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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (04) : 206 -211. doi: 10.3877/cma.j.issn.2095-2007.2019.04.003

论著

远程眼科会诊对青光眼检出效果影响的研究
张莉1,†(), 徐捷1, 曹凯1, 刘含若1, 孙云晓1, 李建军1, 王宁利1   
  1. 1. 100005　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　眼科学与视觉科学北京市重点实验室
  • 收稿日期:2019-06-20 出版日期:2019-08-28
  • 通信作者: 张莉
  • 基金资助:
    国家自然科学基金资助项目(71432004); 北京市医院管理局"青苗"计划专项经费资助项目(QML20170206)

The role of teleophthalmology consulting in improving glaucoma diagnosis in population

Li Zhang1,†(), Jie Xu1, Kai Cao1, Hanruo Liu1, Yunxiao Sun1, Jianjun Li1, Ningli Wang1   

  1. 1. Beijing Key Lab. of Ophthalmology and Visual Science; Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
  • Received:2019-06-20 Published:2019-08-28
  • Corresponding author: Li Zhang
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引用本文：

张莉, 徐捷, 曹凯, 刘含若, 孙云晓, 李建军, 王宁利. 远程眼科会诊对青光眼检出效果影响的研究[J]. 中华眼科医学杂志(电子版), 2019, 09(04): 206-211.

Li Zhang, Jie Xu, Kai Cao, Hanruo Liu, Yunxiao Sun, Jianjun Li, Ningli Wang. The role of teleophthalmology consulting in improving glaucoma diagnosis in population[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(04): 206-211.

目的

探讨远程眼科会诊平台对青光眼患者检出率的作用。

方法

回顾性病例系列研究。首都医科大学附属北京同仁医院眼科研究所建立远程眼科会诊中心，收集远程会诊中心患者和基础眼病筛查者。采用Pearson χ2检验，比较同期在北京进行的基础眼病筛查中青光眼的检出率，评价眼科会诊平台对青光眼检出效果的作用，并分析"青光眼"诊断的患者中早期青光眼所占的比例。

结果

远程会诊平台共收集493 221例患者。其中，检索"青光眼"诊断患者11 538例，占2.34%；可疑青光眼者2174例，占0.44%；青光眼及可疑青光眼诊断的检出率为2.78%。其中，早期青光眼诊断在所有"青光眼"诊断中的构成比为12.50%。同一时期在北京某机关进行眼病筛查者20 861例，青光眼诊断检出417例，占1.79%；可疑青光眼诊断检出33例，占0.16%；青光眼及可疑青光眼诊断检出率为1.95%。其中，早期青光眼诊断在青光眼诊断中的构成比为33.60%。两种方式青光眼检出率比较，经Pearson χ2检验结果显示两者差异无统计学意义( χ2＝2.0，P>0.05)。

结论

应用互联网技术及眼科影像诊断标准，通过远程眼科会诊平台，可实现与基础眼病筛查对青光眼检出等同的效果，且可以实现以信息技术流动代替患者或医师的流动。

关键词: 远程医疗, 青光眼, 诊断
Objective

The aim of this study was to explore the role of teleophthalmology consulting in improving glaucoma diagnosis.

Methods

This study was retrospective case series. Participants were included patients from the Center of Teleophthalmology Consultation and subjects from population-based eye screening. The Center of Teleophthalmology Consultation was established in Beijing Tongren Hospital, Beijing Institute of Ophthalmology. Patients were collected from the remote consultation platform and analyzed with the diagnosis of glaucoma patients. The detection rate of glaucoma in population-based ophthalmological screening undertaken in Beijing during the same period, was compared to the detection rate of glaucoma from the remote consultation platform. The role of ophthalmological consultation platform for glaucoma detection was analyzed. Glaucoma detection rates in patients from the Center of teleophthalmology consultation and population-based eye screeners were compared. The constituent ratio of mild glaucoma was calculated.

Results

A total of 493 221 subjects were collected from the Center of teleophthalmology consultation platform. Among them, 11 538 (2.34%) were diagnosed as glaucoma, 2174 (0.44%) were diagnosed as suspicious glaucoma, and the detection rate of glaucoma and suspicious glaucoma was 2.78%. During the same period, 20 861 subjects from the population-basedeye diseases screening in Beijing was enrolled in this study, 417 patients (1.79%) were diagnosed as glaucoma, 33 cases (0.16%) were diagnosed as suspicious glaucoma, and 1.95% were diagnosed as glaucoma and suspicious glaucoma. Pearson chi-square test showed no statistically significant difference in the detection rate of glaucoma between two groups of subjects ( χ2=2.0, P>0.05). The constituent ratio of mild glaucoma from the teleophthalmology consultation glaucoma patients was 12.5%, this constituent ratio was 33.6%in population-based screening glaucoma patients.

Conclusions

Using internet technology and ophthalmic image diagnostic criteria, the effect of glaucoma detection from the teleophthalmology consultation is equal to that of eye diseases screening in population. Therefore, the moving of patients or doctors can be replaced by the flow of information technology.

Key words: Teleophthalmology, Glaucoma, Diagnosis
图1 青光眼视神经损害的分级与分期眼底图像　图A显示青光眼视神经损害1级(早期)；图B显示青光眼视神经损害2级(早期);图C显示青光眼视神经损害3级(中期);图D显示青光眼视神经损害3级(中期);图E显示青光眼视神经损害4级(右眼晚期)；图F显示青光眼视神经损害5级(左眼晚期)
表1 远程会诊平台对青光眼检出效果的分析
研究分类 例数 年龄(岁) 青光眼例数(%) 可疑青光眼例数(%) 青光眼及可疑青光眼检出率(%) 早期青光眼构成比(%) 中晚期青光眼构成比(%)
远程会诊患者 493 221 7~89 11 538(2.34) 2174(0.44) 2.78 12.50 87.50
基础眼病筛查 20 861 40+ 417(1.79) 33(0.16) 1.95 33.60 66.40
邯郸眼病研究 6716 30+ 115(1.70)        
北京眼病研究 4451 40+ 125(2.80)        
表2 远程会诊平台对青光眼检出成本的分析(人民币：元)
每例患者的平均支出 总计 诊疗费 外地来京食宿及差旅费 最少1名家属陪同费用
医事服务费 检查费 远程会诊费 食宿费 差旅费 误工费 食宿差旅费
远程会诊平台 150 10 40* 100 0 0 0 0
北京同仁医院门诊 4450 100 75** 0 2000 500 500 600
[1]
徐亮，张莉，夏翠然，等. 北京农村及城市特定人群原发性闭角型青光眼的患病率及其影响因素[J]. 中华眼科杂志，2005, 41(1): 8-14.
[2]
徐亮，陈建华，李建军，等. 北京农村及城市特定人群原发性开角型青光眼的患病率调查及其筛查方法评价[J]. 中华眼科杂志，2004, 40(11): 726-732.
[3]
Liang YB, Friedman DS, Zhou Q, et al. Prevalence and characteristics of primary angle closure diseases in a rural adult Chinese population: The Handan Eye Study[J]. Invest Ophthalmol Vis Sci. 2011, 52(12): 8672-8679.
[4]
Liang YB, Friedman DS, Zhou Q, et al. Prevalence of primary open angle glaucoma in a rural adult Chinese population: The Handan Eye Study[J]. Invest Ophthalmol Vis Sci. 2011, 52(11): 8250-8257.
[5]
李建军，徐亮，刘丽娟，等. 远程眼科的现状和挑战[J]. 眼科，2017，26(4): 217-219.
[6]
李建军，张莉，彭晓燕. 远程眼科眼底像阅片诊断应注意的问题[J]. 眼科，2014, 23(4): 217-220.
[7]
李建军，徐亮，彭晓燕，等. 远程眼科单张眼底像质量标准(征求意见稿)[J]. 眼科，2015, 24(1): 11-12.
[8]
李建军，徐亮，彭晓燕，等. 远程眼科眼底照相机外眼及眼前节像质量标准(征求意见稿)[J]. 眼科，2015, 24(2): 136-137.
[9]
张琪，李建军，苏炳男，等. 远程眼科阅片筛查疾病谱初步分析[J]. 眼科，2015, 24 (4): 220-225.
[10]
Jonas JB, Budde WM. Diagnosis and pathogenesis of glaucomatous optic neuropathy: morphological aspects[J]. Prog Retin Eye Res, 2000，19(1): 1-40.
[11]
Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys[J]. Br J Ophthalmol, 2002, 86(3): 238-242.
[12]
Cho HK, Kee C. Population-based glaucoma prevalence studies in Asians[J]. Surv Ophthalmol, 2014, 59(3): 434-447.
[13]
Sharafeldin N, Kawaguchi A, Sundaram A, et al. Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults[J]. Br J Ophthalmol, 2018, 102 (11): 1485-1491.
[14]
Bartnik SE, Copeland SP, Aicken AJ, et al. Optometry-facilitated teleophthalmology: an audit of the first year in Western Australia[J]. Clin Exp Optom, 2018，101(5): 700-703.
[15]
Maa AY, Patel S, Chasan JE, et al. Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases[J]. Telemed J E Health, 2017, 23 (1): 41-48.
[16]
Mohammadpour M, Heidari Z, Mirghorbani M, et al. Smartphones, teleophthalmology, and VISION 2020[J]. Int J Ophthalmol, 2017，10 (12): 1909-1918.
[17]
Ayatollahi H, Nourani A, Khodaveisi T, et al. Teleophthalmology in practice: Lessons learned from a pilot project[J]. Open Med Inform, 2017, 11(1): 20-28.
[18]
Matimba A, Woodward R, Tambo E, et al. Tele ophthalmology: Opportunities for improving diabetes eye care in resource- and specialist limited Sub Saharan African countries[J]. J Telemed Telecare, 2016, 22(5): 311-316.
[19]
Johnson KA, Meyer J, Yazar S, et al. Real time teleophthalmology in rural Western Australia[J]. Aust J Rural Health, 2015, 23 (3): 142-149.
[20]
Tan IJ, Dobson LP, Bartnik S, et al. Real time teleophthalmology versus face to face consultation: A systematic review[J]. J Telemed Telecare, 2017, 23 (7): 629-638.
[21]
Sreelatha OK, Ramesh SV. Teleophthalmology: improving patient outcomes？[J]. Clin Ophthalmol, 2016，10(4): 285-295.
[22]
Chin EK, Ventura BV, See KY, et al. Nonmydriatic fundus photography for teleophthalmology diabetic retinopathy screening in rural and urban clinics[J]. Telemed J E Health, 2014, 20 (2): 102-108.
[23]
Chin EK, Ventura BV, See KY, et al. Nonmydriatic fundus photography for teleophthalmology diabetic retinopathy screening in rural and urban clinics[J]. Telemed J E Health, 2014, 20 (2): 102-108.
[24]
Surendran TS, Raman R. Teleophthalmology in Diabetic Retinopathy[J]. J Diabetes Sci Technol, 2014, 8 (2): 262-266.
[25]
Ng M, Nathoo N, Rudnisky CJ, et al. Improving Access to Eye Care: Teleophthalmology in Alberta, Canada[J]. Journal of Diabetes Science and Technology, 2009, 3(2): 289-296.
[26]
Kanagasingam Y, Bhuiyan A, Abràmoff MD, et al. Progress on retinal image analysis for age related macular degeneration[J]. Prog Retin Eye Res, 2014, 38(1) 20-42.
[27]
Vaziri K, Moshfeghi DM, Moshfeghi AA. Feasibility of telemedicine in detecting diabetic retinopathy and age related macular degeneration[J]. Semin Ophthalmol, 2015, 30 (2): 81-95.
[28]
Thomas SM, Jeyaraman MM, Hodge WG, et al. The effectiveness of teleglaucoma versus in patient examination for glaucoma screening: a systematic review and meta-analysis[J]. PLoS ONE, 2014, 9(12): e113779.
[29]
Verma S, Arora S, Kassam F, et al. Northern Alberta remote teleglaucoma program: clinical outcomes and patient disposition[J]. Can J Ophthalmol, 2014, 49(2): 135-140.
[30]
Arora S, Rudnisky CJ, Damji KF. Improved access and cycle time with an " in house" patient centered teleglaucoma program versus traditional in person assessment[J]. Telemed J E Health, 2014, 20 (5): 439-445.
[31]
Silva PS, Cavallerano JD, Haddad NM, et al. Comparison of Nondiabetic Retinal Findings Identified With Nonmydriatic Fundus Photography vs Ultrawide Field Imaging in an Ocular Telehealth Program[J]. JAMA Ophthalmol, 2016, 134 (3): 330-334.
[32]
Thomas S, Hodge W, Malvankar-Mehta M. The cost effectiveness analysis of teleglaucoma screening device[J]. PLoS ONE, 2015, 10(9): e0137913.
[33]
Lee JY, Lee SWH. Telemedicine Cost Effectiveness for Diabetes Management: A Systematic Review[J]. Diabetes Technol Ther, 2018, 20 (7): 492-500.
[34]
Pathak S, Kumar B. Wireless Teleophthalmology: A novel, low cost, flexible network Architecture and Its Performance Evaluation for Remote Eye Care Solutions[J]. Telemed J E Health, 2017, 23 (9): 753-762.
[35]
de la Torre-Díez I, López-Coronado M, Vaca C, et al. Cost utility and cost effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review[J]. Telemed J E Health, 2015, 21 (2): 81-85.
[36]
Gomez-Ulla F, Fernandez M I, Gonzalez F, et al. Digital Retinal Images and Teleophthalmology for Detecting and Grading Diabetic Retinopathy[J]. Diabetes Care, 2002, 25(8): 1384-1389.
[37]
Strouthidis NG, Chandrasekharan G, Diamond JP, et al. Teleglauoma: ready to go？[J]. Br J Ophthalmol, 2014, 98(10): 1605-1611.
[38]
Sandhu S, Rudnisky C, Arora S, et al. Compressed 3D and 2D digital images versus standard 3D slide film for the evaluation of glaucomatous optic nerve features[J]. Br J Ophthalmol, 2018, 102 (3): 364-368.
[39]
Kozak I, Payne JF, Schatz P, et al. Teleophthalmology image-based navigated retinal laser therapy for diabetic macular edema: a concept of retinal telephotocoagulation[J]. Graefes Arch Clin Exp Ophthalmol, 2017, 255 (8): 1509-1513.
[40]
Kapoor R, Walters SP, Al-Aswad LA. The current state of artificial intelligence in ophthalmology[J]. Surv Ophthalmol, 2019, 64(2): 233-240.
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