Abstract：
Purpose: Strabismus is a common ocular condition requiring precise quantification of gaze deviation and qualification of strabismus category. Telemedicine refers to the use of technology to remotely diagnose and treat medical conditions. This narrative review aimed to assess the efficacy of a variety of telemedicine modalities for the assessment of strabismus. A secondary objective was to quantify overall accuracy, sensitivity, and specificity of automated methods using meta-analysis of available data. Methods: A literature search was conducted using the Ovid MEDLINE, Embase, and Cochrane Library data libraries. Keywords, including \"strabismus,\" \"phoria,\" \"telemed*,\" and \"telehealth,\" were used to locate relevant studies, with Medical Subject Headings terms, free text, and synonyms. No year restrictions were applied. Studies not in English were excluded. Risk of bias was assessed using the QUADAS-2 tool. Results: Thirty-four studies were included. All outcomes relating to accuracy and reliability of telemedicine versus a reference standard were extracted, as well as qualitative observations. High sensitivity, specificity, accuracy, and agreement were consistently shown across studies. Meta-analysis of two subsets featuring automated methods, for which relevant data were available, revealed a pooled accuracy of 0.877 (0.806-0.949), sensitivity of 0.856 (0.805-0.907), and specificity of 0.900 (0.845-0.954). Subcategories \"remote standard assessment,\" \"digital image analysis,\" \"wearable devices,\" \"mobile health (mHealth),\" and \"artificial intelligence\" were independently examined. Conclusions: The majority of systems achieved parity with standard physician assessment, with the added benefit of eliminating subjectivity. Meta-analysis results suggest potential introduction of remote automated assessment where conventional assessment is unavailable, although accuracy of current technologies remains limited compared to in-person examination. Telemedicine modalities described offer convenience for patients, shorter examination times, and the potential to go beyond in-person assessments. The evidence gathered in this review supports the beginning of telemedicine integration into the world of strabismus diagnosis.
摘要：
目的：斜视是一种常见的眼部疾病，需要精确量化注视偏差和确定斜视类别。远程医疗是指使用技术来远程诊断和治疗医疗状况。这篇叙述性综述旨在评估各种远程医疗模式对斜视评估的有效性。第二个目标是量化总体准确性，灵敏度,以及使用可用数据的荟萃分析的自动化方法的特异性。方法：使用OvidMEDLINE进行文献检索，Embase,和Cochrane图书馆数据库。关键词,包括斜视，\"\"隐窝,\"\"电话显示*,“和”远程医疗，“被用来定位相关研究，带有医学主题词的术语，自由文本,和同义词。没有年份限制。非英语研究被排除在外。使用QUADAS-2工具评估偏倚风险。结果：共纳入34项研究。提取了与远程医疗相对于参考标准的准确性和可靠性有关的所有结果，以及定性观察。灵敏度高,特异性，准确度,并且在所有研究中一致显示出一致性。以自动化方法为特征的两个子集的荟萃分析，有相关数据，显示出0.877(0.806-0.949)的合并精度，灵敏度为0.856(0.805-0.907)，特异性为0.900（0.845-0.954）。子类别“远程标准评估，\"\"数字图像分析,\"\"可穿戴设备，\“\”移动健康(mHealth)，“”和“人工智能”进行了独立检查。结论：大多数系统与标准医生评估相当，具有消除主观性的额外好处。荟萃分析结果表明，在无法进行常规评估的情况下，可能会引入远程自动评估。尽管与面对面检查相比，当前技术的准确性仍然有限。所描述的远程医疗模式为患者提供了便利，考试时间短，以及超越面对面评估的潜力。这篇综述中收集的证据支持远程医疗开始融入斜视诊断领域。
