Medical Corps, Israel Defense Forces, Tel Hashomer, Ramat Gan, Israel.
Faculty of Medicine, Military Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Int Ophthalmol. 2022 Sep;42(9):2741-2748. doi: 10.1007/s10792-022-02263-z. Epub 2022 Apr 2.
To describe tele-ophthalmology consultations for primary-physicians in the IDF during the Covid-19 lockdown.
Retrospective cross-sectional study. Medical records of tele-ophthalmology consultations from March to June 2020 were reviewed.
The study included 245 cases in which an ophthalmologist was consulted. In 62.0% cell-phone camera photographs were used. The mean age was 21.5 ± 6.4 years. The most common diagnoses were acute-conjunctivitis (8.6%); conjunctival-hyperemia (non-specific diagnosis, 8.2%); scleritis/episcleritis (7.3%); chronic allergic-conjunctivitis (7.3%); chalazion (7.3%) hordeolum (6.5%); acute allergic-conjunctivitis (4.5%). 37.6% of patients received primary physician-based treatment, 24.9% of patients received specialist-based treatment. 13.1% were referred to the ER. The consult prevented ER referral for 39.2% and changed the physician's treatment plan in 70.6% of cases. Foreign-body sensation complaints were more likely treated by a primary-physician (p = 0.015). Cases with suspected foreign-body diagnosis were referred more to the ER (p < 0.001). For most cases of eyelid complaints and diagnoses, primary physician care was sufficient (p < 0.001). Conjunctival complaints and diagnoses received significantly more ophthalmologist-based treatment (p < 0.001). Corneal disorders were significantly referred more to the ER (p = 0.001).
Despite of possible ethical and legal problems and clinical limitations of this instrument, Tele-ophthalmology using objective aids such as smartphone photography can be an efficient tool in aiding the primary-physician, especially for patients with low access to ophthalmologists, with major impact on patient management.
描述在新冠疫情封锁期间 IDF 初级保健医生的远程眼科咨询情况。
回顾性横断面研究。回顾了 2020 年 3 月至 6 月的远程眼科咨询医疗记录。
该研究包括 245 例咨询眼科医生的病例。62.0%使用了手机摄像头照片。平均年龄为 21.5±6.4 岁。最常见的诊断是急性结膜炎（8.6%）；结膜充血（非特异性诊断，8.2%）；巩膜炎/表层巩膜炎（7.3%）；慢性过敏性结膜炎（7.3%）；霰粒肿（7.3%）；麦粒肿（6.5%）；急性过敏性结膜炎（4.5%）。37.6%的患者接受了初级保健医生的治疗，24.9%的患者接受了专科医生的治疗。13.1%的患者被转至急诊室。该咨询避免了 39.2%的患者被转至急诊室，并改变了 70.6%的医生治疗计划。异物感投诉更有可能由初级保健医生治疗（p=0.015）。疑似异物诊断的病例更倾向于被转至急诊室（p<0.001）。对于大多数眼睑投诉和诊断病例，初级保健医生的治疗是足够的（p<0.001）。结膜投诉和诊断明显需要更多的眼科医生治疗（p<0.001）。角膜疾病明显更倾向于被转至急诊室（p=0.001）。
尽管该仪器存在可能的伦理和法律问题以及临床限制，但使用智能手机摄影等客观辅助手段的远程眼科技术可以成为辅助初级保健医生的有效工具，尤其是对于那些难以获得眼科医生治疗的患者，对患者管理有重大影响。
