Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability
Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability
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DOI：
10.1097/ico.0000000000001294
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发表时间：
2017-10-01
期刊：
影响因子：
2.8
通讯作者：
Lee, Paul P.
中科院分区：
文献类型：
--
作者：
Woodward, Maria A.;Musch, David C.;Lee, Paul P.
目的：角膜和眼前段疾病是眼科专家紧急就诊的主要原因。我们评估了使用2个便携式摄像机的外部照片来检测远程医疗目的的角膜疾病的诊断准确性。方法：这是一项针对临床诊断为角膜擦伤、溃疡、疤痕和翼状胬肉的成人的前瞻性研究。角膜专家通过裂隙灯检查提供了黄金标准的诊断。使用iTouch 5S和Nidek VersaCam摄像机在多个视线下获取双眼图像，并由3名角膜专家解释是否存在病理。检测疾病的准确性与金标准诊断进行比较，并按相机和分级进行分层。信度评价采用加权kappa统计法。评分员对图像质量进行了Likert评分，从1(差)到9(最佳)。结果：总共拍摄了198只眼(110名受试者)。按金标准诊断，59只眼(30%)有角膜瘢痕，34只眼(17%)有溃疡，13只眼(7%)有擦伤，10只眼(5%)有翼状疱疹，82只眼(41%)正常。在不同分级者中，检测AS病理的敏感性iTouch为54%至71%，Nidek为66%至75%；特异性为iTouch为82%至96%，Nidek为91%至98%。ITouch的卡帕范围为0.54-0.71；Nidek的卡帕范围为0.75-0.76。不同等级之间的质量评级是不同的。结论：由标准的非增强型便携式相机拍摄的外部照片，并由眼科医生分级人员远程解读，得到的敏感值还不适合远程医疗应用。还需要进一步的工作来提高远程检测AS病理的能力。
Purpose: Corneal and anterior segment diseases cause most of the urgent visits to eye care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from 2 portable cameras for telemedicine purposes.Methods: This is a prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A cornea specialist provided the gold standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for the presence of pathology. Accuracy to detect disease was compared with gold standard diagnosis, stratified by the camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal).Results: A total of 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54% to 71% for the iTouch and 66% to 75% for the Nidek, across graders; specificity ranged from 82% to 96% for the iTouch and 91% to 98% for the Nidek. The intergrader reliability was moderate to strong (kappa ranges: 0.54-0.71 for the iTouch; 0.75-0.76 for the Nidek). Quality ratings were variable between graders.Conclusions: External photographs taken by standard, nonenhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.