目的：结合眼科住院医师规范化培训(住培)的特点，建立基于钉钉平台的全面质量管理模式(total quality management, TQM)，探索一种高效的顺应时代特征的眼科教学管理模式。方法：研究团队依托中山大学中山眼科中心，选取82名眼科四证合一的住培一年级的学生作为研究对象，并将其随机分为两组，试验组41人采用基于钉钉平台的TQM模式进行全过程教学管理，采用全员参与、全程跟踪、全面评价的管理模式以保障教学质量。对照组41人接受传统的教学管理模式。观察指标为两组间教学前后测试分数、教学后满意度调查的问卷得分等。结果：通过对两组学生进行课前课后的测试，TQM模式组相较于传统模式组在学习成绩有所提升，课前课后分数的差值分别为40(30,40)分和30(20,50)分，比较差异有统计学意义(P =0.031)。问卷调查结果显示，两组满意度总分比较差异无统计学意义[10(10,10) 分 vs. 10(9,10)分，P =0.207]，但在满意度分项内容掌握性上，TQM模式组分值高于传统模式组[5(5,5)分 vs. 5(4,5)分，P =0.046]。结论：基于钉钉平台的TQM模式在眼科教学中能够有效提高住培的教学质量与学生满意度，相比传统教学管理模式具有更大的教学优势，可为眼科住培提供了一种创新且实用的教学管理模式，对于培养适应时代需求的高水平眼科医师具有重要意义。
Objective: To combine the characteristics of standardized training for ophthalmic resident physicians, establishes a Total Quality Management (TQM) model based on the DingTalk platform, and explored an efficient ophthalmic teaching management model that adapts to the characteristics of the times. Methods: The research team, based at Zhongshan Ophthalmic Center, selected 82 first-year postgraduate students undergoing the national standardized training for resident doctors (STRD) as participants, randomly allocating them into two groups. The experimental group consisting of 41 trainees received TQM-modeled online learning via the DingTalk platform, adopting a management model of full participation, full process tracking, and comprehensive evaluation to ensure teaching quality. While the control group, also comprising 41 trainees, underwent traditional offline instruction. The TQM group engaged in live streaming lectures on the DingTalk platform, whereas the conventional group continued with face-to-face teaching in classroom. Data including pre- and post-teaching scores, as well as scores from satisfaction surveys are analyzed. Results: Comparing pre- and post-teaching scores, significant statistical differences were found between the TQM and traditional groups, with mean score improvements of 40(30,40) points and 30(20,50) points, respectively, indicating statistical significance (P =0.013). Furthermore, the questionnaire survey revealed that the TQM group scored higher than the traditional group in aspects such as course design, clinical relevance, content mastery, and instructor satisfaction. In addition, the questionnaire survey showed that there was no statistically significant difference in the total satisfaction score between the two groups (10(10,10) points vs. 10(9,10)points P =0.207), but in terms of mastery of satisfaction sub items, the TQM model group scored higher than the traditional model group (5(5,5) points vs. 5(4,5) points, P =0.046). Conclusions: The application of a TQM-based model on the DingTalk platform significantly enhances the teaching quality and student satisfaction in the residency training of ophthalmologists, demonstrating greater pedagogical advantages over traditional methods. This efficient ophthalmic teaching management model thus provides a promising solution for standardized residency training in ophthalmology, and holds considerable importance for nurturing highly competent ophthalmologists who can meet the demands of the current era.
红光是波长范围在620~760 nm的可见光，兼有良好的光化学和热作用，其穿透力较强，能够达到皮肤深层及组织内部，从而产生一系列的生物效应。在眼科领域，红光疗法最初主要应用于弱视和眼睑皮肤相关疾病的治疗，随着研究的进一步深入，红光逐渐被应用于控制近视进展和视网膜相关疾病。目前，重复低强度红光(repeat low-level red-light, RLRL)在近视进展的控制效果得到充分肯定，成为红光疗法在眼科应用最受关注的热点之一，其主要可能机制包括红光照射能激活线粒体中的细胞色素C氧化酶的活性，促进三磷酸腺苷(adenosine triphosphate, ATP) 生成，改善网膜缺氧状况；促进一氧化氮 (nitric oxide, NO)的合成和释放，引起脉络膜血管的扩张及血流量的增加；诱导巩膜细胞外基质的重塑，增加巩膜的强度。此外，红光疗法可抑制视网膜感光细胞调节通路中的氧化应激、炎症和细胞凋亡，减轻眼表炎症反应和疼痛，有助于周围神经损伤后修复等。文章针对红光疗法在近视、视网膜相关疾病、弱视及眼睑皮肤相关疾病的治疗机制、有效性及安全性进行综述，为红光疗法在眼科领域的应用提供重要的参考价值和依据。
Red light is visible light with a wavelength range of 620-760 nm, which has excellent photochemical and thermal effects. It can penetrate deeply into the skin and tissues with strong power, resulting in a series of biological effects. In the field of ophthalmology, red-light therapy was initially mainly used in the treatment of amblyopia and eyelid skin-related diseases, and with the further development of research, red light has been gradually used in the myopia control and the study of retina-related diseases. At present, the effect of repeated low-intensity red light (RLRL) on myopia progression has been fully recognized, and it has become one of the most concerned hotspots in the application of red-light therapy in ophthalmology. The main possible mechanisms include that red light therapy can activate the activity of cytochrome C oxidase in mitochondria, promote ATP production, and improve retinal hypoxia. It can also induce the synthesis and release of NO, cause the expansion of choroidal vessels with improvement of blood flow, and increase scleral strength by remodeling of scleral extracellular matrix. In addition, red- light therapy can reduce oxidative stress, inflammation and apoptosis in the regulatory pathways of photoreceptor cells, reduce eye inflammation and pain, and help repair peripheral nerves after injury. This article will review the mechanism, effectiveness and safety of red-light therapy in myopia, retinal diseases, amblyopia, and eyelid skin-related diseases, in order to provide important reference value and basis for the application of red-light therapy in ophthalmology.
人工智能(artificial intelligence，AI)在眼科领域的应用不断深入、拓展，目前在糖尿病性视网膜病变、白内障、青光眼以及早产儿视网膜病变在内的多种常见眼病的诊疗中逐渐成为研究热点。AI使医疗资源短缺、诊断标准缺乏、诊疗技术水平低下的现状得到改善，为白内障的诊疗开辟了一条“新赛道”。本文旨在综述AI在白内障诊疗中的应用现状、进展及局限性，为AI在白内障领域的进一步开发、应用及推广提供更多信息。
Artificial intelligence (AI) has been widely applied and promoted in ophthalmology, and has gradually become a research hotspot in the diagnosis and treatment of many common ophthalmopathies, including diabetic retinopathy, cataract, glaucoma, and retinopathy of prematurity. AI improves the shortage of medical care, the lack of diagnostic criteria and the low level of diagnosis and treatment technology, and explores a “new race track” for cataract diagnosis and treatment. The purpose of this article is to review the application status, progress and limitations of AI in the diagnosis and treatment of cataract, aiming to provide more information for further development, application and promotion of AI in the field of cataract.
白内障是世界范围内致盲的主要原因之一，占中低收入国家致盲病例的50%。随着人口老龄化程度的加深，到2050年中国白内障致盲病例预计达到2 000万。卫生支出占比低、医疗设备及眼科医生紧缺、筛查费用昂贵仍是中低收入国家无法开展大规模白内障筛查的主要原因。人工智能(artificial intelligence，AI)协助白内障诊断具有便捷、低成本、可远程进行等优点，有望减少甚至避免白内障致盲的发生。文章将对AI通过结合裂隙灯眼前节图像、眼底照片及扫频源光学相干层析图像进行白内障自动诊断等研究进行简要综述。
Cataract is a primary cause of blindness globally, particularly accounting for 50% of blindness cases in low- and middle- income countries. As the population ages, it is predicated that cataract blindness cases in China will rise to 20 million by 2050. However, low health expenditures, scarcity of medical equipment and ophthalmologists, and high screening costs continue to hinder mass cataract screening in these countries. Artificial intelligence(AI)-assisted cataract diagnosis offers significant advantages, including convenience, cost-effectiveness, and remote accessibility, potentially reducing or even eliminating cataract blindness. This review aims to concisely summarize the research on automatic cataract diagnosis utilizing AI, incorporating slit lamp images of anterior eye segment, fundus photographs, and swept source optical coherence tomography images.
近视防控已经上升到我国国家战略层面，高度近视引起的视神经病变会损害视功能，但在临床上常常被忽视。OCT可以非侵入、高分辨率、快速以及可重复地定量视网膜各层厚度，是评估高度近视相关视神经病变的有力工具。由于高度近视常合并视盘和盘周的改变，视神经纤维层厚度的定量常出现误差。近年来，学者开始聚焦于黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的研究，但其在高度近视眼中的变化规律尚不统一。该文针对近年来高度近视眼黄斑区GCC的测量规范、诊断价值、变化规律等进行综述，以期提高眼科医师对高度近视视神经病变的重视和研究水平。
Myopia prevention and control has risen to the national strategic level in China. Optic neuropathy caused by high myopia can damage visual function, but it is often ignored in clinical practice Optical coherence tomography (OCT) characterized by non-invasiveness, high resolution, rapid, and repeatable quantifying the thickness of each layer in the retina has emerged as a powerful tool for evaluating high myopia related optic neuropathy. Due to the changes in and near the optic disc in high myopia, errors often occur in the quantification of the thickness of the optic nerve fiber layer. In recent years, researchers have gradually focused on the study of the thickness of ganglion cell complex (GCC), but the regularity of its changes in high myopia is not yet unified. This article reviews the measurement specifications, diagnostic values, and change rules of GCC in the macular region of high myopia in recent years, in order to improve the attention and research level of ophthalmologists on high myopia optic neuropathy.
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.
近年来，使用人工智能(artificial intelligence，AI)技术对临床大数据及图像进行分析，对疾病做出智能诊断、预测并提出诊疗决策，AI正逐步成为辅助临床及科研的先进技术。生物样本库作为收集临床信息和样本供科研使用的平台，是临床与科研的桥梁，也是临床信息与科研数据的集成平台。影响生物样本库使用效率及合理共享的因素有信息化建设水平不均衡、获取的临床及检验信息不完全、各库之间信息不对称等。本文对AI和区块链技术在生物样本库建设中的具体应用场景进行探讨，展望大数据时代智能生物样本库信息化建设的核心方向。
In recent years, artificial intelligence (AI) technology has been applied to analyze clinical big data and images and then make intelligent diagnosis, prediction and treatment decisions. It is gradually becoming an advanced technology to assist clinical and scientific research. Biobank is a platform for collecting clinical information and samples for scientific research, serving as a bridge between clinical and scientific research. It is also an integrated platform of clinical information and scientific research data. However, there are some challenges. First, clinical and laboratory information obtained is incomplete. Additionally, the information among different databases is asymmetric, which seriously impedes the information sharing among different Biobanks. In this article, the specific application scenarios of AI technology and blockchain in the construction of a Biobank were discussed, aiming to pinpoint the core direction of the information construction of an intelligent Biobank in the era of big data.
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。
At present, there is an imbalance in the development of ophthalmology in China. There are huge differences in the level of ophthalmology related facilities, diagnosis and treatment technologies between big cities and rural, remote areas. New intelligent diagnosis and treatment models are still needed to solve the imbalance. Since the eye is the only organ that can directly observe the blood vessels and nerves of the human body, the eye can reflect the health status of other organs and diagnosis of eye diseases based on medical images of some ophthalmic examinations can be made as well as other characteristics. Therefore, the development of artificial intelligence in ophthalmology has unique advantages. In addition, artificial intelligence can improve the accuracy and efficiency of information transmission across time and space to a certain extent. The advantages of artificial intelligence in ophthalmology and telematics are helping to solve the imbalance in ophthalmology development. From the perspective of the application of ophthalmic artificial intelligence in telemedicine, this paper mainly analyzes and summarizes the development degree, advantages and existing problems of artificial intelligence in the telemedicine of ophthalmic diseases in China, and discusses the prospect of the application of ophthalmic artificial intelligence in telemedicine.
目的：探索和评价“线上教学-理论小课-Wetlab实操”眼解剖整合课程在眼科住院医师规范化培训（住培）教学中的应用和效果。方法：纳入中山大学中山眼科中心2023年新入培的住培学员93名，在岗前培训时进行眼解剖整合课程教学。在课程前后分别进行测试，评价课程教学效果，并在课程结束后采用匿名线下测试考核和满意度问卷调查的形式对课程的满意度进行调查。结果：培训前（T1）和培训后（T2）总分中位数分别是60分和70分，T1最低分、25%、75%和最高分分别是10、40、62.5和90，T2最低分、25%、75%和最高分分别是30、60、80和100，T2得分显著高于T1得分，差异具有统计学意义（P<0.000 1）；T1和T2的自信度平均值分别为26.53±5.08、31.83±4.02，差异有统计学意义（P<0.001）。学员普遍表示对整合课程满意。结论：学员们接受整合课程培训后，对眼解剖学知识的掌握程度有明显提高，对整合课程满意度高。眼解剖整合课程有效性显著，是具有推广意义的教学改革。
Objective: To explore and evaluate the application and effect of an integrated ocular anatomy course comprising three main components: ‘online preview,’ ‘lecture,’ and ‘Wetlab dissection training’in the standardized training teaching of ophthalmology residents (hereinafter referred to as "resident training"). Methods: A total of 93 new resident trainees from Zhongshan Ophthalmic Center of Sun Yat-sen University in 2023 were included in the integrated course on ocular anatomy during pre-job training. Tests were carried out before and after the course to evaluate the teaching effect of the course, and questionnaires were issued after the course to investigate the satisfaction of the course. It adopts the form of anonymous offline test and satisfaction questionnaire. Results: The median total scores before (T1) and after (T2) training were 60 and 70, respectively; the lowest scores, 25%, 75% and highest scores of T1 were 10, 40, 62.5 and 90, respectively; the lowest scores, 25%, 75% and highest scores of T2 were 30, 60, 80 and 100, respectively, and the scores of T2 were significantly higher than those of T1. The difference was statistically significant (P<0.000 1). The mean confidence of T1 and T2 were 26.53±5.08 and 31.83±4.02, respectively, and the difference was statistically significant (P<0.001). Participants generally expressed satisfaction with the integrated programme. Conclusions: After receiving the training of the integrated course, the students' mastery of the knowledge of ocular anatomy has been significantly improved, and the satisfaction of the integrated course is high. The integrated course on ocular anatomy is effective, and it is a teaching reform with popularization significance.
中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy，CSC）是一种以脉络膜增厚、血管通透性增加为特征的脉络膜谱系疾病，所以对脉络膜的观察对于CSC的监测和治疗非常重要。随着光学相干断层扫描成像（optical coherence tomography，OCT）的发展，对脉络膜的认识有了显著提升，也让我们更深刻地理解了它在眼后段疾病中的重要作用，提高了对各种脉络膜视网膜疾病的诊断能力。近年来，随着扫频源光学相干断层扫描（swept source optical coherence tomography，SS - OCT）及扫频源光学相干断层扫描血流成像（swept source optical coherence tomography angiography，SS - OCTA）的发展，其扫描波长、深度、广度及扫描速度均显著提升，实现了对脉络膜结构的无创定量化评估，推进了对CSC等脉络膜谱系疾病的病理机制的认识和临床管理。文章就近年SS-OCT及SS-OCTA在 CSC 中的应用及研究进展进行总结。主要进展有：发现CSC脉络膜增厚不仅局限于黄斑区，且发现其脉络膜血管及基质成分均显著增加；CSC为双眼受累，而表现为单眼症状；涡静脉回流障碍机制在该疾病中起到关键作用；SS-OCT能进一步对后极部的视网膜下积液进行监测和分析；发现了急性与慢性CSC脉络膜相关参数的改变的不同；最后探究了巩膜机制在该疾病中可能起到的作用。
Central serous chorioretinopathy (CSC) is one of the choroidal spectrum diseases, characterized by choriod thickening and increased vascular permeability. Therefore it is very important to observe choroid, as this allows us to monitor it and formulate an appropriate therapeutic schedule. With the development of optical coherence tomography (OCT), our understanding of choroid has been significantly improved. We have got a deeper insight into its important role in posterior diseases, and also the diagnostic capability for choroidal and retinal diseases has also improved. In recent years, the development of swept source optical coherence tomography (SS-OCT) and swept source optical coherence tomography angiogrphy (SS-OCTA) has further advanced our ability to assess choroidal conditions. These technologies offer enhanced scanning wavelengths, depth, breadth, and scanning speed, enabling non-invasive quantitative assessment of choroidal structures. This has advanced our understanding of the pathophysiological mechanisms and clinical management of CSC and other choroidal spectrum diseases.This review summarizes the application of swept source optical coherence tomography (SS - OCT) and swept source optical coherence tomography angiography (SS - OCTA) in CSC and its research progress. The main advancements include: choroidal thickening in CSC is not limited to macular area, both choroidal vascular and stromal components are significantly increased; CSC can affect both eyes, although it often presents with unilateral symptoms; impaired vortex vein outflow plays a key role in the pathogenesis of this disease; SS-OCT can further monitor and analyze subretinal fluid accumulation in the posterior pole; differences in changes in choroidal parameters between acute and chronic CSC have been identified; and finally, the potential role of scleral mechanisms in this disease have been explored.
