Department of Ophthalmology, Cheltenham General Hospital NHS Foundation Trust, Sandford Road, Cheltenham, GL53 7AN, UK.
Department of Ophthalmology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
Eye (Lond). 2023 Jun;37(9):1885-1889. doi: 10.1038/s41433-022-02233-w. Epub 2022 Sep 27.
BACKGROUND/OBJECTIVES: In recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty.
SUBJECTS/METHODS: Fifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire ('History'), and the questionnaire with the photo ('History with Image'), as well as rate their clinical confidence on a 1-5 scale.
Diagnostic accuracy was significantly higher in "History with Image" (98.2%), when compared to "History" only (48.2%). "History with Image" prevented significantly more appointments when compared to "History" alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between 'History with Image' and 'Clinic' appointments was similar. Clinical'Confidence was significantly higher at 4.5 with 'History with Image' when compared to 2.37 with 'History Only'.
A low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.
背景/目的：近年来，眼科急诊患者数量显著增加，而就诊能力却有所下降。COVID-19 加剧了这一问题，并展示了远程医疗作为解决方案的潜力。我们的研究评估了基于智能手机的镜头附件在改善眼科急诊前节相关投诉转诊途径方面的潜在益处。
受试者/方法：招募了 54 名连续的前节抱怨患者。每位患者都填写了一份问卷，以模拟从转诊点的病史。使用智能手机镜头拍摄白光和钴蓝光照片。负责审查患者的临床医生被要求记录实际诊断以及他们认为患者可以安全就诊的时间框架；包括在分诊时提供管理建议的情况下和不提供管理建议的情况下。随后的图像和问卷由一位独立于数据收集过程的单一顾问眼科医生进行审查。评估员被要求根据问卷（“病史”）以及带有照片的问卷（“病史与图像”）做出诊断和管理计划，并根据 1-5 的等级评估他们的临床信心。
与仅“病史”相比，“病史与图像”的诊断准确性显著更高（98.2%）。与仅“病史”相比，“病史与图像”可显著减少预约次数，且与回顾性门诊评估相似。如果可以提供临床建议，则可增加可避免的预约。“病史与图像”和“门诊”之间的预约时间框架相似。与仅“病史”相比，“病史与图像”时的临床“信心”明显更高，为 4.5，而仅“病史”时为 2.37。
低成本的智能手机镜头附件，加上标准化的临床问卷，可以通过减少不必要的预约，改善医院眼科服务的转诊途径，同时在分诊时提高临床信心和诊断准确性。需要进一步开展转诊途径的工作，包括开发允许安全图像传输的系统，以了解广泛采用该技术的可行性。
