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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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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/OL]. 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/OL]. 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
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