression to squamous cell carcinoma. Seven cases (18%) had local recurrence successfully treated by further local excision. No patient had perineural spread or distant metastasis. CONCLUSIONS: This lesion, which serves as a marker for severe actinic damage, may masquerade as chronic blepharitis. Early diagnosis prior to dermal invasion is important. Complete excision is the recommended treatment. Adjunctive treatment with topical 5-fluorouracil may be appropriate in some circumstances. Long-term follow up is mandatory.