Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses
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DOI：
10.1136/bjophthalmol-2018-313451
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发表时间：
2019-12-01
影响因子：
4.1
通讯作者：
Katz, L. Jay
中科院分区：
文献类型：
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作者：
Hark, Lisa A.;Myers, Jonathan S.;Katz, L. Jay
目的评价远程医疗眼科筛查（就诊1）的眼部表现与全面眼科检查（就诊2）的诊断之间的一致性。方法采用基于初级保健实践（PCP）的远程医疗筛查方案，结合眼底摄影、眼压（IOP）和临床资料进行筛查。符合条件的个人是40岁以上的非洲裔美国人、西班牙裔/拉丁裔或亚洲人；65岁以上的白种人；年龄在40岁以上且有青光眼或糖尿病家族史的任何种族的成年人。有异常图像或IOP升高的参与者被邀请返回进行完整的眼科检查。第一次和第二次访问均在参与者当地的PCP进行。第一次就诊时的眼部检查结果和第二次就诊时的眼科检查诊断，包括费用分析。结果906名参加访视的患者中，有536人因视力或图像不清晰而被邀请访视。在347名（64.9%）就诊的患者中，2280名（80.7%）被诊断患有至少一种眼部疾病。参与者主要是女性（59.9%）和非裔美国人（65.6%），平均年龄（+/- SD）为60.6 +/- 11.0岁。在第1次就诊和第2次就诊之间，任何眼部发现的诊断确认率都很高（86.0%）。183例就诊时神经可疑的患者中，143例（78.1%）就诊时诊断为青光眼或疑似青光眼。结论该筛选模式可在国内外推广应用。如果检测到异常或无法读取的眼底图像或IOP低于21毫米汞柱，应转诊给眼科医生。
Aims To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). Methods A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. Results Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (+/- SD) of 60.6 +/- 11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. Conclusions This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg.