Referral patterns of intraocular tumour patients to a dedicated Canadian ocular oncology department

Objective: Intraocular tumours are uncommon lesions requiring comprehensive management at tertiary referral centers. This study analyzes referral patterns of intraocular tumours, accuracy of referral diagnosis, and modes of treatment provided for patients at a dedicated Canadian Ocular Oncology Department. Design: Retrospective chart review. Participants: A total of 1050 new patient referrals of intraocular tumours to the department of Ocular Oncology at Princess Margaret Hospital (PMH) between 2005 and 2008 inclusive. Methods: Data collected for each patient included demographics, referral diagnosis, final diagnosis, and treatment provided or recommended. Home address postal codes were used to determine patients' geographical distance to PMH. Results: Most patients originated from Ontario (81.5%) followed by Alberta (7.1%) with a median age of referral at 61 years old. The most common referral diagnoses were unknown diagnosis (47.6%), uveal melanoma (26.9%), and nevus (18.9%). After evaluation at PMH, uveal nevus was the most common final diagnosis (39.7%) followed by melanoma (39.2%). The referring physicians correctly diagnosed 48.5% of total melanomas. The proportion of melanoma diagnosis relative to total referrals by province ranged from 29.6% for Ontario to 100% for Quebec. Distance from the patient's address to PMH was <200 kilometres in 64.5% of patients and >1000 kilometres in 21.6% of patients. Conclusions : The limited accuracy of referral diagnoses and increased proportion of melanoma referrals from greater distances demonstrates the need for increased knowledge in ocular oncology, improvement of eye cancer care facilities at the referral base, and/or the implementation of tele-ophthalmology.