A meaningful “freckle in the eye” assessment is measurement-based, not memory-based. The goal is to document baseline size and risk features, then detect true change over time. ¹
Key tests include:
- Colour fundus photography (best for side-by-side size comparison over years)
- Optical coherence tomography (OCT) (detects subretinal fluid and outer retinal disruption overlying a choroidal naevus) ²
- Fundus autofluorescence (helps identify lipofuscin/orange pigment patterns linked to higher-risk lesions) ³
- B-scan ultrasound (measures thickness and internal reflectivity; thickness is a major discriminator in risk models) ¹
Multimodal imaging improves risk stratification because a lesion can look “quiet” clinically yet show subclinical fluid on OCT, or demonstrate suspicious features like lipofuscin signal on autofluorescence. Ultrasound adds an independent thickness metric and internal acoustic characteristics that help distinguish naevus from melanoma-suspect lesions. ¹ ²
In practice, clinicians combine these objective findings with structured checklists to decide between local surveillance, shortened recall, or ocular oncology referral. ¹
References
- Dalvin LA, Shields CL, Lally SE, Huang X, Ancona-Lezama D, Williams BK Jr, et al. Combination of multimodal imaging features predictive of choroidal nevus transformation into melanoma. British Journal of Ophthalmology. 2019;103(10):1441-1447. doi:10.1136/bjophthalmol-2018-312967. PMID: 30523045.
- Shields CL, Materin MA, Mashayekhi A, Shields JA. Optical coherence tomography of choroidal nevus in 120 patients. Retina. 2005;25(3):243-252. doi:10.1097/00006982-200504000-00001. PMID: 15805899.
- Lavinsky D, Belfort RN, Navajas E, Torres V, Martins MC, Belfort R Jr. Fundus autofluorescence of choroidal nevus and melanoma. British Journal of Ophthalmology. 2007;91(10):1299-1302. doi:10.1136/bjo.2007.116343. PMID: 17314128.
Related Topics
- When Does a “Freckle” in the Eye Become Concerning?
- What Does a “Freckle in the Eye” Actually Mean? Choroidal, Iris and Conjunctival Naevi Explained
- Choroidal Naevus vs Choroidal Melanoma: Understanding TFSOM-DIM Risk Factors
- How Often Should a Choroidal Naevus Be Checked? Follow-Up Intervals and Imaging Plans
- Iris “Freckles”: Using the ABCDEF Guide to Spot Higher-Risk Iris Naevi
- Conjunctival “Freckles” on the White of the Eye: When a Naevus Is Usually Harmless
- Primary Acquired Melanosis (PAM): Why Some Flat Conjunctival Pigment Needs Oncology Input
- Eye Freckle Symptoms You Shouldn’t Ignore: Blurred Vision, Distortion, Hyphema and Pain
- Multimodal Imaging for Eye Freckles: Optical Coherence Tomography, Autofluorescence, Ultrasound and Photography
- MOLES and TFSOM-DIM: How Specialists Score Choroidal Naevi and Decide on Referral
- Growth Without Transformation: When a Choroidal Naevus Gets Bigger but Isn’t Melanoma
- High-Risk Features in Conjunctival Pigmented Lesions: PAM, Forniceal Location and Feeder Vessels
- Eye Freckles in Young Patients: Special Considerations for Iris and Choroidal Naevi Under 40
- Monitoring an Eye Freckle Safely: Why Baseline Photos and Structured Recall Matter
- When Does an Eye Freckle Need Biopsy or Treatment Instead of Observation?
- Living With an Eye Freckle: Cancer Risk, Prognosis and When to Seek a Second Opinion
- Eye Freckle Assessment at Blue Fin Vision®: Photography and Optical Coherence Tomography
- B-scan Ultrasound for Eye Freckles: Measuring Thickness and Looking for Melanoma Features
- Monitoring a Choroidal Naevus at Blue Fin Vision®: Structured Imaging, Written Plans and When We Refer
- Second Opinion on a ‘Suspicious’ Eye Freckle: Differentiating Naevus from Choroidal Melanoma
- Linked Care With Ocular Oncology: Fast Referral and Follow-Up if Melanoma Is Suspected
