利用数字技术进行糖尿病视网膜病变远程医疗筛查:国外经验

Dimitry A. Andreev, N. Kamynina
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摘要

背景。及时发现和治疗糖尿病视网膜病变(DR)可以防止失明的发生。然而,许多患者在确诊时已是晚期,无法进行有效治疗。在这种情况下,积极筛查糖尿病视网膜病变发挥了重要作用。目前已开发出各种筛查项目,包括使用数字技术的项目。分析并总结有关 DR 筛查数字化的文献数据。本研究根据 PubMed / Medline 文献数据库和谷歌系统的搜索结果进行。使用的关键词包括 "糖尿病"、"视网膜病变"、"远程医疗"、"数字技术"、"人工智能 "等。通过审查文章的标题和摘要,筛选出相关出版物。研究探讨了组织 DR 筛查远程医疗项目的方法。介绍了用于诊断研究的创新数字技术实例以及各种电子系统和设备的特点。研究指出,DR 筛查可在当地中心进行,并将数据传输到区域专业诊断(分析)中心,在那里进行远程医疗分析。糖尿病医生可获得所有诊断信息,并开具处方和调整治疗方案。这一操作原则促进了不同专家之间的互动,从而提高了筛查效率。虽然糖尿病视网膜病变的远程医疗筛查已在一些国家开展,但仍处于早期发展阶段。许多现代技术,如便携式移动设备,都可以在远程医疗项目的实施中得到调整和应用。深度机器学习算法和其他基于人工智能的方法显示出卓越的效果。一些系统已经获得了监管部门的批准。结论通过将创新筛查技术整合到常规临床实践中实施的统一数字平台,可以改善糖尿病视网膜病变的早期诊断。
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Telemedicine Screening for Diabetic Retinopathy Using Digital Technology: Foreign Experience
Background. Timely detection and treatment of diabetic retinopathy (DR) could prevent the development of blindness. However, large number of patients are diagnosed at late stages when effective treatment becomes impossible. In this context, active screening for DR plays an important role. Various screening programs have been developed, including programs using digital technologies.Objective. To analyze and summarize the literature data on digitalization of DR screening.Materials and methods. The study was carried out based on the results of a search in the PubMed / Medline bibliographic database and the Google system. The used keywords were “diabetes”, “retinopathy”, “telemedi-cine”, “digital technologies”, “artificial intelligence” and others. Relevant publications were selected by exam-ining the titles and abstracts of articles.Results. The study addressed the approaches to organizing the telemedicine programs of DR screening. The examples of innovative digital technologies for performing diagnostic studies as well as the characteristics of various electronic systems and devices are presented. It was noted that the DR screening could be performed in a local center with data transfer to a regional specialized diagnostic (analytical) center where telemedicine analysis is done. All diagnostic information is available to the diabetologist who prescribes and adjusts ther-apy. This operating principle facilitates the interaction between various specialists and thus increases the efficiency of screening.Discussion. Although the telemedicine screening for diabetic retinopathy has already been introduced in a number of countries, it is still at its early stages of development. Many modern technologies such as portable mobile devices could be adapted and used in the implementation of telemedicine programs. Deep machine learning algorithms and other artificial intelligence-based approaches demonstrate excellent results. Some systems have already received regulatory approval. Conclusions. The early diagnostics of diabetic retinopathy could be improved by integrating innovative screening technologies in a unified digital platform implemented in routine clinical practice.
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