School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2022 Jul 1;85(7):793-798. doi: 10.1097/JCMA.0000000000000755. Epub 2022 Jun 30.
Although teleophthalmology has gained traction in recent years, it is at the center of the coronavirus disease pandemic. However, most hospitals are not ready owing to a severe lack of real-world experience. Furthermore, a limited number of studies have evaluated telemedicine applications on remote islands. This study aimed to evaluate real-world clinical and referral accuracy, image quality, physician-perceived diagnostic certainty, and patient satisfaction with telemedicine eye screening using a novel handheld fundus camera in a rural and medically underserved population.
This prospective study included 176 eyes from a remote island. All participants underwent a comprehensive ophthalmic examination. Nonmydriatic retinal images obtained using a handheld fundus camera were reviewed by two retinal specialists to determine image quality, diagnosis, and need for referrals. The agreement of diagnosis between image-based assessments was compared with that of binocular indirect ophthalmoscopic assessments.
Image quality of fundus photographs was considered acceptable or ideal in 97.7% and 95.5% of eyes assessed by two reviewers, respectively. There was considerable agreement in diagnosis between the indirect ophthalmoscopic assessment and image-based assessment by two reviewers (Cohen's kappa = 0.80 and 0.78, respectively). Likewise, substantial agreement was achieved in the referrals. The sensitivity for referable retinopathy from the two reviewers was 78% (95% confidence interval [CI], 57%-91%) and 78% (95% CI, 57%-91%), whereas specificity was 99% (95% CI, 95%-99%] and 98% (95% CI, 93%-99%), respectively. For physicians' perceived certainty of diagnosis, 93.8% and 90.3% were considered either certain or reliable. Overall, 97.4% of participants were satisfied with their experiences and greatly valued the telemedicine services.
Novel fundus camera-based telemedicine screening demonstrated high accuracy in detecting clinically significant retinopathy in real-world settings. It achieved high patient satisfaction and physician-perceived certainty in diagnosis with reliable image quality, which may be scaled internationally to overcome geographical barriers under the global pandemic.
尽管远程眼科近年来受到关注，但它正处于冠状病毒病大流行的中心。然而，由于缺乏实际经验，大多数医院还没有准备好。此外，只有少数研究评估了远程医疗在偏远岛屿上的应用。本研究旨在评估一种新型手持式眼底相机在农村和医疗服务不足人群中的远程眼科筛查的临床和转诊准确性、图像质量、医生感知诊断确定性和患者满意度。
这是一项前瞻性研究，纳入了一个偏远岛屿的 176 只眼。所有参与者均接受全面眼科检查。使用手持式眼底相机获得的非散瞳视网膜图像由两名视网膜专家进行评估，以确定图像质量、诊断和转诊需求。基于图像的评估与双目间接检眼镜评估的诊断一致性进行比较。
两名评估者分别评估 97.7%和 95.5%的眼底照片图像质量可接受或理想。间接检眼镜评估与两名评估者的基于图像的评估在诊断方面具有高度一致性（Cohen's kappa=0.80 和 0.78）。同样，转诊也达成了很大的一致性。两名评估者对可转诊视网膜病变的敏感度分别为 78%（95%置信区间[CI]，57%-91%）和 78%（95% CI，57%-91%），而特异性分别为 99%（95% CI，95%-99%）和 98%（95% CI，93%-99%）。对于医生诊断的确定性感知，93.8%和 90.3%的医生认为诊断是确定或可靠的。总的来说，97.4%的参与者对他们的体验感到满意，并非常重视远程医疗服务。
基于新型眼底相机的远程医疗筛查在真实环境中检测有临床意义的视网膜病变具有很高的准确性。它实现了高患者满意度和医生感知诊断的确定性，并具有可靠的图像质量，这可能在全球大流行下在国际范围内扩展，以克服地理障碍。
