Remote Screening for Optic Nerve Cupping Using Smartphone-based Nonmydriatic Fundus Photography.
Remote Screening for Optic Nerve Cupping Using Smartphone-based Nonmydriatic Fundus Photography.
复制标题
DOI：
10.1097/ijg.0000000000001680
复制
发表时间：
2021-01-01
影响因子：
2
通讯作者：
Ramsey DJ
中科院分区：
文献类型：
--
作者：
LaMonica LC;Bhardwaj MK;Hawley NL;Naseri T;Reupena MS;Cooper ML;Cotran PR;Roh S;Ramsey DJ
利用低成本、手持式无散光眼底相机研究影响青光眼疑似视盘状态的评分一致性的因素。一名外行检查人员使用iPhone 6S附带的PanOptic iExaminer对萨摩亚独立国家的206名参与者进行了彩色眼底照片采集。图像由眼科医生和验光师远程分级，确定有青光眼风险的参与者的图像升级到青光眼专科进行审查。眼底照片亮度，对比度和焦点测量使用杯，边缘，和颞区的椎间盘。立体图像对随后产生从一个子集的个别非散体照片。在16.0%（33/206）的参与者中发现了视盘拔罐提示青光眼的特征。评分者之间有中等程度的一致性（90.3%），k=0.53 （95% CI=0.33-0.73）。杯盘比及其差异的类内相关系数分别为0.84 （95% CI=0.81-0.87）和0.68 （95% CI=0.59-0.75）。在确定的33名参与者中，经专科医生审查，94%具有潜在青光眼的临床风险标准。彩色眼底照片杯的亮度与杯盘到椎间盘（CDR）分级显著相关，R2 = 0.36 (p<0.001)，其中椎间盘越亮CDR越高。基于智能手机的筛查是一种简单、低成本的方法，能够测量视神经的CDR。当与其他青光眼危险因素（如眼压）的检测相结合时，这种测量CDR的方法可以帮助识别那些应该进行进一步眼科评估的患者。我们目前正在进行研究，以评估基于智能手机的远程筛查的敏感性和特异性。在萨摩亚独立国家，对使用低成本智能手机相机拍摄的非散瞳眼底照片进行评估，有助于对视神经杯盘比扩大的患者进行远程筛查，萨摩亚是一个服务不足的国家，全国只有一名全职眼科医生。
To investigate factors that impact inter-rater agreement of glaucoma suspect optic disc status using a low-cost, handheld non-mydriatic fundus camera. Color fundus photographs were obtained using the PanOptic iExaminer attached to an iPhone 6S by a lay examiner on 206 participants in the Independent Nation of Samoa. Images were remotely graded by an ophthalmologist and optometrist and images from participants identified as at-risk for glaucoma were escalated to a glaucoma subspecialist for review. Fundus photo brightness, contrast, and focus were measured using the cup, rim, and temporal regions of the disc. Stereoscopic image pairs were subsequently generated from a subset of individual non-mydriatic photographs. Features suggestive of glaucoma based on optic disc cupping were identified in 16.0% (33/206) of participants. There was moderately strong agreement between graders (90.3%) with k=0.53 (95% CI=0.33-0.73). The intra-class correlation coefficients for the cup-to-disc ratio and its difference were 0.84 (95% CI=0.81-0.87) and 0.68 (95% CI=0.59-0.75). Of the 33 participants identified, 94% had clinical risk criteria for potential glaucoma when reviewed by a subspecialist. Color fundus photograph cup brightness was significantly associated with cup-to-disc (CDR) grade, R2 = 0.36 (p<0.001) in which a brighter disc yielded a higher CDR. Smartphone-based screening is a simple, low-cost method capable of measuring the CDR of the optic nerve. When combined with testing for other glaucoma risk factors such as intraocular pressure, this method of measuring CDR may help identify those patients who should be referred for further ophthalmologic assessment. We are currently conducting studies to assess the sensitivity and specificity of smart phone-based remote screening. Evaluation of non-mydriatic fundus photographs captured with a low-cost, smartphone-based camera facilitated remote screening of patients for enlarged optic nerve cup-to-disc ratio in the Independent Nation of Samoa, an underserved setting with one full-time ophthalmologist in the entire country.