Woodward Maria A, Bavinger J Clay, Amin Sejal, Blachley Taylor S, Musch David C, Lee Paul P, Newman-Casey Paula Anne
1 Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
2 Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA.
J Telemed Telecare. 2017 Feb;23(2):365-370. doi: 10.1177/1357633X16634544. Epub 2016 Jul 9.
Introduction We compared remote, image-based patient consultations to in-person consultations at emergency department and inpatient hospital settings. Methods Patients evaluated by the ophthalmic consultation services (gold standard) were imaged over a two-week period. A trained study coordinator took anterior segment photographs (AS) and posterior segment photographs (PS) with a portable camera (PictorPlus, Volk Optical, Cleveland, OH). Ophthalmologists (graders) determined photograph quality, presence of pathology, and their confidence in disease detection. At a separate session, graders reassessed photographs accompanied by a one-sentence summary of demographics and chief complaint (CHx). We computed accuracy and reliability statistics. Results We took AS photographs of 24 eyes of 15 patients and PS photographs of 39 eyes of 20 patients. The majority of images were rated as acceptable or excellent in quality (AS: 89-96%; PS: 70-75%). Graders detected AS pathology with 62-81% sensitivity based on photographs, increasing to 87-88% sensitivity with photographs plus CHx. Graders detected PS pathology with 79-86% sensitivity based on a photograph only, increasing to 100% sensitivity with photographs plus CHx. Discussion In this pilot study, there is evidence that portable ophthalmic imaging technologies could enable ophthalmologists to remotely evaluate anterior and posterior segment eye diseases with good sensitivity. The ophthalmologist could detect ocular pathology on photographs more accurately if they were provided brief clinical information.
引言 我们将基于图像的远程患者会诊与急诊科和住院部环境中的面对面会诊进行了比较。方法 在两周时间内，对由眼科会诊服务（金标准）评估的患者进行成像。一名经过培训的研究协调员使用便携式相机（PictorPlus，Volk Optical，俄亥俄州克利夫兰）拍摄眼前节照片（AS）和眼后节照片（PS）。眼科医生（分级者）确定照片质量、病变的存在情况以及他们对疾病检测的信心。在另一次会议上，分级者重新评估了附有一句人口统计学和主要诉求（CHx）总结的照片。我们计算了准确性和可靠性统计数据。结果 我们拍摄了15名患者24只眼的眼前节照片和20名患者39只眼的眼后节照片。大多数图像的质量被评为可接受或优秀（眼前节：89 - 96%；眼后节：70 - 75%）。分级者根据照片检测眼前节病变的敏感性为62 - 81%，照片加上CHx后敏感性提高到87 - 88%。分级者仅根据照片检测眼后节病变的敏感性为79 - 86%，照片加上CHx后敏感性提高到100%。讨论 在这项初步研究中，有证据表明便携式眼科成像技术能够使眼科医生以良好的敏感性远程评估眼前节和眼后节眼部疾病。如果向眼科医生提供简短的临床信息，他们能够更准确地在照片上检测出眼部病变。
