以防盲及健康评估为目标的区域性电子健康体系研究项目简介

要点 ·拟建立国际最大的虚拟眼科医院,以各区域重点眼科中心为主建立眼科影像远程会诊的示范区 ·创新防盲模式.建立农村以白内障为主的防盲模式,城市以可预防盲防治为主的筛查模式 ·构建多学科协作的电子健康体系,对专科医院、社区医院及健康体检中心进行远程眼科会诊,通过视网膜微血管改变评估健康 ·建立眼科远程医疗的规范及标准,开发眼科远程医疗的硬件及软件     

远程眼保健计划可持续发展的战略思考

要点 ·远程医疗作为新型医疗服务模式,已逐渐为政府、医院、医生和患者普遍接受 ·眼科作为以影像学为主的学科,开展远程医疗有得天独厚的优势 ·为了保证远程眼科可行性、有效性和可持续发展,必须考虑以下内容:(1)明确需求;(2)互动性与安全性;(3)产出评价;(4)组织的和人为因素;(5)适应性和可扩展性;(6)最大可使用性     

纵向网格的社区医疗与远程眼科

要点 ·现行的医疗保健模式难于满足社区卫生服务要求,导致社区人群"看病难,看病贵" ·纵向网格化医疗是对目前卫生医疗资源存在的"纵向应用不充分,横向协同不足"的现状进行改革尝试 ·远程眼科是以眼保健为目的储存-传输或互动、实时的信息系统.通过远程眼科与大医院眼科建立的远程会诊,可以跨地区、时区为社区眼病患者提供高质量的眼科服务 ·远程眼课促进了纵向网格化社区医疗的建立,并为社区眼保健提供一种低成本、高成效的眼病防治模式     

眼科及防盲在医疗改革示范中的优势

目前在我国多数初级医疗机构中尚缺乏初级眼保健服务,由于多数眼科疾病的诊断以影像学检查为主,因此眼科及防盲在远程医疗、电子健康领域中具有技术优势及需求市场。我们根据地区经济水平、医疗条件探索了不同的防盲模式：在城市社区开展可预防盲防治模式,在农村开展可治愈盲防治模式,提倡将初级眼保健与初级卫生保健进行整合。开展数字眼科区域协同医疗有利于共享信息,提高效率与质量以及全方位管理,但需要政府的主导作用及政策支持。     

眼科人工智能在远程医疗中的应用

当下,我国眼科的发展存在失衡现象,大城市与农村及偏远地区在眼科相关诊疗设施水平、诊疗技术等方面存在巨大差异,仍需探寻新的智能诊疗模式以解决失衡问题。由于眼球是唯一可以直接观察人体血管和神经的器官,眼部可反映其他脏器的健康状态,部分眼科检查的医学图像可对眼部疾病做出诊断等特点,眼科开展人工智能(artificial intelligence,AI)具有独到的优势。此外,人工智能可在一定程度上提高跨时间空间传递信息的精准度及效率。人工智能在眼科及远程信息传递的优势为解决眼科发展失衡状况提供了助力。本文从眼科人工智能在眼科远程医疗相关应用的角度,主要分析并总结当下我国人工智能在眼科相关疾病远程医疗中的发展程度、所具优势以及存在问题,并讨论眼科人工智能在远程医疗的应用展望。     

远程眼科眼底照相机外眼及眼前节像质量标准(征求意见稿)

目前远程眼科医疗工作中传输的眼底像多数是采用每眼单张后极部45o眼底像。眼底像质量是决定远程眼科阅片筛查与诊断质量的基础[1]。为了提高远程眼科服务质量,国家卫生计生委医疗服务标准委员会委托北京市眼科研究所草拟了远程眼科影像学诊断标准。其中的单张眼底像质量标准见参考文献2。对于眼底像因屈光间质混浊而照不清楚者,应同时提供眼底照相机照的外眼及眼前节像。外眼及眼前节照相以裂隙灯显微镜照相     

眼科远程医疗在中国西部地区面临的机遇与挑战

要点 ·中国西部地区地域辽阔,眼科资源的分布有待于进一步调整 ·远程眼科医疗使基层医疗单位与区域中心医院建立有机联系,有利于解决西部地区部分眼病患者的看病难问题     

青光眼视神经损害的远程筛查标准(征求意见稿)

为了提高远程眼科服务质量,国家卫生计生委医疗服务标准委员会委托北京市眼科研究所草拟了远程眼科影像学诊断标准。现将青光眼视神经损害的远程筛查标准的征求意见稿刊出,供眼科同道商榷。青光眼视神经损害远程筛查以眼底数码照相作为判定的基础。眼底数码照相质量标准见参考文献[1]。一、青光眼视神经损害的判定标准出现以下2条之一者可判定存在青光眼视神经损害:(1)正常视盘首先在颞下方或颞上方发     

2015年至2021年国家远程医疗中心眼科远程会诊医疗现状分析

目的:观察眼科远程会诊患者人口资料、疾病构成情况及远程会诊的便利性。方法:回顾性研究。回顾性分析2015年至2021年于郑州大学第一附属医院国家远程医疗中心眼科远程会诊患者的人口资料、变化趋势以及远程会诊疾病分类及参与远程会诊医院情况等信息,并对患者远程会诊等待时间、远程会诊医师级别构成等数据进行分析。结果:7年期间通...     

本期导读

本期以远程眼科学为重点报道内容。远程医疗包括远程眼科属于互联网医疗的重要组成部分,眼科在远程医疗中具有独特的优势,眼科多数疾病的诊断主要基于影像学检测,眼科影像检测多无创、快捷、图像小而便于互联网甚至是移动终端传输。徐亮等在“互联网医疗是眼科发展不容忽视的机遇”述评中提出,为保证眼科互联网医疗发展的质量及安全性,需对眼科互联网医疗的具体内容、应用范畴以及各种眼科影像检测方法及互联网传输的标准化等问题进行研究。互联网医疗为眼科学发展带来了不容忽视的机遇,但互联网医疗不能取代面对面的传统诊疗,眼科互联网医疗是对传统眼科诊疗服务有益的补充及发展。张琪等在“远程眼科阅片筛查疾病谱初步分析”一文中,回顾性分析了2015年3-4月来自54家不同地域基层医院远程传输的1192例患者资料,结果显示目前远程眼科阅片筛查诊断中,较常见的全身性疾病眼部表现主要是高血压性视网膜病变、糖尿病视网膜病变,较常见的眼病主要是白内障、黄斑前膜、病理性近视、青光眼等。这些疾病在50岁以上者更常见,且高血压性视网膜病变在黄河以北地区的患者中更常见。提示目前对于高血压、糖尿病等全身性慢病有效防治的迫切性,并且在50岁之前即应重视这些疾病的防控以利于防止其器官并发症发生。此外,广泛开展白内障防盲手术目前仍是各级医院眼科十分重要的任务。苏炳男等在“远程眼科阅片服务中基层医院上传图像的质量评估分析”一文中,回顾性分析了38家基层医院传输的158例患者资料的质量。结果显示,46.8%的患者资料存在至少一种质量缺陷,其中眼底像位置不正、眼底像模糊时缺少外眼像以及眼底像黄斑区暗影是较常见的质量缺陷。提示在远程眼科培训内容的宽度、深度以及人员管理等方面尚需进一步规范,这些质量缺陷通过提高远程眼科参与者的责任心,加强专业知识学习与技能培训以及必要的激励机制等措施有望得到改进,从而提高远程眼科服务质量。
 本期还刊登了眼科其他领域的一些研究结果,欢迎广大读者关注。     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Proximal and accommodative convergence and age

The authors have estimated the phoria for distant and near fixation in two groups of subjects (mean age 27.5 ± 4.4 and 59.2 ± 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower in presbyopic than in nonpresbyopic subjects. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.     

Anesthesia and preoperative and postoperative medications

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.     

Anesthesia and preoperative and postoperative medications

Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti-inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Estrogen and progesterone receptors and human conjunctiva

Freshly frozen conjunctival tissue from premenopausal and postmenopausal women and male subjects were processed for estrogen and progesterone receptors by using monoclonal antibodies and a peroxidase-antiperoxidase technique. No immunocytochemical staining was localized in the nuclei of the cells treated with the monoclonal antibodies to human estrogen receptor or human progesterone receptor in any of the conjunctival specimens, in contrast to the strongly positive staining in breast adenocarcinoma controls. Immunocytochemical staining disclosed no evidence for estrogen or progesterone receptors on cells of the ocular surface.