该眼部疾病可以通过远程医疗成功筛选

24个月前重返列表：中介

2014年6月26日-训练非医师评估研究视网膜图像在远程中心阅读中心成功确定新生儿可能需要专门的医疗评估早产儿视网膜病变（ROP）传输到电脑屏幕，可治疗失明的主要原因。

从一个新的多中心研究结果加强使用远程医疗解决早产儿全世界谁不能由眼科医生初步评估未满足的医疗需求的情况下。

“这项研究提供了一个远程医疗方法的验证与ROP筛查可能有助于防止成千上万的孩子失明，”首席研究员格雷厄姆E。奎因，医学博士，MSCE说，在费城儿童医院的研究者在ROP长期经验的儿科的眼科医生。奎因也是一个眼科教授在宾夕法尼亚大学医学院。

奎因是通讯作者，对ROP的e-rop协作组进行远程医疗评价研究的主要研究者，一个合作的新生儿重症监护病房在13北美中心。国家眼科研究所，国家卫生研究院的一部分，资助今天发表的研究报告JAMA眼科。

ROP involves an abnormal growth of blood vessels in the retina that may lead to scarring, retinal detachment and, in severe cases, blindness。 Some degree of ROP occurs in more than half of all infants born at 30 weeks gestation or earlier, but only 5 to 8 percent of cases become severe enough to warrant treatment。 Because early detection and prompt treatment are essential to identifying high-risk eyes, the American Academy of Ophthalmology recommends routine screening for all infants born at or before 30 weeks gestation or weighing less than 1,500 grams (3。3 pounds)。

Over recent years, the U。S。 has seen a decline in the number of ophthalmologists who conduct ROP screening examinations。 At the same time, in middle-income nations with long-standing shortages of ophthalmologists, improved survival of premature infants has expanded the numbers of babies at risk for ROP。 In parts of Latin America, Asia and Eastern Europe, rates of childhood blindness caused by ROP range from 15 to 30 percent or even higher, compared to 13 percent in the U。S。

To address the public health issue of detecting potentially serious ROP, the e-ROP Cooperative Group tested the validity of a telemedicine approach by comparing evaluations by ophthalmologists with those done independently by trained non-physician image readers。

The study team analyzed results in 1,257 premature infants in neonatal intensive care units (NICUs) at 12 study centers in the U。S。 and one in Canada from 2011 to 2013。 On average, the babies were 13 weeks premature and all weighed less than 1,251 grams (about 2。75 pounds) at birth。

The infants all received usual care — regularly scheduled diagnostic examinations by an ophthalmologist who determined whether their ROP had a severity that warranted referral for further evaluation (designated RW-ROP)。 In addition, NICU staff members, called certified retinal imagers, took retinal photographs of all the infants, and those images were transmitted to trained image readers at a central location at the University of Pennsylvania。 The image readers, all of them non-physicians, followed a standard protocol to assess whether features of RW-ROP were present in retinal images。

The image readers were unaware of which infants had been designated by the ophthalmologists as needing referral。 The two groups had broadly similar results: The image readers identified 90 percent of the infants that ophthalmologists rated as having RW-ROP。 When the readers did not find RW-ROP on grading, 87 percent of the time the ophthalmologist had not noted RW-ROP on the examination。

Among the 244 babies that the ophthalmologists identified as having findings consistent with RW-ROP, 162 subsequently received treatment。 Of these 162 infants, the non-physician image readers identified RW-ROP in 159 of them, meaning that 98 times out of a 100, the eye was identified as a high-risk eye。

Quinn and colleagues pointed out several potential advantages of telemedicine screening for ROP。 Non-physician imagers could perform retinal imaging more frequently than ophthalmologists, and NICU staff can implement an imaging schedule individualized to specific babies。 Grading of retinal photographs could allow a more standardized approach to ROP screening, while reducing the numbers of babies needing to be examined by ophthalmologists could thus lower the costs of routine ROP screening。

Finally, remote screening could decrease the number of unnecessary patient transfers to larger nurseries with more on-site ophthalmologists。 “Telemedicine potentially gives every hospital access to excellent ROP screening,” said Quinn。

Quinn added that further studies needed to be done to discover whether the results are generalizable to infants not covered in this study, such as preterm babies with higher birth weights than 1,251 grams。 Hospital systems also would need to acquire special cameras for taking retinal images, as well as training NICU staff and establishing remote image reading centers。

Overall, said Quinn, the results are encouraging。 “Although further investigations must be done before a telemedicine approach can be broadly implemented, this is a very important next step。”

The National Eye Institute, part of the National Institutes of Health, Department of Health and Human Services supported this study (grant EY017014)。

“急性期ROP的评价一个远程医疗系统的有效性，”JAMA眼科, published June 26, 2014。