Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Oct;83(10):962-966. doi: 10.1097/JCMA.0000000000000382.
A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases.
A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists.
A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera.
This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.
适合远程医疗筛查的眼底相机可以扩大眼科保健服务的规模。本研究的目的是根据照片的质量和对各种视网膜疾病进行准确诊断的照片可用性，比较手持式免散瞳数字眼底相机和传统散瞳眼底相机。
使用手持式免散瞳眼底相机和传统眼底相机对眼科诊所的门诊患者进行瞳孔扩张前后的眼底照相。两名经验丰富的视网膜专家对照片的质量和诊断一致性进行了盲法和评估。
共收集了 200 名患者 393 只眼的 867 张照片。使用手持式免散瞳眼底相机在非散瞳状态下拍摄的照片中，约有 80%的照片具有良好（55.7%）或优秀（22.7%）的图像质量。医生之间的总体诊断一致性超过 90%。在散瞳后使用手持式免散瞳眼底相机时，具有良好（45%）或优秀（49.7%）质量的图像比例达到 94.7%，诊断一致性为 93.4%。晶状体混浊与使用手持式相机获得的图像质量有关（p=0.041），并且对手持式相机图像的诊断不一致与预先存在的糖尿病诊断有关（p=0.009）。大约 40%的患者表示愿意使用手持式免散瞳相机。
本研究证明了手持式免散瞳眼底相机在临床实践中的有效性及其用于远程医疗筛查视网膜疾病的可行性。
