| Background:Infant strabismus is a special type of strabismus.Because the child is young,can not cooperate with the examination.If the strabismus problem can not be found in time and get effective intervention,or there is no regular return visit after treatment,the doctor can not evaluate the treatment effect or adjust the treatment plan in time.It may seriously affect the development of visual function,and even affect the quality of life.However,due to the low return visit rate of infant strabismus patients,the long-term treatment effect of infant strabismus is not good.Can we find an appropriate way to make the children with strabismus return to the hospital without going back and forth,and get the same diagnosis and treatment effect as in the hospital?Can remote diagnosis and treatment based on the Internet realize the remote management of the whole course of treatment for infant strabismus patients,so as to solve the problem of“difficult and expensive to see a doctor”for strabismus patients?At present,there is no relevant literature report.Objective:By studying the components of“standardized eye position image for effective strabismus remote quantitative diagnosis”,the standardized operation process of acquiring eye position image was established;Through the application of“Computer-aided objective quantitative diagnosis technology of strabismus”in standardized eye position images of remote diagnosis and treatment,a“special examination method of strabismus”which can replace face-to-face diagnosis was established;Based on this,we establish the“Internet plus”remote diagnosis and treatment mode for infantile strabismus and the Internet remote diagnosis interactive platform.Through the evaluation of the“Internet plus”remote diagnosis and treatment mode of infantile strabismus in the real world,the application value is verified.Methods:First,the“Internet plus”platform construction of remote diagnosis and treatment mode for infant strabismus.1.On the basis of establishing the eye position image database of infant strabismus patients from January 2019 to January 2021,through the method of clinical experience combined with logical reasoning,the constituent elements of“standardized eye position image of effective strabismus remote quantitative diagnosis”were studied and verified,and the standardized operation process of eye position image acquisition was formulated.2.Apply the“Computer-aided objective quantitative diagnosis technology of strabismus”in the database of“standardized eye position image for effective remote quantitative diagnosis of strabismus”.According to the eye position algorithm,research the“special examination method of strabismus”which can replace face-to-face diagnosis and is suitable for remote diagnosis and treatment.3.Through the“strabismus specialist examination”suitable for remote diagnosis and treatment,we establish the“Internet plus”infant strabismus remote diagnosis and treatment mode and complete the platform construction.Second,“Internet plus”application value evaluation of remote diagnosis and treatment mode for infantile strabismus.1.Retrospective analysis from January 2019 to January 2021,the outpatient follow-up rate of infant strabismus patients after 1 week,1 month,3 months,6 months and 1 year,to study the compliance of“face-to-face”diagnosis and treatment.2.To compare the“Internet plus”infant’s strabismus remote diagnosis and treatment with the gold standard,the difference between the two diagnostic methods in the aspects of“qualitative diagnosis”,“quantitative diagnosis”and“treatment plan formulation”is analyzed.The sensitivity and specificity of remote diagnosis and treatment in the aspects of“qualitative diagnosis”,“quantitative diagnosis”and“treatment plan formulation”are studied.And evaluate its application value.3.The data of all remote consultation cases were collected,and the medical expenses of children were sorted out through descriptive analysis to evaluate the social and economic benefits of remote diagnosis and treatment.Results:First,the“Internet plus”platform construction of remote diagnosis and treatment mode for infant strabismus.1.A database of“invalid eye position images”(861 pieces of images)and“effective eye position images”(1460 pieces of images)was established by integrating eye position images.Through the analysis of“invalid eye position images”,the reasons of“invalid eye position images”were summarized as follows.There were268 cases(31.13%)of“head irregularities”;543 cases(63.07%)of“facial asymmetry”;279 cases(32.4%)of“non-fixation”;65 cases(7.55%)of“corneal reflectivity covered by upper eyelid”;224 cases(26.02%)of“no bilateral ears exposed”;53 cases(6.16%)of“far shooting distance”;198 cases(23.00%)of“unclear focus during shooting”;164 cases(19.05%)of“the difference level between shooting lens and the eyes”;217 cases(25.20%)of“shooting without turning on the phone or camera flash”.2.According to the“hypothetical propositional reasoning rule”and“equivalent propositional reasoning rule”,the constituent elements of“standardized eye position image for effective strabismus remote quantitative diagnosis”are deduced.The image picture is clear.The brightness is moderate.The front is close.The head size is moderate.The head is upright.The bilateral ears are symmetrical.The gaze eye is in the horizontal line.The corneal reflection point is clear and visible.3.Image shooting requirements:(1)Choose the indoor environment with moderate light intensity.(2)The shooting distance is 35～50cm.(3)Flash should be used when taking pictures(forced flash mode).(4)The photographer was facing the child.(5)The child can choose standing or sitting position,keep the body upright,and keep the head straight(expose both ears,keep the ears symmetrical)(parents can straighten the head behind the child).(6)Keep the camera or mobile phone lens on the same level with the child’s eyes.(7)When taking pictures,make sure that the child’s eyes are looking at the lens and the upper eyelid does not cover the pupil.Image shooting sequence:(1)Take the image of the first eye position(looking at the lens from the front).If the child does not wear glasses,take the naked eye image.If the child wears glasses,take the naked eye and wearing glasses image at the same time with 3～5 images.(2)One image covering the left eye and one image covering the right eye were taken respectively.(3)Take the images of eyeballs in nine directions:parents should hold the children’s head upright,and take pictures of the children’s eyeballs moving to the front,top right,top right,top left,right,bottom right,bottom right and bottom left respectively.During the shooting process,the children’s head should be kept still,and the children’s attention can be attracted with the help of toys.The upper eyelid of the child can be lifted up to fully expose the bulbar conjunctiva.Image quality inspection:clear image,moderate distance,head upright,binaural symmetry,at least one eye gazing at the lens,clear corneal reflection point.4.A remote diagnosis and treatment mode for strabismus patients is established.Doctors and parents use the same application program based on different platforms to carry out diagnosis and treatment activities through the Internet.Guided by the“standardized operation process of eye position image acquisition”,parents take eye position images of patients with strabismus with the help of mobile phones or digital cameras,and upload them to the application.Doctors can make a diagnosis and make a treatment plan for children with strabismus by asking their medical history,and according to the eye images provided by their parents.They can also carry out preoperative evaluation,surgical plan design and evaluation of diagnosis and treatment effect,so as to realize the remote management mode for the whole course of treatment of patients with strabismus.On this basis,a closed-loop Internet remote diagnosis interactive platform is provided.Second,Internet plus application value evaluation of remote diagnosis and treatment mode for infantile strabismus.1.“Face to face”diagnosis and treatment of follow-up analysis:after 1 week,1month,3 months,6 months,1 year,the success rate of follow-up were 81.51%,53.39%,39.80%,35.44%,44.78%respectively(χ~2=57.326,P<0.001).The overall follow-up rate showed a downward trend,and the difference of follow-up rate in different time periods was statistically significant.2.Analysis of the return visit from different sources.The return visit rates of 1week,1 month,3 months,6 months and 1 year after surgery in Guangzhou were86.27%,52.94%,43.48%,32.43%and 38.71%respectively.The return visit rates from Guangdong Province(excluding Guangzhou)were 84.48%,56.14%,35.56%,43.24%and 45.16%respectively.The return visit rates from other Provinces(excluding Guangdong)were 40.00%,40.00%,42.86%,0.00%and 80.00%respectively.3.The sensitivity and accuracy of“Internet plus”remote diagnosis and treatment for infants with strabismus is 84%and 87.50%respectively.It is considered that the diagnosis and treatment of face to face is more consistent with“qualitative diagnosis”and has higher sensitivity and specificity.4.The comparison between“face to face”diagnosis and treatment and“Internet plus”remote diagnosis and treatment of infantile strabismus(P=0.283).There is no difference between the two diagnostic methods in quantitative diagnosis.The area under the“quantitative diagnosis”ROC curve for the“Internet plus”remote diagnosis and treatment of infantile strabismus is 0.875(P<0.001).The sensitivity is 0.813 and the specificity is 0.951.5.The sensitivity and the specificity of the“Internet plus”treatment program for infants with strabismus are 77.78%and 93.75%respectively.It is considered that the diagnosis and treatment of face to face is highly consistent with the“treatment plan”and has high sensitivity and specificity.6.Among the 57 children in this study,16 were from Guangzhou,36 were from Guangdong Province(excluding Guangzhou)and 5 were from other Provinces(except Guangdong).Each teleconsultation reduced the total medical expenses by70576.36 yuan,including 11742 yuan for direct medical expenses and 58831.36 yuan for indirect medical expenses.The medical cost of each teleconsultation can be saved by 1159.07 yuan,832.14 yuan per capita in Guangzhou,1265.12 yuan per capita in Guangdong Province(excluding Guangzhou)and 2342.96 yuan per capita outside Guangdong Province.Conclusion:1.According to the rule of logical reasoning,this study infers the constituent elements of“standardized eye position image of effective strabismus remote quantitative diagnosis”,and formulates“standardized operation process of eye position image acquisition”.2.This study verified that the“standardized operation process of eye position image acquisition”formed according to the components of“standardized eye position image of effective strabismus remote quantitative diagnosis”is reliable,and the collected images can meet the requirements of remote strabismus quantitative diagnosis and treatment.3.In this study,“computer-aided objective quantitative diagnosis technology of strabismus”is applied to calculate the degree of strabismus of children with strabismus,and it is proved that this technology is effective and reliable in the remote diagnosis and treatment of strabismus.4.Based on the“Internet plus”infant remote strabismus remote diagnosis and treatment mode,the study built a closed loop“Internet plus”infant remote strabismus diagnostic and therapeutic platform,which can satisfy the whole course of remote management for infants with strabismus.5.“Internet plus”infant diagnosis and treatment of“face to face”diagnosis and treatment are highly consistent in terms of“qualitative diagnosis”,“quantitative diagnosis”and“treatment plan formulation”,and have high sensitivity and specificity.The results showed that the“Internet plus”remote diagnosis and treatment of infantile strabismus was reliable and effective in the diagnosis and treatment plan formulation.6.The infants with strabismus have low compliance in clinic,and the application of“Internet plus”infantile strabismus can save children and their families’time for going to the hospital,reducing the financial burden,and alleviating social problems such as“difficult to see a doctor,expensive medical treatment and frequent visits to the doctor”. |
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