Department of Surgery, Division of Ophthalmology, McMaster University, Canada.
Department of Surgery, McMaster Paediatric Eye Research Group, Canada.
J Telemed Telecare. 2021 Feb;27(2):116-122. doi: 10.1177/1357633X19864823. Epub 2019 Jul 31.
The aim of this study was to assess the potential of using video screening to interpret the results of paediatric eye examinations.
Prospective multi-centred, blinded study.
Children aged 5 months to 11 years referred to a paediatric ophthalmology centre were enrolled in the study. Outcome measures included the degree of agreement between examiners for assessment of various aspects of paediatric eye examination. In Phase 1, children were individually assessed in the clinic by three different examiners to determine the level of agreement. In Phase 2 a video recording was made of the first ophthalmologist examining the children. The other two examiners viewed the video recordings to make their diagnoses. Areas of assessment included lid function, pupillary function, ocular motility, strabismus, nystagmus, torticollis and facial asymmetry. Agreement between examiners was measured using Gwet's agreement coefficient (AC1).
A total of 27 patients in Phase 1 (mean age 4.0 years) and 160 children in Phase 2 (mean age 4.8 years) underwent clinical and video-recorded screening. In Phase 1, all but one area of ocular examination (heterotropia) achieved ≥84% agreement between three examiners. In Phase 2, there was greater variation between direct clinical examination and interpretation of video findings, ranging from 55-100% agreement.
Using experienced clinicians and changing only one variable in Phase 2 (the method of assessment - direct examination versus video interpretation), the results show the possible usefulness of video-recorded screening as a means of assessing children. Further research is indicated to assess the accuracy of ophthalmologists interpreting video recordings of eye examinations performed by trained non-eye-care professionals.
本研究旨在评估使用视频筛查来解读儿科眼部检查结果的潜力。
前瞻性多中心、盲法研究。
将 5 个月至 11 岁的儿童招募到儿科眼科中心进行研究。主要结局指标包括评估儿科眼部检查各个方面时，检查者之间的一致性程度。在第 1 阶段，由 3 名不同的检查者分别对儿童进行个体评估，以确定一致性水平。在第 2 阶段，对第 1 位眼科医生检查儿童的过程进行视频录制。其他 2 位检查者观看视频记录以做出诊断。评估的领域包括眼睑功能、瞳孔功能、眼球运动、斜视、眼球震颤、斜颈和面部不对称。使用 Gwet 的一致性系数（AC1）衡量检查者之间的一致性。
共有 27 名儿童（平均年龄 4.0 岁）参加第 1 阶段的临床和视频筛查，160 名儿童（平均年龄 4.8 岁）参加第 2 阶段的视频筛查。在第 1 阶段，除了一项眼部检查领域（斜视）外，所有检查者之间的一致性均≥84%。在第 2 阶段，直接临床检查和视频解读结果之间的差异更大，一致性程度为 55-100%。
使用经验丰富的临床医生，并在第 2 阶段仅改变一个变量（评估方法-直接检查与视频解读），结果表明视频筛查作为评估儿童的一种手段可能具有一定的用处。需要进一步的研究来评估眼科医生解读经过培训的非眼科专业人员进行的眼部检查视频记录的准确性。
