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Last week we showed a red and a green Optomap scan (Figures 1a and 1b respectively) revealing a large pigmented area. The colour differentiation helps to locate the lesion to the choroid. David Austen (Loughborough) describes the case in more detail: 'The patient was originally brought for his first eye examination aged nine months as his mum wondered if his left eye turned in. Reassurance was given that all was OK. The family moved to a village 150 miles away where he was seen several times locally for routine examinations.
'He returned to us in November 2006 aged five years as his parents thought he was holding his Game Boy very close. A routine Optomap exam was performed and a large pigmented lesion was found, approximately 16x9mm, and which was only visible on the red (sub-retinal) scan (Figure 2).
'We emailed Bill Jones (Optos consultant in the US) and asked if he thought we should monitor the lesion or refer, as it appeared to be a flat naevus. He agreed it appeared to be a naevus but recommended: "Follow closely to make sure that it is stable." We took the precaution of also emailing a local ophthalmologist who replied: "Five-year-old with a naevus - if it is easy to see/measure etc then I wouldn't have any problems with you keeping a watch on him."
'We saw him three months later and have followed him every six months. There has been no change in appearance to date. We feel it is impressive that the family have so much confidence in our practice and Optomap that they are very happy to regularly make the 300-mile round trip to monitor the naevus.'
Malignant choroidal melanoma
Optometrist Kevin York (Northampton) found a large pigmented lesion as follows: 'A 61-year-old male presented for an eye examination in 2004 aware of a "flicker and temporal mistiness" in his left eye. The sight test was unremarkable but an Optomap scan revealed a large underlying choroidal naevoid area above the optic disc in his left eye not evident with an ophthalmoscope (Figures 3, 4a and 4b). He was subsequently referred to the hospital eye service and a malignant choroidal melanoma was diagnosed that required immediate intensive treatment (Figure 5 after treatment). A letter from the patient later explained what happened: "My first ever Optomap detected the presence of what later was diagnosed as a malignant melanoma in my left eye. Prompt referral to the local eye department led to urgent referral to St Paul's Eye Unit in Liverpool. I received treatment in a matter of weeks. The cancer is now stable and I have been discharged. Several doctors have since told me that I am lucky to be still alive - and this is thanks to the Optomap!"' ?
