Bar-Sela Shai M, Glovinsky Yoseph
Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
J Telemed Telecare. 2007;13(3):119-24. doi: 10.1258/135763307780677640.
We examined the feasibility of a low-bandwidth, Internet-based tele-ophthalmology system for consultation in an ophthalmic emergency room. Forty-nine patients (98 eyes) with complicated cases were seen during night shifts in the ophthalmic emergency room. Ocular images were taken using a slit-lamp connected to a video camera, processed and transmitted to a senior physician by email. A telephone was used for real-time audio communication. Each case was re-examined by the same senior physician the following day. The time needed to capture and to process the images was 5 min (SD 2). Each case was given a feasibility score (0-100%), which was defined as the contribution made by the transmitted images in presenting clinical details which could not have been described verbally. High feasibility scores (mean scores ranging from 85 to 90) were found for the following images: ocular surface, anterior chamber, anterior chamber angle, pupils, lens, optic nerve and macula. In contrast, images of vitreous and peripheral retina received low feasibility scores (mean score 65). There was 100% agreement between the diagnosis made during consultation and the on-site examination made by the senior ophthalmologist later on. Ninety-eight percent of the patients stated that they would prefer being examined under the telemedicine system on their next emergency room visit, rather than the traditional resident on-site examination.
我们考察了一种低带宽、基于互联网的远程眼科系统在眼科急诊室进行会诊的可行性。在眼科急诊室的夜班期间，共诊治了49例（98只眼）复杂病例。使用连接视频摄像机的裂隙灯采集眼部图像，进行处理后通过电子邮件发送给一位主任医师。通过电话进行实时音频通信。次日，同一位主任医师对每个病例进行了复查。采集和处理图像所需时间为5分钟（标准差2）。每个病例都给出了一个可行性评分（0 - 100%），该评分定义为所传输图像在呈现无法用言语描述的临床细节方面的贡献。对于以下图像，发现可行性评分较高（平均评分在85至90之间）：眼表、前房、前房角、瞳孔、晶状体、视神经和黄斑。相比之下，玻璃体和周边视网膜的图像可行性评分较低（平均评分65）。会诊时做出的诊断与眼科主任医师随后进行的现场检查之间的一致性为100%。98%的患者表示，他们更愿意在下次急诊室就诊时接受远程医疗系统检查，而不是传统的住院医师现场检查。
