通过远程可视化技术拓展眼科诊断的范围和任务转移。
Extending the Reach and Task-Shifting Ophthalmology Diagnostics Through Remote Visualisation.
机构信息
Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
NHS Forth Valley, Larbert, Scotland, UK.
出版信息
Adv Exp Med Biol. 2020;1260:161-174. doi: 10.1007/978-3-030-47483-6_9.
Driven by the global increase in the size and median age of the world population, sight loss is becoming a major public health challenge. Furthermore, the increased survival of premature neonates in low- and middle-income countries is causing an increase in developmental paediatric ophthalmic disease. Finally, there is an ongoing change in health-seeking behaviour worldwide, with consequent demand for increased access to healthcare, including ophthalmology. There is therefore the need to maximise the reach of resource-limited ophthalmology expertise in the context of increasing demand. Yet, ophthalmic diagnostics critically relies on visualisation, through optical imaging, of the front and of the back of the eye, and teleophthalmology, the remote visualisation of diagnostic images, shows promise to offer a viable solution.In this chapter, we first explore the strategies at the core of teleophthalmology and, in particular, real-time vs store-and-forward remote visualisation techniques, including considerations on suitability for different tasks and environments. We then introduce the key technologies suitable for teleophthalmology: anterior segment imaging, posterior segment imaging (retinal imaging) and, briefly, radiographic/tomographic techniques. We highlight enabling factors, such as high-resolution handheld imaging, high data rate mobile transmission, cloud storage and computing, 3D printing and other rapid fabrication technologies and patient and healthcare system acceptance of remote consultations. We then briefly discuss four canonical implementation settings, namely, national service provision integration, field and community screening, optometric decision support and virtual clinics, giving representative examples. We conclude with considerations on the outlook of the field, in particular, on artificial intelligence and on robotic actuation of the patient end point as a complement to televisualisation.
由于世界人口规模和中位数年龄的全球增长,视力丧失正成为一个主要的公共卫生挑战。此外,中低收入国家早产儿存活率的提高导致发育性儿科眼病的发病率增加。最后,全球的健康寻求行为正在发生变化,随之而来的是对更多医疗保健的需求,包括眼科。因此,需要在需求增加的情况下最大限度地扩大资源有限的眼科专业知识的覆盖面。然而,眼科诊断严重依赖于通过光学成像对眼睛前后部的可视化,远程眼科诊断通过远程可视化诊断图像,有望提供可行的解决方案。在本章中,我们首先探讨远程眼科的核心策略,特别是实时与存储转发远程可视化技术,包括对不同任务和环境的适用性的考虑。然后,我们介绍适用于远程眼科的关键技术:前段成像、后段成像(视网膜成像),以及简要介绍放射性/断层摄影技术。我们强调了一些促进因素,如高分辨率手持式成像、高数据率移动传输、云存储和计算、3D 打印和其他快速制造技术以及远程咨询的患者和医疗系统的接受程度。然后,我们简要讨论了四个典型的实施场景,即国家服务提供整合、现场和社区筛查、验光决策支持和虚拟诊所,并给出了代表性的例子。最后,我们考虑了该领域的前景,特别是人工智能和作为电视可视化补充的患者端点的机器人驱动。