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.

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：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.

目的：调查八年制临床医学生对眼科学直播课堂的满意度及教学效果。方法：基于八年制临床医 学生的直播课堂教学体验视角，进行问卷调查、课堂测验及课程考试，问卷内容包括调查对象基 本情况、直播课堂教学评价及满意度3个部分。采用SPSS 20.0统计学软件进行数据分析。结果：共 92名学生完成了问卷调查，男37名，女55名，年龄为(22.9±0.71)岁。课堂内容、课堂资源、平台设 计、平台技术及学习交流5个纬度的得分为40.60±4.582、17.43±2.814、13.07±1.759、13.14±2.052、 20.82±2.685；其中，与线下课堂交流相似性、学习交流积极性2个子条目的得分最低，分别为 3.42±1.131、3.85±0.864，这二者具有相关性(r=0.276，P=0.008)。直播课堂满意度的总得分为 13.52±1.872，课堂内容对其有显著影响(P<0.001)，标准化回归系数为0.687。相较于课前测验，课 测验成绩(65.9±11.4分)的提升差异具有统计学意义(P=0.033)；但是与2013级相比，2015级学生的 课程考试成绩(72.6±7.0分)降低，差异有统计学意义(P=0.009)。结论：课堂内容对直播课堂教学满 意度具有重要影响，需要注意直播课堂与线下课堂交流方式的差异，改进学习交流的参与积极性， 以提升教学效果。

Objective: To investigate the satisfaction and teaching effect of 8-year program medical students in live-streamed classroom on ophthalmology. Methods Based on teaching experience of live-streamed classroofrom the perspective of the 8-year program medical students, a questionnaire survey, classroom tests and course examination were conducted. The content of the questionnaire includes 3 parts: the basic information of the respondents, evaluation of live-streamed classroom teaching and its satisfaction. The SPSS 20.0 statistical software was used for data analysis. Results: A total of 92 students completed the questionnaire survey, including 37 males and 55 females, aged (22.9±0.71) years. The sores of content, resource, platform design, platform technology and learning communication of live-streamed classroom were 40.60±4.582, 17.43±2.814, 13.07±1.759, 13.14±2.052 and 20.82±2.685, respectively. Among all items, the scores of the similarity of offline classroom communication styles and enthusiasm for communication were lowest, with the points of 3.42±1.131 and 3.85±0.864, respectively, and the correlation of the two items were statistically significant (correlation coefficient =0.276, P=0.008). The total score of the live-streamed classroom satisfaction was 13.52±1.872. The classroom content has a significant effect on the satisfaction of the live-streamed classroom (P<0.001), and the standardized regression coefficient is 0.687. Compared with the pre-class test, the post-class test score was 65.9±11.4, with a statistically significant improvement (P=0.033); however, compared with grade 2013, the course test score of the students of grade 2015 was 72.6±7.0, with a statistically significant reduction (P=0.009). Conclusion: The classroom content has an important impact on the satisfaction of live-streamed classroom teaching. It is necessary to pay attention to the communication difference between live -streamed classroom and offline classroom settings, and improve the enthusiasm for participation in the study communication, in order to improve the effectiveness of teaching. 

数字眼科技术的蓬勃发展已经渗透于眼科各领域，并为眼科前沿技术研究带来了重大变革。文章对眼科前沿技术研究和发展进行综述，重点关注各项技术的突破和成果，聚焦国内的同时也放眼全球，阐明近年来全球数字眼科前沿技术现状和成果。如人工智能可运用于诸多疾病的精准监测、高发疾病的高效评估、远程医疗的技术支持等，提高了筛查、诊断、治疗等各环节的精确度和效率，减轻了医生的负担，展现了极大的应用潜能。其余各类技术方面，如数字成像技术也取得了飞跃式进展，在手术导航和影像诊断方面实现突破；3D建模技术和机器学习技术在手术设计和提高手术成功率方面立下汗马功劳，为世界各地的眼科疾病患者提供了更为高效、便捷的服务。此外，数字眼科技术还呈现出多元化发展的态势，与多学科协同交流，交叉运用。虽然诸多眼科前沿技术还处在发展初期，距离全覆盖实施仍有一定距离，在算法的准确性和可解释性、医疗伦理、民众接受度、医疗纠纷、临床技术挑战等问题上还存在很多不确定性。但毫无疑问的是，随着医学水平的日益提升，上述技术必会得到不断完善和普及。

The rapid evolution of digital ophthalmology technology has profoundly transformed various fields within ophthalmology. This article provides a comprehensive overview of the research and advancements in cutting-edge ophthalmology technologies, emphasizing both domestic and global breakthroughs and achievements. For instance, artificial intelligence has demonstrated remarkable potential in precise monitoring of various diseases, efficient assessment of high-prevalence conditions, and the technological support for telemedicine, thereby enhancing the accuracy and efficiency of screening, diagnosis, treatment processes, while alleviating the workload of medical professionals. Additionally, digital imaging technology has made significant strides in surgical navigation and diagnostic imaging, while 3D modeling and novel machine learning techniques have contributed to surgical planning and enhanced surgical success rates, ultimately delivering more efficient and convenient services to patients with eye diseases worldwide. Despite the diversified development trends and interdisciplinary collaborations that digital ophthalmology technology exhibits, many of these cutting-edge technology are still in their infancy, facing challenges in achieving high coverage, algorithm accuracy and interpretability, medical ethics, public acceptance, medical disputes, and clinical technical hurdles. Nonetheless, while the continuous advancement of medical standards, it is anticipated that these technologies will undergo further refinement and widespread adoption.

患者，男性，1岁9个月。以“发现右眼上、下眼睑肿物25 d”首诊于眼科，要求切除，但经影像学及病理学检查，诊断为多发性朗格汉斯细胞组织细胞增生症，且全身骨骼多处出现溶骨性改变，不符合切除指征。给予多次全身化学治疗后眼部肿物明显变小。该例诊治提醒眼科医生，眼部肿物可由全身系统性疾病引起，不可盲目切除，必要时做进一步检查。术中切除物均建议行病理活组织检查，以免延误治疗。

patient, male, 1year and 9months old, was first diagnosed as “eye tumor” in the ophthalmology department and requested for excision. But it was diagnosed as multiple Langerhans cell histiocytosis (LCH) through imaging and pathological examination ultimately.Bone lytic changes appeared in many parts of the whole body, which did not meet the indication of excision.The tumor was smaller after systemic chemotherapy. The diagnosis and treatment of this case suggests ophthalmologists that eye tumors can be caused by caused by systemic diseases, systemic diseases. During operation, it is recommended to perform pathological biopsy to avoid treatment delay.

眼睛由屈光系统和视觉神经系统两大部分构成，是人体最重要的感觉器官之一。眼部各组织的发育或功能异常都可能造成不同程度的视力损害。目前主要通过动物实验或体外细胞培养的方法探究眼病的病理生理机制和治疗手段，但上述两种方法都存在一定的局限性。体外细胞培养不能完全反映器官的形态、结构和生化特征，而动物模型的物种和遗传背景具有异质性。近年来，随着原代组织、胚胎干细胞、诱导多能干细胞衍生的体外三维结构类器官和器官微流控芯片技术的不断发展，构建出了与在体器官的结构、功能更为相似的器官克隆模型，能够提供更敏感、定量、规模化的表型分析，更好地应用于眼的发育、生理结构、疾病机制、个性化医学诊断和治疗方法等方面的研究。目前，眼科的微流控器官芯片与类器官技术在角膜、晶状体、泪腺、视网膜结构发育和疾病模型均展现出巨大的应用潜力。

The eye is composed of refractive system and visual nervous system. It is one of the most important sensory organs of the human body. The abnormal development or function of eye tissues may cause various degrees of visual impairment. At present, the pathophysiological mechanism and treatment of eye diseases are mainly explored through animal experiments and in-vitro cell culture. However, they are of certain limitations. The in-vitro cell culture cannot fully reflect the morphological, structural and biochemical characteristics of organs, whereas the animal models are heterogeneous of species and genetic background. In recent years, with the continuous development of in-vitro three-dimensional structure organoids and organ microfluidic organ-on-a-chip technology derived from primary tissues, embryonic stem cells and induced pluripotent stem cells, organ cloning models more similar to in vivo organs in terms of the structure and function have been constructed. These models can provide more sensitive, quantitative and large-scale phenotypic analysis, and can be better applied to the research of eye development, physiological structure, disease mechanism, personalized medical diagnosis and treatment. At present, microfluidic organ-on-a-chip and organoids technologies have shown great application potential in the structural development and disease models’ construction of cornea, lens, lacrimal gland and retina.

目的：探讨督导式教学门诊在眼科住院医师规范化培训中的具体实践和教学效果。方法：通过合理排班、限制号源等措施设立每周固定的督导式教学门诊时间，安排老师和学员出诊；在教学门诊开展4个月后，通过问卷调查和临床技能考核的形式采集反馈意见并评估教学效果。 结果：共有16名老师和8名学员参加了督导式教学门诊，调查问卷结果显示100%的带教老师和学员认可该教学模式，参加过教学门诊的学员临床技能考核得分显著高于对照组(t =3.631， P<0.05)。结论：督导式教学门诊应用于眼科住院医师规范化培训具有实际可行性，并可以提高学员的临床技能水平。

Objective: To explore the application and effects of supervised teaching clinic in standardized training of ophthalmology residents. Methods: A weekly supervised teaching clinic was set through reasonable scheduling and limiting the registration numbers. After 4 months of application, feedbacks were collected through questionnaire survey from both the teachers and residents. Clinical skills assessments were also taken to evaluate the teaching effect. Results: A total of 16 teachers and 8 residents participated in the supervised teaching clinic. The results of the questionnaire showed that 100% of the teachers and residents agreed with the teaching mode. The clinical skill assessment scores of the residents who participated in the teaching clinic were significantly higher than those of the control group (t=3.631, P<0.05). Conclusion: The application of supervised teaching clinic in standardized training of ophthalmology residents is feasible and can improve the clinical skills of the residents. 

目的：以提升进行住院医师规范化培训(住培)的眼科医生临床诊疗思维能力为导向，建立LRC渐进协作教学体系(LRC Stepwise Collaborative Learning Model)。方法：2023年7月—2023年12月，以26名进行眼科住培的医生为试验组的研究对象，采用小讲课(Lecture)、教学查房(Rounds)及病例讨论(Case discussion)的LRC渐进协作教学体系，通过定量分析方法评估教学效果。结果：实施LRC渐进协作教学模式后，住培医生平均成绩由培训前的50.00 (40, 50)分提高至培训后的90.00 (80, 100)分，差异具有统计学意义(P＜0.001)。问卷调查满分5分，小讲课、教学查房和病例讨论三种教学形式的满意度满分比例分别为92.3%(24/26)，84.6%(22/26)、76.9%(20/26)，三种教学形式的满意评分分别为5.00 (5.00, 5.00)、5.00 (5.00, 5.00)、5.00 (4.75, 5.00)分。结论：LRC渐进协作教学体系作为住培教学新体系，得到眼科住培医生的认可，促进临床诊疗思维的整体提升，有助于岗位胜任力的培养，为未来教学模式的设计与实施提供了重要参考。

Objective: To introduce the LRC Stepwise Collaborative Learning Model, a novel teaching approach designed to improve clinical thinking skills in ophthalmology training. Methods: From July 2023 to December 2024, 26 ophthalmology residents were included in the experimental group, underwent training using LRC Stepwise Collaborative Learning Model of Lectures, Rounds and Case Discussions. Their educational outcomes were quantitatively analyzed. Results: The LRC Stepwise Collaborative Learning Model improved average resident scores from pre-training [50(40, 50) points] to post-training [90(80,100) points], with a statistical significance (P < 0.001). The questionnaire survey had a maximum score of 5 points, and the rates of full marks for the three teaching forms of lectures, rounds, and case discussions were 92.3% (24/26), 84.6% (22/26), and 76.9% (20/26), respectively. The satisfaction scores for the three teaching forms were 5.00 (5.00, 5.00), 5.00 (5.00, 5.00), and 5.00 (4.75, 5.00) points, respectively. Conclusions: The LRC Stepwise Collaborative Learning Model, as a new training system for residency education, has been recognized by ophthalmology residents. It facilitates the overall improvement of clinical thinking, contributes to competency development, and provides valuable insights for future teaching model designs.