Peter Jayanthi, Piantadosi Julia, Piantadosi Cynthia, Cooper Peter, Gehling Neil, Kaufmann Claude, Goggin Michael
Department of Ophthalmology, University of Adelaide, The Queen Elizabeth Hospital, South Australia, Australia.
Clin Exp Ophthalmol. 2006 May-Jun;34(4):312-6. doi: 10.1111/j.1442-9071.2006.01217.x.
The high prevalence of diabetic retinopathy (21-36%) and 2 yearly reviews recommended by the National Health and Medical Research Council for diabetics with no retinopathy creates a considerable burden for review in rural and regional Australia. Screening for diabetic retinopathy using telemedicine has significant implications. If effective, such a tool would have an impact on finance and resource allocation. The purpose of the study was to establish if telemedicine could distinguish clinically significant macular oedema (CSME) from eyes free of this form of disease.
A study population with representative examples of normal fundi and the different grades of retinopathy was chosen from existing records. The specificity and sensitivity of telemedicine diagnosis was compared with fundus photography and examination by an experienced ophthalmologist as a 'gold standard', in a blinded manner. Real-time telemedicine assessment was performed with live video and audio connections with the transmitting and receiving units set in different areas of the ophthalmology department. The transmission end consisted of a video camera mounted on a slit lamp and the receiving unit consisted of a 21'' LCD monitor. A video conference link was established using three ISDN lines capable of 128 kb per second transfer per line allowing for a total of 348 kb per second when utilizing all three lines for high resolution images. Fundus photographs were taken with a Zeiss FF 450 Plus Digital imaging system.
For telemedicine, sensitivity was 38% (95% CI, 35-40%) and specificity was 95% (95% CI, 91-99%). For photography, sensitivity was 75% (95% CI, 71-79%) and specificity was 95% (95% CI, 91-99%).
In this pilot study, sensitivity of detection of CSME by photography was considerably better than for live-link telemedicine. This study tends to confirm the continued superiority of examination of the patient by an experienced ophthalmologist as the best method of screening for CSME, a sight threatening form of diabetic retinopathy.
糖尿病视网膜病变的高患病率（21%-36%）以及澳大利亚国家卫生与医学研究委员会建议对无视网膜病变的糖尿病患者每两年进行一次复查，给澳大利亚农村和偏远地区的复查工作带来了相当大的负担。使用远程医疗筛查糖尿病视网膜病变具有重大意义。如果有效，这样一种工具将对资金和资源分配产生影响。本研究的目的是确定远程医疗能否将具有临床意义的黄斑水肿（CSME）与无此种疾病的眼睛区分开来。
从现有记录中选取具有正常眼底及不同等级视网膜病变代表性实例的研究人群。以经验丰富的眼科医生进行的眼底照相和检查作为“金标准”，以盲法比较远程医疗诊断的特异性和敏感性。通过实时视频和音频连接进行实时远程医疗评估，发送和接收单元设置在眼科部门的不同区域。传输端由安装在裂隙灯上的摄像机组成，接收单元由一台21英寸液晶显示器组成。使用三条ISDN线路建立视频会议链接，每条线路每秒能够传输128 kb，当使用所有三条线路传输高分辨率图像时，总共每秒可传输348 kb。使用蔡司FF 450 Plus数字成像系统拍摄眼底照片。
对于远程医疗，敏感性为38%（95%可信区间，35%-40%），特异性为95%（95%可信区间，91%-99%）。对于摄影，敏感性为75%（95%可信区间，71%-79%），特异性为95%（95%可信区间，91%-99%）。
在这项初步研究中，摄影检测CSME的敏感性明显优于实时链接远程医疗。本研究倾向于证实，由经验丰富的眼科医生对患者进行检查作为筛查CSME（一种威胁视力的糖尿病视网膜病变形式）的最佳方法，仍然具有优越性。
