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Planned Care Innovation Exemplars

Virtual Pigmented Ocular Lesions Clinic

Richard Waters, Senior Clinical Photographer, Medical Illustration
Douglas Neil, Head of Medical Photography
Mr Gary Shuttleworth, Consultant Ophthalmologist, Singleton Hospital

Swansea Bay University Health board

The Challenge:

  • POLs are regularly detected (10-30% in adults) in primary care and range from benign to life threatening
  • Prompt clinical recognition and detection is key to preventing long term damage
  • Specialist services may be overburdened by referring all pigmented lesions for opinion
  • Anxious patient waits for ophthalmology (18- 24 month waiting list)


  • Proof of concept of referral pathway redesign for POLS
  • Provide high quality images for more accurate triage and diagnosis
  • Facilitate early detection and treatment of ophthalmic melanoma
  • Effective use of MDT skill set
  • Reduce waits and RTT for ophthalmology


  • Ophthalmology specialist grades and redirects suitable referrals to POLS clinic
  • Colour fundus photography, optical coherence tomography (OCT) scans and ultrasound are performed
  • Ophthalmology specialist reviews scans and determines if they need to see patient in clinic or whether they can be discharged

Outcomes / Benefits:

  • Service ran successfully, over 70 patients referred and imaged
  • Reduced time and touch points for ophthalmology
  • Reduced ophthalmology waiting list and RTT
  • Patient focussed service with reduced patient time and patient touch points
  • Referrals seen more quickly through Medical Illustrations
  • Rapid triage reduces the risk of delayed assessments
  • Service fits with the remit of ophthalmic photographers who are equipped with the knowledge, experience and skill set required for producing high quality diagnostically meaningful images.

What Next:

  • Full POLS audit due to be completed
  • Further test the service on a wider cohort of patients and lesion types
  • Extend the model to different levels of service provision, e.g., vascular ulcers
  • Support other health boards across Wales to adopt

View project posters and slides from the PCIP National Showcase Event