数码彩色眼底照相对糖尿病视网膜病变早期诊断模式的研究

目的采用直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描等4种方法,对糖尿病视网膜病变患者进行检查和评估,探讨早期糖尿病视网膜病变筛查方法。方法对2009年1月~2010年1月就诊我院眼科门诊的糖尿病患者,进行直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描检查。以荧光素眼底血管造影诊断为标准,分析各种检查结果的敏感性、特异性及与眼底荧光血管造影诊断的一致性。结果以糖尿病视网膜病变1期为筛查阈值时,眼底彩色照相的敏感性、特异性均明显高于直接眼底镜检查,Kappa检验有高度一致性;以糖尿病视网膜病变2期为筛查阈值时,直接眼底镜检查与眼底彩色照相的特异性基本一致,但眼底彩色照相的敏感性明显高于直接眼底镜检查,Kappa检验有高度一致性。同正常组相比,糖尿病视网膜病变1期视网膜各方位厚度并无明显增加,糖尿病视网膜病变2期各方位神经上皮层厚度比相应方位的正常组增加。结论数码彩色眼底照相可作为糖尿病视网膜病变2期以上患者的主要筛查诊断方法。     

光学相干层析成像的视网膜层状结构自动分割

目的利用算法实现对视网膜层状结构的自动分割及定量分析是光学相干层析成像技术应用于青光眼及视网膜病变早期诊断的关键。现存处理方法对图像质量要求较高且可靠性不高。该文拟利用改进的非线性复合扩散滤波等方法解决这个问题。方法首先对自主搭建的OCT系统获得的20幅视网膜图像,通过自动阈值、改进的非线性复合扩散滤波、形态学操作、峰值探测等综合算法,进行分割,比较准确的分割出内界膜（ILM）、外核层（ONL）、内节层和外节层（IS/OS）以及视网膜色素上皮与脉络膜层（RPE_ChCap）边界,最后测量得到视网膜的厚度。结果本算法对视网膜的分割与专家手动测量有较好的一致性,视网膜中心凹测量结果与Zeiss Stratus OCT视网膜中心厚度212±20μm数据一致。结论该文提出的算法有希望应用于临床视网膜疾病的诊断。     

河北怀来地区老年人视力状况及影响因素分析

目的分析影响河北怀来地区老年人视力的主要因素。方法对2010年1月~2012年12月在河北怀来县医院眼科门诊就诊的70岁以上的老年人行眼科常规查体,对矫正视力低于1.0的患者行直接、间接检眼镜检查、视野、眼底荧光血管造影(FFA)、吲哚青绿脉络膜血管造影(ICGA)、光学相干断层扫描(OCT)等检查,找出病因。结果共有2960人(5920眼)参与检查,其中白内障4410眼(74.50%),老年性黄斑变性(AMD)1440眼(24.32%),青光眼252眼(4.25%),单纯性视神经萎缩133眼(2.25%),眼底视网膜病变(糖尿病视网膜病变、视网膜静脉阻塞等)146眼(2.47%)。影响视力的主要原因是白内障、AMD、青光眼、视神经萎缩及眼底视网膜病变。结论老年人眼部疾病明显增多,加强宣传眼病防治知识可有效改善老年人的生活质量。     

Fundus imaging and the telemedical management of diabetes

Diabetes is the major preventable form of blindness among people of working age in the Western world, despite the improvements in laser photocoagulation treatments. It is known that regular glycaemic control and annual retinal screening of people with diabetes can reduce its incidence. Effective treatment needs to be available but also screening methods which are simple to perform and cost-effective should be implemented. It will be important in future to integrate digital images of the fundus into the health records of diabetic patients. Screening programmes for the detection of diabetic retinopathy aided by image-processing software for processing fundus images will save manpower and increase quality. Before this can happen, we need more clinical studies of store-and-forward techniques, so that they can be standardized and their effectiveness established against that of traditional analogue screening.     

神经纤维层厚度与屈光不正和年龄的关系研究

目的 运用偏相关分析评估通过光学相干断层扫描（OCT）测量健康人神经纤维层厚度（RNFL）与屈光不正和年龄的相关性.方法 对106例健康受试者的右眼的各个钟点、各象限和整个RNFL平均厚度进行横断面分析,其中高度近视33例（SE〈-6.0 D）,中度近视60例（-6.0 D≤SE〈-3.0 D）,低度近视和正视眼13例（-3.0 D≤SE〈0.5 D）,用偏相关分析来评估RNFL和等效球径（SE）和年龄的相关性.结果 高度近视眼中平均RNFL厚度（95.74±13.46）μm比中度近视眼（101.43±11.53）μm以及低度近视和正视眼（108.06±8.42）μm的RNFL厚度要薄（P〈0.05）.1、5、6和12钟点处以及上下方象限的RNFL厚度和平均RNFL厚度与SE呈正相关（r=0.36,0.33,0.43,0.29,0.28,0.39,P〈0.01,r=0.22,P〈0.05）,而8、9和10点处以及颢侧象限的RNFL厚度随着近视的发展与SE呈负相关（r=-0.21,P〈0.05,r=-0.36,P〈0.01;r=-0.24,P〈0.05;r=-0.30,P〈0.01）.2、3、4、6钟点处以及鼻侧和下方RNFL厚度的变化同年龄具有相关性（r=-0.20,-0.20,-0.20,P〈0.05,r=0.31,P〈0.01）.结论 RNFL厚度随着屈光不正和年龄的变化而变化,运用RNFL厚度评估青光眼要考虑屈光状态和年龄,同时要了解RNFL厚度变化所在的位置.     

光学相干断层成像术对近视眼视网膜神经纤维层厚度的临床研究

目的研究人视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度随近视屈光度变化的特点及对开角型青光眼早期诊断的意义。方法选择2011年7月²013年6月62例(106眼)近视眼患者,分为低、中、高度3组和对照组25例33眼,用光学相干断层成像术(optical coherence tomography,OCT)进行视网膜神经纤维层厚度测量,研究近视眼平均视网膜神经纤维层厚度与屈光度的相关性,并比较各近视组与正常组神经纤维层厚度的差别,及鼻、上、颞、下4个象限的分区视网膜神经纤维层厚度的特点。计量资料用采用t检验。近视眼平均神经纤维层厚度与屈光度之间关系采用直线相关分析,P<0.05为差异有统计学意义。结果低、中、高度近视组平均RNFL厚度测量值分别为(116.52±9.60)、(116.96±7.89)、(102.13±12.54)μm,对照组平均RNFL厚度测量值为(109.45±8.29)μm。高度近视组平均RNFL厚度与对照组相比差异有统计学意义(P<0.05)。近视眼平均神经纤维层厚度与屈光度成负相关关系(r=-0.534,P<0.05)。低度近视组只有鼻侧RNFL厚度与正常组相比差异有统计学意义(P<0.05);中度近视组鼻侧RNFL厚度与正常组比较差异有统计学意义(P<0.05),而且下方也有差异有统计学意义(P<0.05);高度近视组上方、下方及鼻侧RNFL厚度均变薄,与正常组相比差异有统计学意义(P<0.05),高度近视组上方、下方和鼻侧RNFL厚度分别与中度近视组相比差异有统计学意义(P<0.05)。结论近视眼平均RNFL厚度随屈光度的增加而减少,分区分析可以发现:除颞侧外,上、下及鼻侧视网膜神经纤维层变化与平均相一致。对近视眼患者应采用不同的指标结合RNFL厚度下降辅助诊断早期青光眼。     

Optical coherence tomography, an important new tool in the investigation of the retina

Optical coherence tomography, an important new tool in the investigation ofthe retina Recently optical coherence tomography (OCT) has been introduced into the field of ophthalmology to enhance visualization ofthe various retinal layers. OCT uses interference of near infra-red, low-coherent light reflected from the retina and from a reference mirror, to create transverse sections of the retina. The strength of the signal is a measure of the reflection of the retinal layer which is situated at the same distance from the light source as the mirror. Accurate placement ofthe mirror gives a transverse view of the retina with an axial resolution of 10 microm, with which the resolution of a histological section can be approximated. OCT is used in ophthalmic diseases such as macular oedema, macular holes and other abnormalities on the retinal-vitreous border, following photodynamic therapy and in treating glaucoma. OCT has been used to detect early glaucoma by measuring the thickness of the retinal nerve fibre layer. OCT and fluorescence angiography complement one another as diagnostic methods but OCT is superior in the diagnosis of macular oedema and macular holes. OCT provides images of retinal pathology which can easily be interpreted by both ophthalmologists and patients.     

光学相干断层扫描定量糖尿病性黄斑水肿的黄斑厚度及与视功能相关分析

目的 观察糖尿病性黄斑水肿(DME)的光学相干断层扫描(OCT)临床特征,并探讨其与视功能改变的相关性.方法 40例49眼DME患者(DME组)及31例31眼无DME患者(对照组)分别应用OCT进行黄斑厚度定量分析,同时采用图形视觉诱发电位(P-VEP)及黄斑10°视野平均缺损(MD)指数检查视功能,根据DME组有无合并增生型糖尿病视网膜病变分为A组(非增生型糖尿病视网膜病变+DME,30眼)和B组(增生型糖尿病视网膜病变+DME,19眼).结果 DMEOCT图像定量分析发现,DME组黄斑厚度[(299.25±63.87)μm]较对照组[(204.35±37.94)μm]增厚,且视力、MD指数受损更为严重,其差异有统计学意义(P＜0.05).A组与B组的黄斑厚度、视力、MD指数比较差异均无统计学意义(P＞0.05);OCT黄斑厚度与视力存在线性负相关(r=-0.437,P＜0.05);OCT黄斑厚度与MD指数存在线性正相关(r=0.441,P＜0.05).结论 OCT为评估DME的发生、发展及疗效判断提供了一种有效、客观的检测手段,随着黄斑厚度的增加,视功能指标中视力下降、黄斑10°视野受损程度加重.

Abstract：

Objective To explore the clinical features of diabetic macular edema (DME) with optical coherence tomography (OCT) and correlation with visual function. Methods Forty-nine eyes from 40 patients with DME (DME group) and 31 eyes from 31 patients without DME (control group) were examined with OCT,pattern reversal visual evoked potentials (P-VEP),macular perimetry. According to proliferative diabetic retinopathy (PDR), 49 eyes with DME were divided into group A (without PDR, 30eyes) and group B (with PDR, 19 eyes). Results The retinal macular thickness of central fovea in DME group [(299.25±63.87)μm] was more than that in contol group [(204.35 ± 37.94)μm], visual acuity and macular visual field in DME group were significantly different than those in control group, respectively (P ＜ 0.05). The retinal macular thickness of central fovea,visual acuity and visual field were no significant differences between group A and group B (P＞0.05). OCT macular thickness and visual correlation coefficient was -0.437(P＜ 0.05 ); OCT macular thickness and mean defect correlation coefficient was 0.441(P ＜ 0.05). Conclusions OCT can provide a useful tool for monitoring the occurrence and development of DME, can assess the response to treatment. With increasing of the macular retinal thickness, the visual acuity and macular visual field of visual function are more damaged.     

免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效评价

目的:探索免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效。方法:本次研究对象为100例疑似糖尿病视网膜病变患者,均进行免散瞳眼底照相仪检查,随访分析此项检查在视网膜病变分期中正确率以及图像质量。结果:免散瞳眼底照相仪图像质量可以评估的有78.05%,对视网膜病变Ⅰ期诊断正确率为96.00%,对Ⅱ期诊断正确率为95.83%,对Ⅲ期诊断正确率为94.74%,对Ⅳ期诊断正确率为94.44%。同时对糖尿病视网膜病变敏感度为95.35%,特异度为92.86%,漏诊率为4.65%,误诊率为7.14%。结论:在评估糖尿病视网膜病变患者时,运用免散瞳眼底照相仪检查,可及时发现眼底病变,为后期随访提供详细参考信息。     

上海市中心城区2型糖尿病患者视网膜病变现况调查

目的评价上海市中心城区成年人2型糖尿病患者糖尿病视网膜病变的患病率及相关因素。方法采用整群抽样方法选取上海市中心城区30岁以上已诊断为2型糖尿病的患者1039例，其中资料完整者767例纳入本研究。结果（1）767例患者完成1534张眼底摄片，其中不能分级者95例（12．4％），可以分级者672例（87．6％）；（2）非增殖期糖尿病视网膜病变145例，占可分级2型糖尿病患者的21．6％，其中轻度59例（8．8％）、中度75例（11．2％）、重度11例（1．6％），增殖期糖尿病视网膜病变9例（1．3％）；（3）糖尿病视网膜病变者较非病变者年龄更长，糖化血红蛋白、尿素氮和肌酐更高，逐步logistic回归分析显示糖尿病病程及空腹血糖水平为糖尿病视网膜病变的危险因素。结论上海市中心城区30岁以上已诊断2型糖尿病患者视网膜病变的现患率为22．9％，空腹血糖和糖尿病病程是影响因素。     

The potential of digital monochrome images versus colour slides in telescreening for diabetic retinopathy

We explored the potential of digital monochrome images as an alternative to colour slides in screening for diabetic retinopathy. Twenty-eight patients with diabetes were recruited for the study and 20 actually participated. Using a fundus camera (Nikon 505AF) one set of three digital images and one set of three colour slides were taken per eye. Two independent ophthalmologists graded the colour slides and the digital images for diabetic retinopathy. The ophthalmologists spent about two minutes grading each set of images, suggesting that specialists could potentially screen a large number of patients. The agreement between the two screening methods was 0.95 and 0.89, with respect to disease or no disease. The agreement (kappa) between the two ophthalmologists for grade of retinopathy was 0.47 when colour slides were employed and 0.61 when digital monochrome images were employed. The results indicate that digital red-free monochrome images represent a superior screening tool for diabetic retinopathy. Tele-screening may be beneficial when patients have to travel substantial distances to visit an ophthalmologist.     

近视眼视网膜神经纤维层厚度与中央角膜厚度相关性研究

目的 探讨近视眼患者视网膜神经纤维层（RNFL）厚度与中央角膜厚度（CCT）之间的关系.方法 选择91例眼科门诊近视患者（91眼）,其中低度近视（等效球镜度数[SE]＞-3.0D）28例（28眼）,中度近视（SE-0.3D～-6.0D）33例（33眼）,高度近视（SE＜-6.0D）30例（30眼）.均接受包括眼压、验光、裂隙灯、眼底等常规眼部检查,排除除屈光不正以外其他眼部疾病.利用RTVue Fourior OCT（Optovue Inc,USA）测量视盘周围RNFL厚度;利用CAM-L模块测量CCT.结果 近视眼患者RNFL厚度是（108.5±10.1）μm,CCT是（524.7±36.8）μm,在低中高近视组差异均无统计学意义（P＞0.05）.单因素相关及多元线性回归分析发现：颞侧（tl1,tu1）RNFL厚度与CCT呈正相关（tl1单因素及多因素r=0.281,0.093;tu1单因素及多因素r=0.352,0.163;P＜0.05）;鼻侧（nl2,nu2）和下方偏鼻侧（in2,in1）区域RNFL厚度与SE呈正相关（P＜0.05）;下方偏颞侧（it2）RNFL厚度与SE呈负相关（P＜0.05）;其他部位RNFL厚度与CCT、SE无相关（P＞0.05）.结论 近视眼视盘周围局部区域RNFL厚度与CCT存在相关性,表明中央角膜厚度与青光眼视神经病变敏感结构指标具有一定关系,对青光眼诊治具有重要指导意义.     

Screening for diabetic retinopathy: review of current methods

Objective: To review the current screening methods for diabetic retinopathy, with a focus on nonmydriatic digital fundus photography. Methods: Articles from Medline were reviewed from 1976 to November 2011 for different combinations of the words "diabetic retinopathy," "screening," "fundus photography," and "nonmydriasis." Results: Because of its ease of use and cost-effectiveness, digital fundus photography is becoming the preferred method for diagnosing diabetic retinopathy. Current research has proven that pupillary dilation is not a necessary step in the fundus examination, although it reduces the number of unnecessary referrals to ophthalmologists. Automated grading systems, while saving time and reducing human error, still need refinement before they can replace manual grading by trained ophthalmologists. Conclusion: Nonmydriatic digital fundus photography with manual grading by a trained technician is an acceptable method of screening for diabetic retinopathy.     

Magnesium deficiency and other risk factors for diabetic retinopathy

A case control study was carried out to detect the relation between magnesium deficiency and diabetic retinopathy and to study other risk factors for diabetic retinopathy. The study involved 30 cases with diabetic retinopathy, 30 diabetics and 30 non-diabetics with normal retina as controls. Serum magnesium was significantly lower in the diabetic control group than both other groups. Significant association between diabetic retinopathy and hypertension, poor control of blood sugar, irregularity in drug treatment, lack of routine fundus examination, high gravidity and low socioeconomic status were found. Multiple regression analysis was used to adjust for all variables mentioned. Magnesium deficiency was found to be statistically significantly associated with diabetic retinopathy after considering the effects of other variables.     

视网膜眼底图像中视盘的检测方法

视盘的准确检测对视网膜眼底图像的其他特征,如血管和微动脉瘤的精确检测非常重要。本文提出一种结合视盘亮度和圆形度特征的视盘检测方法,先对眼底图像进行预处理,然后运用数学形态学运算去除血管的干扰,采用阈值分割提取出可能为视盘的区域,最后再根据视盘的面积和圆形度特征检测出真正的视盘区域。实验结果表明,本文算法具有较高的定位精度和较快的定位速度。     

Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

BackgroundDiabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden.ObjectiveThe aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy.MethodsThis validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression.ResultsIn 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P<.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (P=.04) with diabetic retinopathy.ConclusionsDigital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.     

Screening For Diabetic Retinopathy: Review of Current Methods

Abstract

Objective: To review the current screening methods for diabetic retinopathy, with a focus on nonmydriatic digital fundus photography. Methods: Articles from Medline were reviewed from 1976 to November 2011 for different combinations of the words “diabetic retinopathy,” “screening,” “fundus photography,” and “nonmydriasis.” Results: Because of its ease of use and cost-effectiveness, digital fundus photography is becoming the preferred method for diagnosing diabetic retinopathy. Current research has proven that pupillary dilation is not a necessary step in the fundus examination, although it reduces the number of unnecessary referrals to ophthalmologists. Automated grading systems, while saving time and reducing human error, still need refinement before they can replace manual grading by trained ophthalmologists. Conclusion: Nonmydriatic digital fundus photography with manual grading by a trained technician is an acceptable method of screening for diabetic retinopathy.     

Picture archiving and fundus imaging in a glaucoma clinic

Ophthalmological image archiving and distribution can be automated using a picture archiving and communication system (PACS). A fundus PACS has been in clinical use since February 2000 at the ophthalmology clinic of Tampere University Hospital. It consists of a digital fundus camera, an imaging workstation, from which new patients can be added to the archive, 10 viewing stations and an image archive server. In glaucoma imaging, the fundus images taken from a patient are transferred from the imaging workstation to the image archive server and are then immediately available from the physician's viewing workstation; the transfer time of an average image, of 350 kbit, is 0.0035 s, even though the archive is located 5 km away. After 18 months of operation there were over 16,000 images archived; these took 5.3 GByte of a total storage capacity of 41.9 GByte. The network and archive server achieved 99% reliability in use. Digital imaging makes it possible to shift ophthalmology clinics towards more patient-oriented treatment procedures.     

Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine

Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.     

糖尿病性视网膜病变筛查系统呼叫中心模块设计与实现

糖尿病性视网膜病变是导致眼病患者致盲的重要因素之一,定期的视网膜病变筛查对及时发现病变并治疗有很大的帮助,糖尿病性视网膜病变远程筛查是提高患者筛查依从性的一种有效方法,已经得到广泛认可。本文将对远程糖尿病性视网膜病变筛查系统进行分析,并且提出呼叫中心模块的系统设计方案。该模块由语音卡搭建,文中介绍了系统硬件架构,以及软件的实现。通过测试,本方案所构建的糖尿病性视网膜病变远程筛查呼叫中心模块能够很好地满足整个系统的功能要求,并且结构较为简单,通用性良好。