眼科影像檢查可辨識心血管風險因素


  【24drs.com】根據發表於2012年世界眼科研討會的研究,德國的一個遠距醫療計畫有助於內科醫師和眼科醫師之間的互動,使用視網膜的檢查資料而幫助確認心血管事件風險增加的病患。
  
  德國Erlangen大學Georg Michelson醫師發表研究時表示,眼睛反映出血管和神經退化疾病,特別的是,視網膜微血管病變和某些全身性疾病有關,例如動脈性高血壓、中風、糖尿病;舉例而言,中風患者的視網膜血管壁厚度增加,而這可以用免散瞳眼底照相機檢查得知。
  
  Michelson醫師指出,其團隊之前的研究顯示,出現棉絮狀斑者的中風風險增加6.35倍,微小動脈瘤風險則是增加4.71倍;斑點狀出血者的中風風險增加4.25倍。
  
  這些實證關聯促使Michelson醫師發展了他的TalkingEyes計畫,包括了31名開業內科醫師,這些醫師使用攜帶式免散瞳眼底照相機在診間拍攝病患視網膜的數位相片,將這些視網膜影像上傳到網路上的病患病歷,由眼科醫師進行評估,之後在病患的電子化病歷上加註報告。
  
  Michelson醫師解釋,如果我們可以利用遠距醫療網路連結內科醫師和眼科醫師,將可改善病患照護。
  
  這篇研究中,6,999病患在一般開業醫師診間進行了視網膜檢查,這些病患的年齡中位數是54歲、身體質量指數中位數是27.6 kg/m2,40%表示有動脈高血壓病史、11.1%有第2型糖尿病。
  
  檢查時,醫師們拍攝了視網膜的45°相片、抽血、量血壓;之後使用PROCAM指標計算心血管風險值,一名眼科醫師在遠端分析眼底影像。
  
  Michelson醫師報告指出,9%研究對象之視網膜血管有相關的型態改變,例如動靜脈交錯、視網膜出血、微血管瘤、微小梗塞。
  
  根據PROCAM指標,只有2%的病患被發現心血管事件風險高,不過,55名病患(0.8%)未被發現有風險,他報告指出,我們發現相關的視網膜微血管病變變化。
  
  Michelson醫師表示,我們在約60,000名病患進行此計劃,相信檢視這些獨特的風險因素對於治療有所影響。
  
  他認為這些變化的發生可能有兩個面向,第一,接受篩檢者對於整體的健康風險有比較大的警覺性,所以他們較常有動機就醫而受檢查,其次,醫師對提高的風險跡證有所反應。
  
  大約20%的案例中,治療決策是根據這些結果而定。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6741&x_classno=0

Eye Imaging Identifies Cardiovascular Risk Factors

By Neil Canavan
Medscape Medical News

February 28, 2012 (Abu Dhabi, United Arab Emirates) — A telemedicine program in Germany facilitates interaction between internists and ophthalmologists and helps to identify patients at increased risk for cardiovascular events using information from the retina, according to a study presented here at the World Ophthalmology Congress 2012.

"The eye mirrors vascular and neurodegenerative diseases," said study presenter Georg Michelson, MD, from the University of Erlangen in Germany. "In particular, retinal microangiopathy correlates with certain systemic diseases such as arterial hypertension, stroke, and diabetes." For instance, retinal vessel-wall thickness, which is increased in stroke, can be seen using a nonmydriatic fundus camera.

Dr. Michelson described previous research done by his team, which showed that stroke risk increased 6.35-fold when cotton-wool spots were observed, and increased 4.71-fold with microaneurysms; stroke risk was 4.25-fold higher with blot hemorrhages.

These proven associations led Dr. Michelson to develop his TalkingEyes program, consisting of a network of 31 internists in private practice. The physicians use a mobile nonmydriatic fundus camera to take digital photographs of the retina in the office. These retinal images are uploaded to a Web-based patient chart, where they are evaluated by an ophthalmologist, who then adds a report to the patient's e-chart.

"If we can connect ophthalmologists to internists with a telemedicine network, this could improve patient care," Dr. Michelson explained.

In this study, 6999 patients had retinal exams performed in the general practitioner's office. Median patient age was 54 years, median body mass index was 27.6 kg/m2, 40% reported a history of arterial hypertension, and 11.1% had type 2 diabetes.

During the examination, physicians took 45° photographs of the retina, obtained blood samples, and measured blood pressure. They then calculated cardiovascular risk using the PROCAM index. An ophthalmologist analyzed the fundus images remotely.

Dr. Michelson reported that 9% of the cohort had relevant morphologic changes in retinal vessels, such as arteriovenous crossings, retinal bleeding, microaneurysms, and microinfarcts.

Using the PROCAM index, only 2% of patients were found to be at high risk for a cardiovascular event. However, in 55 patients (0.8%) where no risk was indicated, "we found relevant retinal microangiopathic changes," he reported.

"We have now performed this in about 60,000 patients, and we believe that identifying these unique risk factors is having an impact on therapy," said Dr. Michelson.

He believes changes are occurring in 2 ways. "First, individuals who were screened gained a greater awareness of their risk factors overall, so they are motivated to go to the doctor more often for observation." Second, physicians are responding to evidence of elevated risk.

"In about 20% of cases, we see that therapeutic decisions are being made based on these findings."

Dr. Michelson has disclosed no relevant financial relationships.

World Ophthalmology Congress (WOC) 2012: Abstract IS-TEL-FR 65. Presented February 17, 2012.

    
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