Zungu Thokozani, Mdala Shaffi, Twabi Halima Sumayya, Kayange Petros, Gelisken Faik
Ophthalmology, Kamuzu University of Health Sciences, Blantyre, Malawi.
Ophthalmology, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Klin Monbl Augenheilkd. 2025 Jan 23. doi: 10.1055/a-2441-7861.
The study aimed to assess the reliability of tele-education in training a Malawian ophthalmology resident to interpret optical coherence tomography (OCT) images of patients with macular conditions.
This was a retrospective analysis of 1000 macula-centered OCT image series from 1000 eyes of 1000 consecutive patients from Malawi, which involved initial interpretation by a German retina specialist (observer 1) (T). Observer 1 then trained a Malawian resident (observer 2) via email, and observer 2 independently interpreted images at T, followed by face-to-face training in Malawi and reinterpretation at T and T (3-month intervals). The observers had to recognize, on OCT imaging, the normal macular structure, vitreofoveal traction (VFT), absent fovea depression (FD), epiretinal membrane (ERM), lamellar macular hole (LMH), full-thickness macular hole (FTMH), foveoschisis, intraretinal pseudocyst (IPC), intraretinal hyperreflective foci (IHF), subretinal fluid (SRF), pigment epithelial detachment (PED), and drusen. Cohen's Kappa statistic measured inter-observer agreement.
At T post-tele-education, almost perfect agreement (κ = 0.86; 99.6% agreement) was observed for FTMH. Agreement remained high at T post-face-to-face training (κ = 0.9; 99.7%) and decreased substantially at T (κ = 0.77; 99.4%). Following tele-education (T), substantial agreement (κ range: 0.77 - 0.86) was found for IPC, PED, IHF, and FD, while ERM showed fair agreement (κ = 0.33; 81%). Face-to-face training notably improved agreement for SRF (T κ = 0.6, T κ = 0.63), LMH (T κ = 0.6, T κ = 0.67), and normal macular structure (T κ = 0.6, T κ = 0.62).
There was good agreement in the detection of the majority of the OCT features seen in most of the macular pathologies following training through tele-education and the results did not change significantly following face-to-face teaching. Tele-education could reliably complement training in vitreoretinal diagnostic skills in resource-limited settings.
本研究旨在评估远程教学在培训马拉维眼科住院医师解读黄斑疾病患者光学相干断层扫描（OCT）图像方面的可靠性。
这是一项对来自马拉维的1000例连续患者的1000只眼睛的以黄斑为中心的OCT图像系列进行的回顾性分析，其中包括由一位德国视网膜专家（观察者1）（T）进行的初始解读。观察者1随后通过电子邮件培训一名马拉维住院医师（观察者2），观察者2在T时独立解读图像，随后在马拉维进行面对面培训，并在T和T（间隔3个月）时重新解读。观察者必须在OCT成像上识别正常黄斑结构、玻璃体黄斑牵引（VFT）、无黄斑凹陷（FD）、视网膜前膜（ERM）、板层黄斑裂孔（LMH）、全层黄斑裂孔（FTMH）、黄斑劈裂、视网膜内假性囊肿（IPC）、视网膜内高反射灶（IHF）、视网膜下液（SRF）、色素上皮脱离（PED）和玻璃膜疣。采用Cohen's Kappa统计量测量观察者间的一致性。
在远程教学后的T时，对于FTMH观察到几乎完美的一致性（κ = 0.86；一致性为99.6%）。在面对面培训后的T时一致性仍然很高（κ = 0.9；99.7%），而在T时显著下降（κ = 0.77；99.4%）。在远程教学（T）后，对于IPC、PED、IHF和FD发现有实质性一致性（κ范围：0.77 - 0.86），而ERM显示出一般一致性（κ = 0.33；81%）。面对面培训显著提高了对于SRF（T时κ = 0.6，T时κ = 0.63）、LMH（T时κ = 0.6，T时κ = 0.67）和正常黄斑结构（T时κ = 0.6，T时κ = 0.62）的一致性。
通过远程教学培训后，在大多数黄斑病变中观察到的大多数OCT特征的检测方面有良好的一致性，并且在面对面教学后结果没有显著变化。在资源有限的环境中，远程教学可以可靠地补充玻璃体视网膜诊断技能的培训。
