PDF(Pubmed)
Abstract：
BACKGROUND: Uncorrected refractive errors pose a significant challenge globally, particularly in remote regions of low-middle income countries where access to optometric care is often limited. Telerefraction, which involves refraction by a trained technician followed by real-time consultation with remote optometrist, is a promising approach for such remote settings. This study aimed to evaluate the accuracy of this model.
METHODS: This prospective study, conducted in New Delhi, compared tele-refraction to in-person examinations. Trained technicians used a simple device, Click-check, to perform objective refraction and a tele-refraction platform to enter the findings of objective refraction. Final prescription was made after consulting a remote optometrist on that platform. Masked face-to-face optometrists served as the gold standard. The study involved refraction in 222 patients and 428 eyes.
RESULTS: Tele-refraction demonstrated a strong agreement with in-person optometry, achieving 84.6% in spherical correction and 81% conformity in spherical equivalent. The mean difference of spherical equivalent between the two arms was only 0.11 D. The consultation with a remote optometrist improved conformity of spherical equivalent by 14.8% over objective refraction. 82 percent eyes matched in best corrected visual acuity and 92 percent were within 0.1 logMAR difference. For cylindrical axis, 74% eye were within acceptable 10 degrees of difference. The mismatch amongst the individual trained technicians, in terms of difference between the tele-refraction arm and the face-to face optometrist arm was found to be significant for cylindrical axis and not for spherical power and spherical equivalent.
CONCLUSIONS: Our study found tele-refraction by a trained technician comparable to refraction done by face-to-face optometrist. Tele-refraction, coupled with remote optometrist guidance can address the optometry resource gap in underserved areas. Thus, this model offers a transformative approach to enhancing the accessibility and quality of eye care services, which can significantly contribute to our efforts in achieving the global targets set by the World Health Organization for effective refractive error coverage. More standardized training for these technicians on ClickCheckTM for detecting the cylindrical axis with better accuracy, can improve this model further.
METHODS: This prospective study, conducted in New Delhi, compared tele-refraction to in-person examinations. Trained technicians used a simple device, Click-check, to perform objective refraction and a tele-refraction platform to enter the findings of objective refraction. Final prescription was made after consulting a remote optometrist on that platform. Masked face-to-face optometrists served as the gold standard. The study involved refraction in 222 patients and 428 eyes.
RESULTS: Tele-refraction demonstrated a strong agreement with in-person optometry, achieving 84.6% in spherical correction and 81% conformity in spherical equivalent. The mean difference of spherical equivalent between the two arms was only 0.11 D. The consultation with a remote optometrist improved conformity of spherical equivalent by 14.8% over objective refraction. 82 percent eyes matched in best corrected visual acuity and 92 percent were within 0.1 logMAR difference. For cylindrical axis, 74% eye were within acceptable 10 degrees of difference. The mismatch amongst the individual trained technicians, in terms of difference between the tele-refraction arm and the face-to face optometrist arm was found to be significant for cylindrical axis and not for spherical power and spherical equivalent.
CONCLUSIONS: Our study found tele-refraction by a trained technician comparable to refraction done by face-to-face optometrist. Tele-refraction, coupled with remote optometrist guidance can address the optometry resource gap in underserved areas. Thus, this model offers a transformative approach to enhancing the accessibility and quality of eye care services, which can significantly contribute to our efforts in achieving the global targets set by the World Health Organization for effective refractive error coverage. More standardized training for these technicians on ClickCheckTM for detecting the cylindrical axis with better accuracy, can improve this model further.
摘要：
背景：未矫正的屈光不正在全球范围内构成重大挑战，特别是在中低收入国家的偏远地区，那里获得验光护理的机会往往有限。远射,其中包括由训练有素的技术人员进行屈光，然后与远程验光师进行实时咨询，对于这种远程设置是一种有前途的方法。本研究旨在评估该模型的准确性。
方法：这项前瞻性研究，在新德里进行，将远距折射与面对面检查进行了比较。训练有素的技术人员使用了一个简单的装置，单击检查，进行客观折射和远程折射平台输入客观折射的发现。最终处方是在该平台上咨询远程验光师后制定的。蒙面的面对面验光师是黄金标准。该研究涉及222例患者和428只眼的屈光。
结果：远程屈光与现场验光有很强的一致性，达到84.6%的球面矫正和81%的球面一致性。两个臂之间的等效球面的平均差仅为0.11D。与远程验光师的协商使等效球面的一致性比客观屈光度提高了14.8％。82％的眼睛与最佳矫正视力匹配，92％的眼睛在0.1logMAR差异内。对于圆柱轴，74%的眼睛在可接受的10度差异内。个别受过训练的技术人员之间的不匹配，就远距屈光臂和面对面验光师臂之间的差异而言，对于圆柱轴而言，而对于球形屈光力和等效球形而言，差异很大。
结论：我们的研究发现，由训练有素的技术人员进行的远程屈光与面对面验光师进行的屈光相当。远程折射,加上远程验光师指导，可以解决服务不足地区的验光资源缺口。因此，这种模式提供了一种变革性的方法来提高眼科护理服务的可及性和质量，这可以大大有助于我们努力实现世界卫生组织为有效覆盖屈光不正而设定的全球目标。对这些技术人员进行更规范的ClickCheckTM培训，以更好的精度检测圆柱轴，可以进一步改进这个模型。
方法：这项前瞻性研究，在新德里进行，将远距折射与面对面检查进行了比较。训练有素的技术人员使用了一个简单的装置，单击检查，进行客观折射和远程折射平台输入客观折射的发现。最终处方是在该平台上咨询远程验光师后制定的。蒙面的面对面验光师是黄金标准。该研究涉及222例患者和428只眼的屈光。
结果：远程屈光与现场验光有很强的一致性，达到84.6%的球面矫正和81%的球面一致性。两个臂之间的等效球面的平均差仅为0.11D。与远程验光师的协商使等效球面的一致性比客观屈光度提高了14.8％。82％的眼睛与最佳矫正视力匹配，92％的眼睛在0.1logMAR差异内。对于圆柱轴，74%的眼睛在可接受的10度差异内。个别受过训练的技术人员之间的不匹配，就远距屈光臂和面对面验光师臂之间的差异而言，对于圆柱轴而言，而对于球形屈光力和等效球形而言，差异很大。
结论：我们的研究发现，由训练有素的技术人员进行的远程屈光与面对面验光师进行的屈光相当。远程折射,加上远程验光师指导，可以解决服务不足地区的验光资源缺口。因此，这种模式提供了一种变革性的方法来提高眼科护理服务的可及性和质量，这可以大大有助于我们努力实现世界卫生组织为有效覆盖屈光不正而设定的全球目标。对这些技术人员进行更规范的ClickCheckTM培训，以更好的精度检测圆柱轴，可以进一步改进这个模型。
