Keck School of Medicine, University of Southern California, USA.
The Vision Center at Children's Hospital Los Angeles, USA.
J Telemed Telecare. 2023 Jul;29(6):467-473. doi: 10.1177/1357633X21990991. Epub 2021 Feb 3.
This study aimed to assess the validity of telemedicine consultations using digital slit-lamp videos to detect anterior segment pathology in a paediatric population.
A paediatric anterior segment specialist simultaneously performed and recorded anterior segment examinations using the Topcon digital-ready slit lamp. Components of the examination included the eyelids/eyelashes, conjunctiva/sclera, cornea, anterior chamber, iris and lens. Masked to clinical findings, a paediatric ophthalmologist reviewed and graded the live video feed transmitted at 4 Mbps. At least three months later, both ophthalmologists graded the stored videos. We compared the sensitivity, specificity, percent agreement and weighted kappa (κ) of diagnosing anterior segment pathologies via live-streamed and store-and-forward video clips compared to the in-person standard examination.
Examinations of 89 eyes from 45 children (5-17 years old) with known anterior segment pathology were included. Agreement between live-streamed and in-person standard examinations for conjunctiva/sclera, anterior chamber, iris and lens findings was almost perfect (sensitivity 89-96%, specificity 95-100%, κ = 0.87-0.97). Substantial agreement was found for cornea pathology (sensitivity 88%, specificity 90%, κ = 0.72), and moderate agreement was found for eyelids/eyelashes pathology (sensitivity 54%, specificity 92%, κ = 0.46). Store-and-forward results were similar, though slightly better for eyelids/eyelashes and slightly worse for conjunctiva/sclera.
Digital slit-lamp videos hold promise for synchronous and asynchronous telemedicine in diagnosing paediatric anterior segment pathologies.
本研究旨在评估使用数字裂隙灯视频进行远程医疗咨询以检测儿科人群前节病理学的有效性。
一位儿科前节专家同时使用 Topcon 数字准备裂隙灯进行前节检查并记录。检查内容包括眼睑/睫毛、结膜/巩膜、角膜、前房、虹膜和晶状体。在不了解临床发现的情况下，一名小儿眼科医生对实时视频流以 4 Mbps 的速度进行了审查和分级。至少三个月后，两位眼科医生对存储的视频进行了分级。我们比较了通过实时流媒体和存储转发视频片段与亲自标准检查诊断前节病变的敏感性、特异性、百分比一致性和加权 Kappa（κ）。
纳入了 45 名患有已知前节病变的儿童（5-17 岁）的 89 只眼睛的检查。实时流媒体和亲自标准检查的结膜/巩膜、前房、虹膜和晶状体检查结果之间的一致性几乎是完美的（敏感性 89-96%，特异性 95-100%，κ=0.87-0.97）。角膜病变的一致性较高（敏感性 88%，特异性 90%，κ=0.72），眼睑/睫毛病变的一致性为中度（敏感性 54%，特异性 92%，κ=0.46）。存储转发结果相似，但对眼睑/睫毛的结果略好，对结膜/巩膜的结果略差。
数字裂隙灯视频有望用于同步和异步远程医疗以诊断儿科前节病变。
