Prospective study on suspicious ocular melanocytic lesions 2022

Participant survey

Pigmented lesions of the eye may transform into melanoma and when this occurs, the disease can spread systemically, with death occasionally occurring within a year. A nationwide study on pigmented/melanocytic lesions of the eye in Aotearoa/New Zealand will be conducted in 2022 with the ultimate aim of streamlining and improving the referral process for pigmented lesions concerning for ocular melanoma. We plan to utilise telemedicine to facilitate early diagnosis, timely commencement of ocular melanoma treatment where appropriate, and regular reviews. The participation of all NZ optometrists is absolutely vital to the success of this nationwide study and to recognise your participation, we will be providing regular study feedback and be offering CPD points.

We appreciate your time in filling out this market survey to indicate your interest/availability for this study and welcome any feedback below. We will contact you directly with more information before the start date of the study.

Please contact Joevy.lim@auckland.ac.nz if you have any questions.

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* 1. Will you be interested in participating in our study?

Yes. Please fill in the rest of this form so we can contact you in the near future.

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* 2. Practitioner Full Name:

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* 3. Name of Practice:

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* 4. Practitioner Role:

Optometrist

Ophthalmologist

Other (please specify)

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* 5. Place of your Practice

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* 6. Please provide your e-mail below so that we can get in contact when the study commences.

Email Address

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* 7. Please indicate the availability of the following ophthalmic devices at your practice

Photo slit-lamp biomicroscope

Standard retinal camera

Wide-field posterior segment imaging (e.g. OPTOS)

Anterior segment OCT

Smart phone based slit-lamp photography

Other devices available at you practice (please specify)

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* 8. Would you prefer to have a 2-page online or physical copy of the referral form to complete (takes approximately 5 minutes to fill)?

Online referral form (PDF)

Physical referral form

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* 9. Do you have any questions or recommendations you would like to share regarding this study?

Thank you very much for filling in this form and for your feedback. We will be in touch shortly, watch this space!