人工智能(artificial intelligence，AI)为解决中国患者“看病难”问题提供了可行方案。眼科AI已实现为患者提供筛查、远程诊断及治疗建议等方面的服务，能显著减轻医疗资源不足的压力和患者的经济负担。而AI的应用过程中，给医疗管理带来的挑战应引起重视。本文从医疗管理的角度，总结分析AI在眼科医疗过程中，尤其是交接环节中出现的主要问题，提出对策与建议，并讨论AI在眼科医疗的应用展望。
Artificial intelligence (AI) has been proposed as a potential solution to address the shortage of ophthalmologists in China. With the increasingly extensive application of AI in the field of ophthalmology, many potential patients with eye diseases have access to a higher quality of medical services. At the same time, new challenges will emerge and proliferate with the advancement of AI application. This paper focuses on the patient handoffs process and discusses two challenges brought by the application of AI, namely “communication” and “standardization”. Natural language processing techniques and the development of standardized databases are proposed to solve each of these challenges. The application prospects of AI in ophthalmology are eventually discussed.
光学相干断层成像(optical coherence tomography，OCT)自1991年发明以来，在生物成像尤其在眼科和心血流成像中起越来越重要的作用。OCT的发展经历了早期的时域系统及最新的频域系统。其中频域系统又分为谱域OCT(spectral domain OCT，SD-OCT)系统和扫频OCT(swept source OCT，SS-OCT)系统。随着眼科临床应用对系统速度、灵敏度及功能化要求的不断提升，眼科扫频OCT已经走向成熟并逐步商用化。本文将简介扫频OCT的原理，并归纳扫频OCT相对于时域和谱域OCT系统的优势，并展示其在眼科临床的应用。
Optical coherence tomography (OCT) has played an important role in biomedical imaging, especially in ocular and cardiovascular imaging. OCT technology has evolved to frequency domain technology from early time-domain technology due to the advantages of high sensitivity and high speed of frequency domain techniques. The swept source OCT is a type of frequency domain OCT. With the increasing requirements for system speed, sensitivity, and functionality in clinical application, swept source OCT is gradually becoming commercially available and widespread in clinical application. In this paper, the principle of swept source OCT was introduced, the advantages of swept source OCT over time domain and spectral domain OCT systems were summarized, and its clinical application in ophthalmology was demonstrated.
培养合格的眼科医师对于防盲治盲工作、为人民提供优质眼健康服务是十分重要的，不同地区的住院医师规范化培训各有特点。文章从各个方面比较了内地与香港眼科住院医师规范化培训体系的异同，包括培训对象、培训师资、轮转阶段和要求、考核机制。香港的培训体系时间为6年，大致上相当于住院医师规范化培训和专科医师规范化培训结合在一起。通过比较两者的差异，有助于我们结合自己的实际情况，改进内地的眼科学住院医师教育培养体系，也为下一步开展眼科专科医师规范化培训提供参考。
The training of qualified ophthalmologists holds paramount significance in preventing blindness, treating eye diseases, and delivering optimal eye health services to the people. Given the unique nature of standardized residency training across geographical regions, this study delves into the comparative analysis of ophthalmology residency standardized training systems in the Mainland and Hong Kong. Specifically, we examine the the similarities and disparities in multiple facets, encompassing trainees' profiles, faculty expertise, rotation phases and prerequisites, as well as assessment methodologies. Notably, the training system in Hong Kong has a duration of 6 years, approximating the combined length of standardized residency training and standardized specialist training. By comparing the differences, we aim to facilitate the refinement of ophthalmology residency education and training in Mainland China, tailored to our specific context, while also serving as a reference for advancing standardized ophthalmology specialist training initiatives.
目的：基于我国国情构建科学、简便且高效的眼科急诊预检分诊标准，为眼科医护人员提供高效的眼科急诊预检分诊工具。方法：基于文献查询法、半结构访谈法、德尔菲法及层次分析法确定眼科急诊预检分诊标准内容。通过提取2023年8月1日-2023年8月10日急诊分诊系统及HIMSS电子病历系统数据，分析初次分诊的级别与接诊医生最终诊断的所属级别符合率，对眼科急诊预检分诊标准体系的应用效果进行初步验证。结果：对18名专家进行２轮专家咨询，有效问卷回收率均为100%，专家权威系数均为0.95，肯德尔和谐系数分别为0.5640.117(均P＜0.05)。最终构建的眼科急诊预检分诊标准体系包括3个一级指标、11个二级指标。初步验证显示，该预检分诊标准体系具有92.7%的分诊准确率。结论：本研究构建的眼科急诊预检分诊标准体系结构合理、内容全面，具有科学性及实用性，可为眼科临床急诊预检分诊工作提供准确、有效的分诊工具，有助于提高临床工作效率及预检分诊质量。
Objective: To establish a scientific, simple, and efficient ophthalmic emergency pre-examination triage standard, and provide efficient ophthalmic emergency pre-examination triage tools for ophthalmic staffs, based on national conditions. Methods: With literature search, semi-structured interview, Delphi Method, and Analytic Hierarchy Process, the content of ophthalmic emergency pre-examination and triage standard are confirmed. By extracting data from the emergency triage system and HIMSS electronic medical record system from August 1st, 2023 to August 10th, 2023, the consistency rate between the initial triage level and the final diagnosis level of the attending doctor was analyzed, and the application effect of the ophthalmic emergency pre-examination and triage standard system was preliminarily verified. Results: Two rounds of expert consultation were conducted among 18 experts, all with a 100% effective questionnaire response rate. The expert authority coefficients were 0.95, and the Kendall harmony coefficients were 0.564 and 0.117, respectively (all P<0.05). The final constructed ophthalmic emergency pre-examination triage standard system includes 3 primary indicators and 11 secondary indicators. Through verification, the pre screening triage standard system has a good triage accuracy rate of up to 92.7%. Conclusions: The structure of the ophthalmic emergency pre-examination triage standard system constructed in this study is reasonable, comprehensive, scientific, and practical. It can provide accurate and effective triage tools for ophthalmic clinical emergency pre-examination triage work efficiency, and preexamination triage quality.
随着人口老龄化、生活方式的改变，眼科疾病患病人数的增加、国家眼病诊疗相关政策的持续推动、居民健康意识的逐渐提升，眼科门急诊患者数量持续增长，亟需构建科学的眼科急诊预检分诊标准，合理配置医疗资源，确保患者得到及时、恰当的治疗。国外已有医院依据患者症状或体征的严重程度对患者进行等级划分，建立起相对成熟的眼科急诊预检分诊模式，我国目前尚没有统一的、权威的眼科急诊预检分诊标准，国内外现行的眼科急诊预检分诊模式的分诊精准度及临床适用性有待进一步探索。该文通过综述国内外眼科急诊分诊标准及应用评价、眼科远程急诊预检分诊方式研究进展，以期为构建符合我国国情的、科学有效的眼科急诊预检分诊标准、提高眼科急诊分诊质量提供参考。
With the aging of population, the changing of lifestyle and the increasing number of ophthalmic emergency patients,Chinese national policies related to ophthalmic diagnosis and treatment are continually promoted, and residents' health awareness are gradually improved, the volume of ophthalmic outpatients and emergency patients continues to increase. It is urgent needed to establish scientific ophthalmic emergency pre-examination and triage criteria, to reasonably allocate medical resources, and to ensure that patients receive timely and appropriate treatment. The relatively mature ophthalmic emergency pre-examination and triage models with the severity of patients' symptoms or physical signs,have been established in foreign hospitals. Currently, there is no unified and authoritative ophthalmic emergency triage criteria in China. The accuracy and clinical applicability of the existing ophthalmic emergency triage models at home and abroad need to be further explored. This article reviewed the ophthalmic emergency triage criteria and application evaluation at home and abroad, and remote emergency triage in ophthalmology, in order to provide a reference for establishing a scientific and effective ophthalmic emergency triage criteria comformed Chinese national conditions, and improving the quality of ophthalmic emergency triage.
目的：分析单中心神经眼科疾病谱及流行病学特点，为指导神经眼科疾病诊断和治疗提供基础。方法：纳入2010年1月1日—2021年12月31日中国人民解放军总医院神经眼科病区收治的神经眼科疾病患者，从电子病例系统检索和记录所有纳入病例的年龄、性别、地区分布及病种亚型分析。结果：共计7245例神经眼科患者纳入统计，其中男性3331例(46.0%)、女性3914例(54.0%)，男女比例1∶1.2；年龄(38.2±17.5)岁。83.25%(6031/7245)为传入神经系统疾病，9.92%(719/7245)为传出神经系统疾病和眼眶疾病，6.83%(495/7245)未归类。病种分析显示，占比最高的是脱髓鞘性视神经炎(demyelinating optic neuritis,DON)，为40.17%(2910/7245)；占比第二的是非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)，为11.37%(824/7245)；占比第三的是外伤性视神经病变5.15%(373/7245)，其中7.85%(569/7245)表现为不明原因视神经萎缩。从年龄分布来看，DON和外伤性视神经病变患者中18~40岁者占比最高(分别为48.63%和44.24%)，NAION患者中41~60岁者占比最高(66.14%)，小于18岁的未成年患者在遗传性视神经病变中占比最高，比例为48.58%。在2226例DON患者中，视神经脊髓炎(neuromyelitis optica,NMO)/视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)比例最高，为60.02%；髓鞘少突胶质细胞糖蛋白抗体(myelinoligodendrocyte glycoprotein antibody,MOG-IgG)阳性视神经炎比例为11.68%；多发性硬化(multiple sclerosis,MS)和MS相关性视神经炎和慢性复发性炎性视神经病变(chronic recurrent inflammatory optic neuropathy,CRION)占比较低，分别是1.8%和2.25%。DON整体患者中，男女比例为1∶3.08；在NMO/NMOSD患者中男女比例为1∶8；MOG阳性视神经炎患者中，男女比例为4∶5；在非典型视神经炎患者中，男性比例高于女性，为1.28∶1；DON患者中，81.79%患者为中青年，MOG阳性视神经炎未成年患者可达41.15%。结论：DON和NAION是神经眼科传入系统疾病最常见两大病种。
Objective: To analyze the spectrum and epidemiological characteristics of neuro-ophthalmic diseases from single center, and to provide basis for guiding the diagnosis and treatment of neuro-ophthalmic diseases. Methods: Patients with neuro-ophthalmic diseases admitted to the neuro-ophthalmology ward of Chinese PLA General Hospital from January 1, 2010 to December 31, 2021 were enrolled. The age, gender, regional distribution and disease subtypes of all included patients were retrieved and recorded from the electronic case system. Results: A total of 7245 patients with neuro-ophthalmic diseases were enrolled, including 3331 males(46.0%)and 3914 females(54.0%), with a male to female ratio of 1:1.2. The average age was 38.2±17.5 years. 83.25%(6031/7245)were afferent nervous system diseases, 9.92% (719/7245)were efferent nervous system diseases and orbital diseases, and 6.83%(495/7245)were not classified. The ratio of demyelinating optic neuritis(DON)was the highest(40.17%,2910/7245), followed by nonarteritic anterior ischemic optic neuropathy(NAION)(11.37%,824/7245)and traumatic optic neuropathy(TON) (5.15%,373/7245). The ratio of optic nerve atrophy with unknown causes was 7.85%(569/7245). Characteristics of age distribution, the DON and TON were more common in 18-40 age group(the proportion were 48.63% and 44.24%,respectively), the NAION was common in 41-60 age group(66.14%), and the hereditary optic neuropathy was common in younger 18 age group (48.58%). In 2226 DON patients, the proportion of neuromyelitis optica(NMO)/neuromyelitis optica spectrum disorder(NMOSD)-optic neuritis(ON)was the highest(60.02%)and myelinoligodendrocyte glycoprotein antibody(MOG-IgG)ON was 11.68%, while multiple sclerosis(MS)-ON and chronic recurrent inflammatory optic neuropathy(CRION)were relatively low(1.8% and 2.25%,respectively). In DON patients, the male to female ratio was 1:3.08. In NMO/NMOSD-ON patients, the ratio of male to female was 1:8, and that of MOG-ON was 4:5. In atypical ON, the ratio of male to female was higher than that of female(1.28:1). In DON patients, 81.79% of patients were young and middle-aged, and the proportion of children with MOG-ON(less than 18 years old)was 41.15%.Conclusions: DON and NAION are the two most common diseases of neuro-ophthalmic afferent system.
目的：探讨2003—2023年热休克蛋白(heat shock proteins,HSP)在眼科领域中的研究进展及前沿趋势。方法：利用Web of Science数据库检索2003年1月—2023年12月26日HSP在眼科领域的文献，采用文献计量学方法、应用VOSviewer及CiteSpaces软件对发文量、国家、机构、期刊、作者、关键词以及学科领域等数据进行定量分析及可视化。结果：共纳入1 079篇HSP在眼科领域的相关文献，总体发文量处于波动状态。美国(n =394)是发文量最多的国家，Investigative Ophthalmology & Visual Science(n =80)是发表相关文献最多的期刊。研究热点主要分为三部分，分别为青光眼发病机制、白内障发病机制及HSP在基因层面的眼科疾病机制研究。研究的前沿主题是青光眼、胆固醇、分子伴侣。生物化学与分子生物学、多学科材料科学和细胞生物学学科领域具有最高的中介中心性值，分别为0.60、0.28和0.26。多学科化学(爆发年份：2017—2023年；强度为6.3)是该领域研究前沿涉及的学科。结论：HSP在眼科领域的研究重点是揭示疾病的遗传背景，探究其在青光眼及白内障中的分子机制以及治疗应用。该领域分子机制研究的进展有赖于多学科的合作。
Objective: To investigate the advances and trends of heat shock proteins (HSP) in ophthalmology published from 2003 to 2023. Methods: The Web of Science database was used to retrieve the literature on heat shock proteins in ophthalmology published from January 1, 2003 to December 26, 2023. Bibliometric methods and VOSviewer and CiteSpaces software were used to analyze and visualize data, including publication count, countries, organizations, journals, authors, keywords and subject categories. Results: A total of 1079 publications related to HSP in ophthalmology were included, and the overall number of publications was fluctuating. The United States (n =394) was the leading contributor among countries. Investigative Ophthalmology & Visual Science (n =80) was the journal with the largest number of publications. The pathogenesis of glaucoma, the pathogenesis of cataract and the mechanism of ophthalmic diseases at the genetic level of HSP were identified as the research hotspots. Glaucoma, cholesterol, and molecular chaperones were identified as frontier research topics. Biochemistry & molecular biology, multidisciplinary materials science, and cell biology have the highest betweenness centrality values of 0.60, 0.28, and 0.26, respectively. Multidisciplinary chemistry (burst years: 2017 to 2023; strength = 6.3) was a subject involved in the research frontier of this field. Conclusion: Research on heat shock proteins in ophthalmology mainly focuses on revealing the genetic background of the diseases and exploring the molecular mechanisms and therapeutic applications in glaucoma and cataracts. The advance in the study on molecular mechanisms in this field depends on multidisciplinary collaboration.
目的：分析某三甲眼科专科医院近5年临床诊疗涉及非手术常规血液检验项目的申请检测情况，为眼科医师了解检验辅助诊断概况、专科医院的实验室项目管理和开展新项目提供依据。方法：从中山大学中山眼科中心医学检验信息管理系统导出2018年1月1日至2022年12月31日期间到院申请进行血液检测的12 866例门诊患者的22 453份样本(共94 081项检验项目)相关检验记录。将申请检测科室及专科医师按照中华医学会眼科学分会推荐分为10个亚专科，对疾病诊断和检测项目等资料进行统计分析，采用文字、柱状图及折线图的形式进行描述。结果：5年间申请进行血液检测的12 866例门诊患者，男性患者6 356例(49.4%)，女性患者6 510例(50.6%)。基于首诊眼病诊断分类，排名前三位的眼病分别为眼整形/眼肿瘤病5 214例 (40.5%)、眼底病 3 487例(27.1%)、角膜病1 711例(13.3%)。申请检测样本量从2018年的3 163份增至2022年的5 903份，总体呈上升趋势。从申请的专科医师分析，眼整形/眼眶病专科医师申请单最多，有6 751份(占30.1%)，其中自身免疫性疾病检测所占比例最高，为49.1%，甲状腺疾病相关检测占41.9%；眼免疫专科医师申请检测量为4 214份(占18.8%)，以自身免疫性疾病检测为主占55.7%，感染性项目检测占32.5%；眼底病专科医师申请检测量为3 629份(16.2%)，其中自身免疫性疾病检测和感染性项目检测分别占47.8%和39.6%；角膜病专科医师申请数为1 436份(占6.4%)，其中过敏性疾病检测比例为41.2%。基于一份申请单可同时检测多个项目，眼整形/眼眶专科申请检测总项最多，有33 513项，甲状腺疾病检测占65.0%；角膜病专科申请16 482项，过敏性疾病检测占83.4%，眼底病专科和眼免疫专科分别为8 794项和8 047项，均以自身免疫性疾病检测为主，分别占42.5%和40.4%。结论：眼科专科医院中非手术常规检验项目在各亚专科的申请数量明显分布不均，项目构成受亚专科疾病特点的影响。眼科实验室应针对性加强非手术常规检测项目的宣传和管理。
Objective: To analyze the application and testing of non-surgical routine blood test items in clinical diagnosis and treatment in a top-tier ophthalmic hospital over the past five years, providing ophthalmologists with insights into the overview of laboratory-assisted diagnosis, laboratory project management in specialized hospitals, and the basis for launching new projects. Methods: Relevant test records of 22,453 samples (totaling 94,081 test items) from 12,866 outpatient patients who applied for blood tests at the Zhongshan Ophthalmic Center of Sun Yat-sen University from January 1, 2018, to December 31, 2022, were retrieved from the medical laboratory information management system. The departments applying for tests and specialist physicians were divided into 10 subspecialties according to the recommendations of the Ophthalmology Branch of the Chinese Medical Association. Statistical analysis was performed on disease diagnosis and test items, and the results were described in the form of text, bar graphs, and line graphs. Results: Among the 12,866 outpatient patients who applied for blood tests over the five-year period, 6,356 (49.4%) were male and 6,510 (50.6%) were female. Based on the classification of first-visit ophthalmic diseases, the top three were ophthalmic plastic surgery/ocular tumor diseases (5,214 cases, 40.5%), fundus diseases (3,487 cases, 27.1%), and corneal diseases (1,711 cases, 13.3%). The number of samples applied for testing increased from 3,163 in 2018 to 5,903 in 2022, showing an overall upward trend. From the perspective of specialist physicians applying for tests, ophthalmic plastic surgery/orbital disease specialists had the highest number of applications, with 6,751 (30.1%), among which autoimmune disease testing accounted for the highest proportion, at 49.1%, and thyroid disease-related testing accounted for 41.9%. The number of applications from ophthalmic immunology specialists was 4,214 (18.8%), with autoimmune disease testing accounting for 55.7% and infectious disease testing accounting for 32.5%. The number of applications from fundus disease specialists was 3,629 (16.2%), with autoimmune disease testing and infectious disease testing accounting for 47.8% and 39.6%, respectively. The number of applications from corneal disease specialists was 1,436 (6.4%), with allergic disease testing accounting for 41.2%. Since multiple tests could be performed on a single application, the ophthalmic plastic surgery/orbital disease subspecialty had the highest total number of tests applied for, with 33,513 tests, of which thyroid disease testing accounted for 65.0%. The corneal disease subspecialty applied for 16,482 tests, with allergic disease testing accounting for 83.4%. The fundus disease subspecialty and ophthalmic immunology subspecialty respectively applied for 8,794 and 8,047 tests, both primarily focused on autoimmune disease testing, accounting for 42.5% and 40.4%, respectively. Conclusions: The number of applications for non-surgical routine test items in ophthalmic specialized hospitals is significantly unevenly distributed among various subspecialties, and the composition of the items is influenced by the characteristics of diseases in each subspecialty. Ophthalmic laboratories should strengthen the promotion and management of non-surgical routine test items in a targeted manner.
目的：构建眼科日间病房护理质量指标，为眼科日间病房的护理质量管理提供理论依据。方法：以Donabedian三维质量结构模式为理论框架，通过查阅文献、小组讨论，初步拟定眼科专科护理质量评价指标。通过专家函询，对指标进行筛选和修订，确定了眼科日间病房护理质量指标。结果：经过2轮函询，专家意见趋向一致，2轮问卷回收率均为100%，协调系数分别为0.129、0.342(P＜0.01)。构建的眼科专科护理质量指标包括3项一级指标，分别为结构指标(二级指标2项)、过程指标(二级指标8项)和结果指标(二级指标3项)。结论：该指标具有较高的科学性、可靠性、可行性以及专科特色，可为眼科日间病房护理质量的评价提供良好的方法。
Objective: To set up nursing quality indicators for ophthalmic intra-day ward, providing theoretical basis for nursing quality management in ophthalmic intra-day ward. Methods: Based on the "Donabedian three dimensional quality structure model" as the theoretical framework, the preliminary ophthalmic specialized nursing quality assessment indicators were designed by literature review and group discussion. The ophthalmic nursing quality indicators for intraday ward were finalized by expers consultated, indicators screened and revised. Results: After two rounds of inquration by letters, the opinions from the experts were consistent. Questionnaire response rates were both 100% in two rounds, with coordination coefficients of 0.129 and 0.342 respectively (P< 0.01). The nursing quality indicators for ophthalmic intra-day ward were established, including 3 primary indicators, which are structual indicators (2 secondary indicators), process indicators (8 secondary indicators) and outcome indicatiors(3 secondary indicators). Conclusion: The indicators are scientific, reliable, feasible with specialized characteristics, which can provide a good reference for evaluating the nursing quality in ophthalmic intra-day wards.
目的：依托最新的第5代移动通信技术(5th generation wireless systems，5G)，构建基于眼底图片的5G医疗眼科远程诊断平台，促进医疗资源上下贯通，提升基层服务能力及医疗服务体系整体效能。方法：基于5G时代医院的信息化发展战略，在海南省卫生健康委员会的资助与指导下，中山大学中山眼科中心海南眼科医院与中国联通通信集团海南有限公司等进行跨行业、多学科的技术力量研究开发，构建5G条件下的平台建设模块和技术路线，确定远程眼科诊断流程，并在海南省内多地区应用。结果：远程诊断平台运行良好。2020年12月至2021年11月，本研究共在海南省17个地区的186个卫生院中开展，共收集1561例患者眼底病图片数据，筛查阳性例数为185例，检出眼底病总阳性率为11.9%。其中有42例需要转诊治疗，转诊率为23%；143例不需要转诊治疗，非转诊率为77%。在1561例眼底图像中，采集异常的眼底图像有490例。排除490例异常眼底图像后，辅助诊断系统与人工诊断结果有1 002张眼底图像诊断相同，69张眼底图像诊断不同，其辅助诊断系统准确率为93.3%。结论：5G移动通信与远程医学影像结合，运用互联网科技催生新型医疗生产力，提高卫生经济的质量和效率，是医疗领域探索5G应用场景的一项应用典范。
Objective: Relying on the latest 5th generation wireless systems (5G), a remote primary ophthalmology care diagnosis platform based on fundus images was constructed in order to promote the connectivity of medical resources and improve the primary health service capabilities and the overall effectiveness of the medical service system. Methods: Based on the 5G informatization development strategy of hospitals, and under the funding and guidance of the Hainan Provincial Health Commission, the Hainan Eye Hospital of Zhongshan Ophthalmic Center and China Unicom Communications Group Hainan Co., Ltd. conducted a cross-industry, multi-disciplinary technical research. To build platform construction modules and technical routes under 5G networks, present the remote ophthalmological diagnosis process, and apply it in many regions in Hainan Province. Results: The performance of the remote diagnosis platform is well. From December 2020 to November 2021, this study was carried out in 186 health centers in 17 regions of Hainan Province. A total of 1 561 patients with fundus disease image data were collected. The number of positive screening fundus disease cases was 185. The total positive rate was 11.9%. Among them, 42 cases required referral for treatment, with a referral rate of 23%, and 143 cases did not require referral for treatment, with a non-referral rate of 77%. Among 1 561 cases of fundus images, 490 fundus images were excluded due to abnormal quality. Compared the results of the diagnosis platform system with manual diagnosis, 1 002 fundus images were identical, and 69 fundus images were different in diagnosis. The accuracy of the auxiliary diagnosis system was 93.3%. Conclusions: The collaboration of 5G mobile communication and telemedicine imaging, combined with internet technology to promote new medical productivity, improve quality and efficiency of the health economy. This study is an application model for exploring 5G application scenarios in the medical field.
