Ribeiro Anna Giselle, Rodrigues Renan Albert Mendonça, Guerreiro Ana Maria, Regatieri Caio Vinicius Saito
Universidade Federal do Rio Grande do Norte, Natal, Brazil.
Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil.
Arq Bras Oftalmol. 2014 Aug;77(4):214-8. doi: 10.5935/0004-2749.20140055.
To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient's condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation.
A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of São Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. RESULTS were then compared to the gold standard diagnosis provided at the hospital.
The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations.
This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.
验证一种远程眼科移动系统，该系统旨在改善巴西偏远贫困地区的眼部紧急筛查并提供相关服务。该系统使一名或多名眼科医生能够远程检查患者病情，并提交描述病例严重程度的诊断结果。如有必要，患者可被转诊至医院进行进一步会诊。
使用一部手机（谷歌Nexus One型号，配备500万像素摄像头）在圣保罗联邦大学医院眼科急诊室从100名随机挑选的患者处收集数据和图片。然后将数据远程发送至在线记录系统，由一名眼科医生进行评估，该医生会就眼部紧急情况提供反馈。随后将结果与医院提供的金标准诊断进行比较。
两名眼科医生给出了紧急情况诊断结果：一名在医院（金标准），一名远程诊断。当我们比较两种诊断结果时，特异性为81.94%，敏感性为92.85%，准确率为85%，阴性预测值为96.72%。这项工作还包括处理时间分析，远程会诊每位患者的平均时间为8.6分钟。
本研究是首次仅使用手机诊断眼部病例紧急情况的研究。基于我们的结果，该系统能够可靠地区分紧急和非紧急情况，并可为贫困地区提供可行的替代服务方案。在筛查技术中，最重要的结果是高度敏感且具有阴性预测值地识别紧急病例。因此，我们的结果表明该工具性能良好，我们建议启动一项主要研究以验证其在资源匮乏地区的有效性。
