Application of remote fundus image reading training in improving the diagnostic ability of ophthalmologists in Xinjiang Uygur Autonomous Region_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhao Xufeng ¹ , Ma Xiuyan ² , Li Xuejing ² , Qin Li ² , Suo Lina ² , Ma Wenping ² , Li Shihao ² , Chen Jiaxing ² , Yang Yaxin ³ , Li Xinxia ³ , Xie Tao ³ , Li Juan ³ , Xiong Yuanshan ³ , Wu Zhiyong ⁴ , Chang Zhihuai ⁴ , Fang Mowen ⁴ , Wang Ting ⁴ , Liu Hong ⁵ , Ma Pengju ⁵ , Liu Pengpeng ⁵ , Ran Jing ⁵ , Yang Di ⁵ , Xue Changle ⁶ , Xie Zhen ⁶ , Fan Zhao ⁶ , Wang Yang ⁶ , Lei Peng ⁷ , Huang Qingjiang ⁷ , Li Bing ¹ , Feng Shi ¹ , Wei Zhangwanyu ¹ , Mao Yishuang ¹ , Yu Weihong ¹ ,  Zhang Linjun ²

1. Department of Ophthalmology, Peking Union Medical College Hospital, Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China;
2. Department of Ophthalmology, Xinjiang Production and Construction Corps Hospital, Urumqi 830002, China;
3. Department of Ophthalmology, First Division Hospital of Xinjiang Production and Construction Corps, Aksu 843000, China;
4. Department of Ophthalmology, Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining 835000, China;
5. Department of Ophthalmology, Eighth Division Hospital of Xinjiang Production and Construction Corps (Shihezi People's Hospital), Shihezi 832000, China;
6. Department of Ophthalmology, Tenth Division Beitun Hospital of Xinjiang Production and Construction Corps, Beitun 831300, China;
7. Department of Ophthalmology, First Division Aral Hospital of Xinjiang Production and Construction Corps, Aral 843300, China;

Corresponding author：

Zhang Linjun, Email: 1535889271@qq.com

Keywords：

Rundus diseases; Hypertensive retinopathy; Diabetic retinopathy; Age-related macular disease; Telemedicine; Image diagnosis

DOI：

10.3760/cma.j.cn511434-20240716-00271

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Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as “Xinjiang Region”) in diagnosing fundus diseases. Methods The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination (P＜0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance (P＜0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance (P＜0.05). There was no significant correlation (P＞0.05) between the improvement of diagnostic level of participating physicians and educational background (Rho=0.07), professional title (Rho=0.13), age (r=0.20), and working time of ophthalmofundus disease specialty (r=0.26).Conclusions Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. Potential for feasibility and effectiveness of a preliminary telemedicine education model in remote areas with inadequate medical resources.

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2. Chen X, Liu L, Liu M, et al. Hypertensive retinopathy and the risk of stroke among hypertensive adults in China[J]. Invest Ophthalmol Vis Sci, 2021, 62(9): 28. DOI: 10.1167/iovs.62.9.28.
3. Hou X, Wang L, Zhu D, et al. Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China[J/OL]. Nat Commun, 2023, 14(1): 4296[2023-07-18]. https://pubmed.ncbi.nlm.nih.gov/37463878/. DOI: 10.1038/s41467-023-39864-w.
4. Wang JG, Zhang W, Li Y, et al. Hypertension in China: epidemiology and treatment initiatives[J]. Nat Rev Cardiol, 2023, 20(8): 531-545. DOI: 10.1038/s41569-022-00829-z.
5. Song P, Du Y, Chan KY, et al. The national and subnational prevalence and burden of age-related macular degeneration in China[J/OL]. J Glob Health, 2017, 7(2): 020703[2017-12-01]. https://pubmed.ncbi.nlm.nih.gov/29302323/. DOI: 10.7189/jogh.07.020703.
6. Suciu CI, Suciu VI, Nicoara SD. Optical coherence tomography (angiography) biomarkers in the assessment and monitoring of diabetic macular edema[J/OL]. J Diabetes Res, 2020, 2020: 6655021[2020-12-31]. https://pubmed.ncbi.nlm.nih.gov/33490283/. DOI: 10.1155/2020/6655021.
7. Yuksel Elgin C, Chen D, Al-Aswad LA. Ophthalmic imaging for the diagnosis and monitoring of glaucoma: a review[J]. Clin Exp Ophthalmol, 2022, 50(2): 183-197. DOI: 10.1111/ceo.14044.
8. 景正伟, 冯晶晶, 王洪源, 等. 中国眼科医师配置公平性分析[J]. 中国卫生资源, 2019, 22(4): 284-289. DOI: 10.3969/j.issn.1007-953X.2019.04.009.Jing ZW, Feng JJ, Wang HY, et al. Analysis on the equity of ophthalmologist resource allocation in China[J]. Chinese Health Resources, 2019, 22(4): 284-289. DOI: 10.3969/j.issn.1007-953X.2019.04.009.
9. Patel SN, Martinez-Castellanos MA, Berrones-Medina D, et al. Assessment of a tele-education system to enhance retinopathy of prematurity training by international ophthalmologists-in-training in Mexico[J]. Ophthalmology, 2017, 124(7): 953-961. DOI: 10.1016/j.ophtha.2017.02.014.
10. Cole E, Beca F, Gil G L, et al. iTeleGEN: development of a web-based diabetic retinopathy education module[J]. Invest Ophth Vis Sci, 2019, 60(9): 5307.
11. Succar T, Zebington G, Billson F, et al. The impact of the virtual ophthalmology clinic on medical students' learning: a randomised controlled trial[J]. Eye (Lond), 2013, 27(10): 1151-1157. DOI: 10.1038/eye.2013.143.
12. 吴丹, 石锐, 肖军. 领办高原藏区公立医院的探索与实践——四川大学华西医院领办下的甘孜实践[J]. 时代人物, 2023, 30(5): 262-264.Wu D, Shi R, Xiao J. The exploration and practice of leading public hospitals in Tibetan Plateau areas—the practice of Garze under the leadership of West China Hospital of Sichuan University[J]. Times Figure, 2023, 30(5): 262-264.
13. 李仁战, 陈翔, 徐敬峰, 等. 医学影像远程会诊中心在基层医院中的应用[J]. 浙江医学, 2015, 37(2): 156-158.Li RZ, Chen X, Xu JF, et al. Application of medical imaging remote consultation center in primary hospitals[J]. Zhejiang Medical Journal, 2015, 37(2): 156-158.

Chinese Journal of Ocular Fundus Diseases

Latest ArticlesApplication of remote fundus image reading training in improving the diagnostic ability of ophthalmologists in Xinjiang Uygur Autonomous Region

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