Cuadros Jorge, Bresnick George
University of California, Berkeley, Meredith Morgan Optometric Eye Center, Berkeley, CA 94720, USA.
J Diabetes Sci Technol. 2009 May 1;3(3):509-16. doi: 10.1177/193229680900300315.
Annual retinal screening of patients with diabetes is the standard clinical practice to prevent visual impairment and blindness from diabetic retinopathy. Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings can effectively detect sight-threatening retinopathy and significantly increase compliance with annual retinal exams. EyePACS is a license-free Web-based DRS system designed to simplify the process of image capture, transmission, and review. The system provides a flexible platform for collaboration among clinicians about diabetic retinopathy.
Primary clinic personnel (i.e., nursing, technical, or administrative staff) are trained and certified by the EyePACS program to acquire retinal images from standard digital retinal cameras. Relevant clinical data and eight high-resolution images per patient (two external and six retinal images) are encrypted and transmitted to a secure Internet server, using a standard computer and Web browser. Images are then interpreted by certified EyePACS reviewers or local eye care providers who are certified through the EyePACS Retinopathy Grading System. Reports indicating retinopathy level and referral recommendations are transmitted back to primary care providers through the EyePACS Web site or through interfaces between EyePACS and Health Level 7-compliant electronic medical records or chronic disease registries.
The pilot phase of the EyePACS DRS program in California (2005-2006) recorded 3562 encounters. Since 2006, EyePACS has been expanded to over 120 primary care sites throughout California and elsewhere recording over 34,000 DRSs. The overall rate of referral is 8.21% for sight-threatening retinopathy and 7.83% for other conditions (e.g., cataract and glaucoma).
The use of license-free Web-based software, standard interfaces, and flexible protocols has allowed primary care providers to adopt retinopathy screening with minimal effort and resources.
对糖尿病患者进行年度视网膜筛查是预防糖尿病性视网膜病变导致视力损害和失明的标准临床做法。基层医疗环境中基于远程医疗的糖尿病性视网膜病变筛查（DRS）能够有效检测出威胁视力的视网膜病变，并显著提高年度视网膜检查的依从性。EyePACS是一个基于网络的免费DRS系统，旨在简化图像采集、传输和审查流程。该系统为临床医生之间就糖尿病性视网膜病变展开协作提供了一个灵活的平台。
基层诊所人员（即护理、技术或行政人员）接受EyePACS项目的培训并获得认证，以便从标准数字视网膜相机获取视网膜图像。使用标准计算机和网络浏览器，将每位患者的相关临床数据和八张高分辨率图像（两张眼外图像和六张视网膜图像）进行加密并传输至安全的互联网服务器。然后，由获得认证的EyePACS审阅人员或通过EyePACS视网膜病变分级系统认证的当地眼科护理人员对图像进行解读。表明视网膜病变级别和转诊建议的报告通过EyePACS网站或EyePACS与符合健康等级7标准的电子病历或慢性病登记系统之间的接口传输回基层医疗服务提供者。
加利福尼亚州EyePACS DRS项目的试点阶段（2005 - 2006年）记录了3562次诊疗。自2006年以来，EyePACS已扩展至加利福尼亚州及其他地区的120多个基层医疗站点，记录了超过34000次DRS。威胁视力的视网膜病变的总体转诊率为8.21%，其他病症（如白内障和青光眼）的转诊率为7.83%。
使用免费的基于网络的软件、标准接口和灵活的协议，使基层医疗服务提供者能够以最少的精力和资源开展视网膜病变筛查。
