From barn lanterns to the 5G intelligent ophthalmic cruiser: the perspective of artificial intelligence and digital technologies on the modality and efficiency of blindness prevention in China
阅读量：11902
DOI：10.12419/es23122101
发布日期：2024-03-28
作者：
Wei Xiao ,Wai Cheng Iao ,林浩添
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关键词
blindness prevention
artificial intelligence
telemedicine
mobile clinics
摘要
Blindness prevention has been an important national policy in China. Previous strategies, such as deploying experienced cataract surgeons to rural areas and assisting in building local ophthalmology centers, had successfully decreased the prevalence of visual impairment and blindness. However, new challenges arise with the aging population and the shift of the disease spectrum towards age-related eye diseases and myopia. With the constant technological boom, digital healthcare innovations in ophthalmology could immensely enhance screening and diagnosing capabilities. Artifcial intelligence (AI) and telemedicine have been proven valuable in clinical ophthalmology settings. Moreover, the integration of cutting-edge communication technology and AI in mobile clinics and remote surgeries is on the horizon, potentially revolutionizing blindness prevention and ophthalmic healthcare. The future of blindness prevention in China is poised to undergo signifcant transformation, driven by emerging challenges and new opportunities.
全文
Introduction
Blindness and visual impairment is the third leading cause of disability in the world.[1] Since the founding of the People’s Republic of China, the prevention and treatment of blindness has been attached great importance.[2] The earliest practice could be dated back to the 1950s, when teams of ophthalmologists went into the rural and coastal areas with barn lanterns to light up the dark village roads, knocking on the doors of villagers who suffered from eye diseases house by house.[3-5] It was part of the initiatives to eliminate blindness caused by cataracts, the major eye disease responsible for curable visual impairment at the time. To restore sight and improve ophthalmology capacity in remote areas, experienced ophthalmologists were sent with the task of performing cataract surgeries, as well as supporting the construction of regional eye centres and training local physicians under the call of national programs such as ‘Sight First, China Action’, ‘Lifeline Express’[6], and ‘China Million Cataract Surgeries Program’[7]. The results were encouraging. Epidemiologic surveys in 2006 and 2014 showed that the prevalence of visual impairment and blindness in China decreased by more than 20%,[8] and the cataract surgical rate was 7 times more than that of 1999, reaching 2,205.[9]Despite the outstanding achievements of the series of efforts in preventing and treating blindness, the demographic and lifestyle changes of the new era are bound to bring about entirely new challenges. The 2014 Nine-Province Surveys in Rural China revealed that retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD) have escalated in prevalence and become some of the major causes of irreversible blindness.[10] The boom of myopia in the digital age has also made myopia-related complications a critical risk factor for visual impairment.[11] Since traditional approaches to blindness prevention mainly increase the treatment capacity of reversible blinding diseases, they are not as effective in tackling the changing disease spectrum. In addition, previous studies demonstrated that the number of ophthalmologists per capita is signifcantly higher in the country’s more developed eastern regions, and that the surgical capacity of county-level ophthalmic institutions is still signifcantly insufcient.[12] Such results indicated that the unequal distribution of high-quality ophthalmic resources in the country remains unresolved.
The rise of intelligent and digital technologies brings unprecedented opportunities for the global healthcare industry. Along with the development of artificial intelligence (AI), 5th generation wireless networks (5G), virtual reality (VR), and augmented reality (AR), digital medicine provides a novel solution to the quest of providing fair and accessible health care services.[13] Real-world applications of digital healthcare innovations in ophthalmology were widely reported. Tele-screening for diabetic retinopathy based on fundus photography has been proven to increase screening rates and cost-effectiveness in many countries.[14-16] The breakthrough of deep learning technology enables automatic image analysis and classifcation, leading to the rise of various screening and diagnostic models of DR,[17-18] AMD,[19] glaucoma,[20] and retinopathy of prematurity[21] based on ocular data such as fundus photos and OCT images. For eye diseases requiring long-term follow-up, virtual clinics for AMD[22-23] and glaucoma[24-25] provided a promising method for effective long-term management. VR and AR-based clinical simulation were also implemented for ophthalmologist training during the COVID-19 pandemic to mitigate exposure risks.[26-27]
The exponential growth in screening, diagnosis and treatment innovations will undoubtedly break the mould in ophthalmic healthcare. How the current technology boom could reshape the prevention of blindness would be a crucial question for China's ophthalmology medical practitioners and policymakers to ponder. The application of AI and 5G technology signifies that healthcare resources can transcend time and space, making it easier for the general public to obtain medical services and for healthcare professionals to obtain training and support. With the popularization of AI models and telemedicine, it would be feasible to implement large-scale blindness prevention projects with broader coverage. Ophthalmologists on the other side of the country will be able to knock on the door of every patient in need, regardless of location and wealth.
A recent study from Liu et al.[28] has provided evidence for emerging new technologies in real-world ophthalmic scenarios. Their results showed a higher cost-efectiveness in AI- and telemedicine-assisted screening than traditional face-to-face screening for a wide range of blinding eye diseases in urban and rural areas. It means that primary care centres can detect AMD, glaucoma, cataracts, diabetic retinopathy, and pathologic myopia at an early stage with basic ophthalmic examination equipment, reducing the chance of developing resultant irreversible blindness. The widespread 5G technology and the recent introduction of surgical robot-assisted cataract surgery,[14-16] vitreoretinal surgery,[29] and corneal transplantation[30] have also provided favourable conditions for developing remote ophthalmologic surgeries.
In recent years, many blindness prevention initiatives incorporating digital healthcare have achieved commendable results. For instance, the nationwide telemedicine-enabled DR screening programme fueled by Lifeline Express has established 29 screening centres across the country and served more than 30,000 diabetic patients from 2014 to 2016.[6] Another teleophthalmology approach in the Guangdong provinceintegrated DR and glaucoma grading with medical educationby linking the regional ophthalmological centre with multiple rural hospitals.[31] The Beijing Eye Public Health Care Project also presented a successful tele-screening schemebased onocular images, reaching over 500,000 residentsand identified cataracts, glaucoma and diabetic retinopathy as the major causes of visual impairment.[32] As for AI diagnosis programs, the Comprehensive Artificial Intelligence Retinal Expert (CARE) system has been proven effective for detecting 14 common retinal abnormalitiesbased on national real-world data.[33] These pioneering studies have provided valuable examples for applying digital health technologies in blindness prevention.
People with visual impairments often suffer from reduced mobility, making it more difficult for them to seek medical assistance actively. Mobile clinics have been shown to play an irreplaceable role for people who have difficulty accessing medical resources.[20] Together with 5G communication technology, Internet of Things (IoT) and AI models, mobile clinics can be an ideal carrier for digital healthcare. In terms of disease screening and management, vehicle-mounted instruments integrated with network connection and diagnostic models could archive remote screening, diagnosis, consultation, and follow-up on the patients’doorstep. An example of real-world application is the 5G Intelligent Ophthalmic Cruiser launched by Zhongshan Ophthalmic Center, which has served more than 10,000 people in over 20 regions over the past year. The cruiseris equipped with automatic eye examination equipment and thevehicular 5G network, allowingthe tele-screening of common eye diseases in remote areas of the country. For sight-restoring surgery, it can be expected that mobile clinics equipped with surgical robots to perform standardized operations will become a new norm in the future. Regarding medical education, the frontiers of ophthalmology could be brought to primary healthcare institutions with ease, signifcantly reducing the learning costs and enhancing the capacity of regional ophthalmic healthcare more efficiently. It could substantially improve the quality of local healthcare, leading to a more sustainable and autogenous system of blindness prevention.
The sci-tech revolution has brought fundamental changes to blindness prevention, presenting new challenges and opportunities beyond traditional methods. From barn lanterns to the 5G Intelligent Ophthalmic Cruiser, digital technologies have reshaped ophthalmic healthcare in China. The real-world application of various telemedicine solutions during the COVID-19 pandemic has accelerated the emergence of digital medicine as the new normal in ophthalmology. Reliability, ethics and morality, and patient acceptance are still pending challenges. Nevertheless, the compelling development in this new era can undoubtedly fuel a series of transformations and advances in blindness prevention in China.
Correction notice
NoneAcknowledgement
NoneAuthor Contributions
(I) Conception and design: Haotian Lin(II)Administrative support: Haotian Lin
(III) Provision of study materials or patients: Haotian Lin, Wei Xiao
(IV) Collection and assembly of data: Wei Xiao, Wai Cheng Iao
(V) Data analysis and interpretation: Wei Xiao, Wai Cheng Iao
(VI) Manuscript writing:All authors
(VII) Final approval of manuscript:All authors
Funding
This work was supported by the Science and Technology Program of Guangzhou (202201020337), the Science and Technology Planning Projects of Guangdong Province (2021B1111610006), the Science and Technology Program of Guangzhou (2024B03J1233), the National Natural Science Foundation of China (82171035), the High-level Science and Technology Journals Projects of Guangdong Province (2021B1212010003), the National Natural Science Foundation of China (82201237), the China Postdoctoral Science Foundation (2023T160751).The funding organizations had no role in the following aspects: design and conduct of the study; the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
ConfictofInterests
None of the authors has any conflicts of interest to disclose. All authors have declared in the completed the ICMJE uniform disclosure form.Patient consent for publication
NoneEthical Statement
This study does not contain any studies with human or animal subjects performed by any of the authorsProvenance and PeerReview
This article was a standard submission to our journal. The article has undergone peer review with ouranonymous review systemData Sharing Statement
NoneOpenAccess Statement
This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.基金
1、This study was funded by the Science and Technology Program of Guangzhou
2、This study was funded by the Science and Technology Planning Projects of Guangdong Province
3、This study was funded by the Science and Technology Program of Guangzhou
4、This study was funded by the National Natural Science Foundation of China
5、This study was funded by the High-level Science and Technology Journals Projects of Guangdong Province
6、This study was funded by the National Natural Science Foundation of China
7、This study was funded by the China Postdoctoral Science Foundation
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