# Assessing the Impact of Simulated Color Vision Deficiency on Ophthalmologists’ Ability to Differentiate between Choroidal Melanoma and Choroidal Nevus

## TL;DR

This study shows that simulated color vision deficiency can reduce ophthalmologists' ability to distinguish between benign and malignant eye tumors, leading to unnecessary referrals.

## Contribution

The study introduces a novel evaluation of how simulated CVD impacts diagnostic accuracy in differentiating choroidal melanoma and choroidal nevus.

## Key findings

- Simulated protanopia and deuteranopia reduced the ability to identify orange pigments and melanotic lesions.
- Participants misdiagnosed choroidal nevi as melanoma in 37-41% of simulated CVD cases.
- Most simulated melanoma cases were correctly referred for oncological treatment despite CVD simulations.

## Abstract

Background: Color vision deficiency (CVD) is an often-overlooked issue within the medical community, and its consequences remain insufficiently explored. We aim to evaluate how CVD affects diagnostic accuracy and distinguish between malignant choroidal melanoma and benign choroidal nevus among ophthalmologists. Methods: In this cross-sectional study, we engaged ophthalmologists through a web-based survey distributed via the professional ophthalmology society’s social media channels. The survey encompassed a series of three fundus images representing normal fundus, choroidal nevus, and choroidal melanoma. Each image underwent simulation for the three primary types of CVD—protanopia, deuteranopia, and tritanopia—alongside a non-simulated version. Results: The study included 41 participants, averaging 40 years of age (±9.2), comprising 28 (68%) men and 13 (32%) women. Significantly lower rates of identifying orange pigments were observed in simulated protanopia images compared to non-simulated ones (p = 0.038). In simulated deutranopia images, the recognition of melanotic lesions was notably reduced compared to non-simulated images (p = 0.048). No such limitation was observed for tritanopia. However, participants retained their ability to identify subretinal fluid and estimate tumor thickness in simulated and non-simulated images. Concerning simulated images of choroidal nevi, participants misdiagnosed nevi as choroidal melanoma in 37% of cases in simulated protanopia nevi images and 41% in simulated deutranopia nevi images. This resulted in unnecessary referrals of benign lesions as malignant, emphasizing the potential for mistaken diagnoses. Nevertheless, almost all simulated images of malignant melanoma were correctly referred for specialized oncological treatment. Conclusions: The simulated CVD conditions of protanopia and deuteranopia affected the accuracy of identifying the melanotic nature of the choroidal tumor and the presence of orange pigments. This limitation led to challenges in correctly diagnosing choroidal melanoma and choroidal nevus, resulting in extra referrals for nevus cases. However, participants were safe and could still determine the possible risk of eyes with choroidal melanoma, so most referred melanoma cases to specialized oncologists as needed.