"We are the first of our first grassroots medical institutions in Shanghai to pilot the artificial intelligence fundus screening project and empower eye disease prevention." Ye Zheng, director of Changfeng Community Health Service Center in Putuo District, Shanghai, said that the integration of grassroots eye disease prevention into intelligent means has its fundamental development logic, "At the beginning, intelligent means were screened for diabetic fundus lesions, and then gradually included blinding diseases, including high myopia, diabetic retinopathy and other fundus diseases, and now it has been extended to the whole population." ”
In the past, diabetic patients who wanted fundus screening could only go to large hospitals and wait in long lines, which was a trouble for many elderly people. But now, with the assistance of artificial intelligence technology and equipment in the community health service center, after the patient completes the fundus radiograph, vision examination and refraction, the system can complete the reading and give the screening results in 20 seconds.
"In addition, according to the diseases detected, the system can also help guide patients to which level of hospital for follow-up treatment, and guide citizens to self-manage their eye health while making referrals." Ye Zheng said.
Why is eye disease prevention so urgent? Data show that the mainland is the country with the largest number of eye disease patients in the world, of which there are about 630 million myopia patients, nearly 290 million dry eye patients, and more than 200 million cataract patients. Wang Ningli, head of the National Blindness Prevention Technical Guidance Group, recently cited a set of data that the proportion of people with moderate visual impairment and severe visual impairment in the mainland has developed at a rate of 136% and 143% in 10 years, ranking first in G20 countries. Early detection and early screening of eye diseases is the key to achieving the integration of medical and prevention.
The above pilot is the prototype of the "Visual Health Intelligent Management Center (VIMC)" launched during this year's "National Eye Day" event. VIMC integrates "fully automatic" vision detection, computer refraction, axial fundus photography and other functions, and forms a service complex throughout the three-level diagnosis and treatment system; VIMC is currently being promoted in the Yangtze River Delta region to achieve a simultaneous improvement in the prevention and treatment of eye diseases.
AI benefits the grassroots of the Yangtze River Delta
The grassroots layer is the "bottom of the net" for eye disease prevention. For example, Ye Zheng has a 72-year-old "old sugar friend" Aunt Tang in the community, with a history of diabetes for more than ten years, and secretly "slips" away after coming to the outpatient clinic every month after dispensing, because she can't control her mouth and likes to eat desserts. It was not until after the pilot of the artificial intelligence fundus screening project that diabetic patients in the outpatient clinic did not have to wait for the annual routine screening, let alone go to the higher-level hospital, and Aunt Tang was tested in the nearest outpatient clinic.
"The test results showed that Aunt Tang had moderate diabetic retinopathy. Since then, under the guidance of our community doctors, Aunt Tang has actively cooperated with diet and exercise adjustments, and her blood sugar has gradually stabilized. After six months of follow-up, diabetic fundus lesions did not develop further. Ye Zheng said that in 2022 alone, the hospital completed more than 5,000 fundus screenings for adults and students in its jurisdiction, accounting for nearly 10% of the total residents in the jurisdiction.
However, Ye Zheng also believes that in fact, at this stage, not all regional community health service centers are equipped with intelligent equipment related to eye disease screening, auxiliary diagnosis, follow-up monitoring, especially fundus photography equipment, which has a greater impact on the homogenization of early screening and diagnosis; At the same time, citizens' online appointments and electronic file updates require the continuous upgrading of information platforms.
Community health service centers combined with pilots also need to be "adapted to local conditions". The reporter learned that since February this year, the Shanghai Eye Disease Prevention and Treatment Center, the leader of VIMC, has visited more than 20 community health service centers to carry out VIMC landing research. Due to the differences in the operation characteristics of each community health service center and the population served, some communities plan to carry out VIMC construction in combination with ophthalmic clinics to assist the ophthalmologists of the center to visually manage residents; There are also communities that combine chronic diseases to carry out VMIC construction; More communities have built full-service VIMC in office buildings to promote the popularization of "eye prevention" science among white-collar workers.
Zou Haidong, president of the Shanghai Eye Disease Prevention and Treatment Center, told First Finance and Economics that in the past, community health service centers in Shanghai generally implemented early screening for cataracts, diabetic retinopathy, highly myopic fundus lesions, macular degeneration, etc., but the shooting equipment technology is older, and the image transmission to the information system is quite laborious, and the doctors of the second- and third-level designated hospitals also spend time and energy on remote "reading films", sometimes more than 100 "reading films" in the morning, doctors are overwhelmed, and patients always hope to "faster and more accurate". So that early diagnosis and early treatment.
"In the past, fundus disease screening was relatively lacking at the grassroots level, but at this stage, some artificial intelligence-based screening equipment has been implemented in our hospital, and if difficult cases are screened, they will be referred to higher-level hospitals in time; After the patient completes surgery or treatment in the higher-level hospital, he can conduct expert follow-up and follow-up in the primary hospital. Yan Yan, president of the Tongshan Branch of the First People's Hospital of Xuzhou City (Tongshan District People's Hospital), said.
Yan Yan told reporters that in the next step, as the "hub" in graded diagnosis and treatment, the hospital will continue to increase investment in artificial intelligence equipment, as well as the construction of relevant information, especially to continue to strengthen the mutual recognition of information in the region, "For the construction of VIMC, it may be taken the lead by the First People's Hospital (General Hospital) of Xuzhou in the future." ”
VIMC is also expected to continue to be laid in the next stage to Jiangsu Dongtai, Suqian, Zhejiang Taizhou and other Yangtze River Delta regions, "tertiary hospitals often have a more complete and mature ophthalmology construction, and some grassroots hospitals, due to the scarcity of ophthalmic professionals and weak eye disease diagnosis capabilities, may need to participate in intelligent visual management systems." Industry insiders said.
Challenges of eye disease prevention and treatment at the grassroots level
As a fully automatic and efficient artificial intelligence vision management platform, what role should it play in the Yangtze River Delta eye disease prevention and treatment system?
Taking VIMC as an example, its hardware includes intelligent devices such as vision detection, computer refraction, fundus photography, etc.; Its software includes artificial intelligence-assisted diagnosis technology and telematics management technology, among which telematics management technology also covers data such as remote consultation, case referral, electronic medical records and eye health records.
Why has VIMC become the gripper of grassroots "eye prevention" work? Zou Haidong told reporters that there are three channels to achieve early screening of eye diseases, the first is the grassroots community health service center, which can provide basic public health services, but the current medical service force in this part is generally lacking; The second is secondary and tertiary hospitals, which can be reimbursed by medical insurance, but need to queue for registration, and some elderly people will find it inconvenient; The third is the physical examination center, but it needs to be paid for by yourself or go through commercial insurance.
"Through VIMC, residents can solve the problem of early eye disease screening in the community, without the need for the full operation of an ophthalmologist specialist." Zou Haidong said that for the application and promotion of VIMC in the Yangtze River Delta, on the one hand, a complete government health information network needs to be formed in the region, and all the inspection data involved in VIMC can be reflected in the network system, and data security needs to be ensured; On the other hand, the cost of equipment purchase is also a key consideration for medical institutions.
For the promotion of artificial intelligence visual management platforms such as VIMC at the grassroots level, Zhao Dahai, a professor at the School of International and Public Affairs of Shanghai Jiao Tong University, said that there may be three influencing factors to consider. The first is VIMC's cost-benefit analysis and whether the quality can stand the test. Second, the connection from the community to the secondary hospital to the higher level hospital needs a more effective way of opening up. Third, the construction of the tertiary medical network linked by VIMC involves a series of core issues such as the division of responsibilities and assessment formulation of institutions, which also requires the coordination and promotion of tertiary hospitals.