Use of telemedicine in screening for diabetic retinopathy
Use of telemedicine in screening for diabetic retinopathy
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DOI：
10.1016/s0008-4182(03)80111-4
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发表时间：
2003-12-01
影响因子：
4.2
通讯作者：
Chow, DR
中科院分区：
文献类型：
--
作者：
Choremis, J;Chow, DR
背景：为了满足负担过重的医疗保健系统的需求，蒙特利尔一家大学附属医院于 2000 年 9 月推出了糖尿病视网膜病变筛查计划。在这篇文章中，我们描述了我们对该项目的初步体验。方法：在该院内分泌门诊安装一台佳能CR6-45NM免散瞳45度相机。 2000 年 9 月至 2001 年 1 月期间到过该诊所的所有患者都同意参加该计划。对于每位患者，填写一份简短的调查问卷（年龄、性别、糖尿病类型、自诊断以来的时间、既往视网膜激光治疗以及是否存在终末器官受累）。随后，每只眼睛至少获得两张照片。这些照片通过医院内联网发送给医院内的视网膜专家。专家对图像进行了未修改的检查，并通过医院内网向内分泌科发送了一份报告（糖尿病视网膜病变的程度分级、是否存在黄斑硬渗出物、所获得图像的质量以及后续建议）。如果视网膜专家判断图像质量较差且无法读取，则要求患者去看他或她的常规眼科医生。 结果：获得了 415 名患者（211 名男性和 204 名女性，平均年龄为 57.5 岁）的 830 只眼睛的图像。大多数 (83.6%) 患有 2 型糖尿病。平均病程为13.3年。 50只眼（6.0%）观察到黄斑硬性渗出物。 117 只眼 (14.1%) 出现非增殖性糖尿病视网膜病变，15 只眼 (1.8%) 出现增殖性糖尿病视网膜病变。意外的发现包括视网膜前膜（三只眼睛）、黄斑裂孔（两只眼睛）、双侧棉絮斑（一名患者）和视网膜中央静脉阻塞（一只眼睛）。总体而言，根据筛查照片，10% 的患者被转诊至视网膜专家处。筛选程序遇到的主要困难是图像不一致。总体而言，35% 的分级图像被认为质量较差，最常见的原因是曝光不良 (84.4%)。研究期间图像质量显着提高 (p < 0.01)。从 65 岁或以上患者获得的图像始终比从 65 岁以下患者获得的图像差 (p < 0.001)。 解释：尽管这样的系统存在缺陷，但我们的经验是有利的，使我们能够以经济高效、可靠的方式筛查大量患者。
Background: A diabetic retinopathy screening program was introduced in September 2000 at a university-affiliated hospital in Montreal to meet the demands of an overburdened health care system. In this article we describe our initial experience with this program.Methods: A Canon CR6-45NM nonmydriatic 45degrees camera was installed in the outpatient endocrinology clinic of the hospital. All patients who visited the clinic between September 2000 and January 2001 agreed to participate in the program. For each patient, a short questionnaire (age, sex, type of diabetes mellitus, time since diagnosis, prior retinal laser therapy and presence of end-organ involvement) was filled in. Subsequently at least two photographs were obtained of each eye. The photographs were sent via the hospital intranet to a retinal specialist within the hospital. The specialist reviewed the images unchanged and sent a report (grading of the level of diabetic retinopathy, presence or absence of macular hard exudates, quality of the images obtained and follow-up recommendations) via the hospital intranet to the endocrinology service. If the images were judged to be of poor quality and could not be read by the retina specialist, the patient was asked to see his or her regular ophthalmologist.Results: Images of 830 eyes of 415 patients (211 men and 204 women with a mean age of 57.5 years) were obtained. Most (83.6%) had type 2 diabetes. The average duration of disease was 13.3 years. Macular hard exudates were observed in 50 eyes (6.0%). Nonproliferative diabetic retinopathy was noted in 117 eyes (14.1%) and proliferative diabetic retinopathy in 15 eyes (1.8%). Unexpected findings included epiretinal membranes (in three eyes), macular holes (in two), bilateral cotton-wool spots (in one patient) and central retinal vein occlusion (in one eye). Overall, 10% of the patients were referred to a retina specialist based on the screening photographs. The main difficulty encountered with the screening program was image inconsistency. Overall, 35% of the images graded were felt to be of poor quality, the most common reason being poor exposure (84.4%). The quality of the images improved significantly over the study period (p < 0.01). Images obtained from patients aged 65 years or more were consistently poorer than those obtained from patients less than 65 years of age (p < 0.001).Interpretation: Despite the imperfections of such a system, our experience was favourable, allowing us to screen large numbers of patients in a cost-effective, reliable manner.