Wills Eye Hospital, Glaucoma Research Center.
Department of Ophthalmology, Columbia University Irving Medical Center.
J Glaucoma. 2019 Apr;28(4):294-301. doi: 10.1097/IJG.0000000000001207.
Intraocular pressure (IOP) measurements, when used during telemedicine eye screening alongside nonmydriatic fundus photography, were shown to improve the likelihood of accurate glaucoma and glaucoma-related diagnoses at the follow-up eye examination.
To determine if IOP measurements, used as an adjunct to nonmydriatic fundus photography, are useful in glaucoma telemedicine screening.
A total of 902 high-risk individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening at visit 1 included fundus photography, assessing family history of glaucoma, and IOP measurements using a hand-held rebound tonometer. Participants with suspicious nerve findings for glaucoma, IOP>21 mm Hg or other ocular pathologies were invited for a follow-up appointment with an ophthalmologist (visit 2).
Of the 902 individuals screened at visit 1, 19.6% (n=177/902) had elevated IOP (>21 mm Hg). Fifteen participants were found to have an IOP>30 mm Hg at visit 1, including 2 with an IOP of >40 mm Hg. Among all who attended visit 2 (n=347), 10.9% had glaucoma and 7.2% had ocular hypertension. For participants having both suspicious nerve findings and IOP>21 mm Hg compared with those with neither, the odds ratio (OR) of being diagnosed with glaucoma was 4.48 (95% CI, 1.50-13.93; P=0.007), whereas for participants with suspicious discs and IOP≤21 mm Hg the OR was 2.04 (95% CI, 0.83-5.53; P=0.15).
In this telemedicine vision screening setting, having a higher IOP at the screening visit increased the likelihood of receiving a final diagnosis of glaucoma. Therefore, this study supports incorporating IOP measurements, using a portable tonometer, into vision screening programs in high-risk populations.
在远程医疗眼科筛查中，眼压（IOP）测量与非散瞳眼底照相结合使用，可提高后续眼科检查中青光眼和相关疾病诊断的准确性。
确定眼压测量作为非散瞳眼底照相的辅助手段在青光眼远程医疗筛查中的作用。
共有 902 名高危人群在 7 家初级保健机构和 4 家联邦合格健康中心通过远程医疗接受青光眼筛查。在初次就诊时进行眼底照相、评估青光眼家族史和使用手持回弹眼压计测量 IOP。对疑似青光眼神经病变、IOP>21mmHg 或其他眼部病变的患者，邀请他们进行眼科医生复诊（就诊 2）。
在初次就诊时接受筛查的 902 人中，19.6%（902 人中有 177 人）的 IOP 升高（>21mmHg）。在就诊 1 时，有 15 名患者的 IOP>30mmHg，其中 2 名患者的 IOP>40mmHg。在所有参加就诊 2（n=347）的患者中，10.9%患有青光眼，7.2%患有高眼压症。与既无可疑神经病变又无 IOP>21mmHg 的患者相比，同时存在可疑神经病变和 IOP>21mmHg 的患者被诊断为青光眼的比值比（OR）为 4.48（95%CI，1.50-13.93；P=0.007），而对于可疑视盘且 IOP≤21mmHg 的患者，OR 为 2.04（95%CI，0.83-5.53；P=0.15）。
在这个远程医疗视力筛查环境中，在筛查就诊时的眼压升高增加了最终诊断为青光眼的可能性。因此，这项研究支持在高危人群的视力筛查项目中纳入使用便携式眼压计进行的眼压测量。
