數位全彩免散瞳眼底攝影裝置之研究

Abstract

眼底檢查可以觀察視網膜及其末端小血管，許多人類的慢性疾病，如高血壓、動脈硬化、糖尿病，會產生全身各部位小血管的變化，包括視網膜上的小血管也同時會發生變化。因為這種全身各部位小血管的病變不容易被觀察到，只有視網膜上的小血管可以使用非侵入光學方式直接看到，所以藉由眼底檢查可以偵測出這些疾病是否已產生血管性的病變，並根據此檢查結果做為病理研判及治療之參考。 過去對於眼底檢查，病患往往需要先點散瞳劑，避免瞳孔因強光縮小，導致拍攝到的眼底視角不大，然而散瞳後數小時會產生畏光與視力模糊等副作用，若病患眼壓過高，點散瞳劑反而會造成青光眼，因此數位免散瞳眼底攝影系統近年來成為眼科熱門的檢查儀器，除了能夠執行免散瞳眼底攝影之外，也可將病患的眼底拍照儲存，提供醫師診斷的參考。雖然免散瞳數位眼底攝影系統能夠提供優異的影像品質，但是價格偏高，即使在大型醫院或醫學中心的儀器數量也不多，有時還會發生不敷使用的情況；而一般門診常用的免散瞳手持式眼底鏡卻缺少數位影像擷取的功能，醫生必須手繪患者眼底圖，患者未必能夠透過手繪病歷了解自己的眼底產生了何種病變。本論文研究目的是開發創新型「數位手持式眼底攝影機」，可以進行人體的眼底(如視網膜、視神經盤或黃斑部)之數位攝影或錄影，並可製作成電子病歷，上傳雲端，透過雲端系統，醫生可進行遠端醫療，進行判讀與診斷，將可以取代傳統的醫學五官鏡。從全球電子病歷和遠距照護的趨勢來看，此數位化醫療器材的出現，將可廣泛地使用於一般診所或醫院、健診中心以及老人照護機構等，作為相關醫師、護理人員、照護人員和社區義工從事健康檢查與紀錄儀器使用。

We can observe the retina and the terminal minute vessels by examining the eye-fundus. Many diseases, such as hypertension, arteriosclerosis and diabetes will make change of the extremities’ terminal minute vessels. The change is not easy to be observed, but we can see the change by a non-invasively optical approach to observe the terminal minute vessels of the retina easily. Thus we can detect these diseases from the eye-fundus examination, and see the vascular pathological changes. The doctors can do the diagnosis and treatment according to the eye-fundus examination. In the past, while taking the eye-fundus examinations, the doctors needed to use Mydriotics for the patients first, thus the pupil wouldn’t be lessened because of the strong light. The pupil size would limit the field of view of the eye-fundus. If it is lessened, the viewing area would decrease, and would be hard to be observed. But the Mydriotics can make the patients sensitive to the ambient light and cause the blurry vision. And if the intraocular pressure of patient is high, the Mydriotics would cause glaucoma. Above all we had mentioned, the digital non-Mydriotics fundus cameras become a popular medical device for human eye-fundus examination for the time being in the clinical applications. The digital non-Mydriotics ophthalmoscope can take digital photos of eye-fundus and save photos without using Mydriotics. Even though the equipment can provide good image quality, they are seldom seen in large-scale hospitals, medicine centers and clinics because the equipment is very expensive. The existing equipment for eye-fundus examination of generally medical service is non-Mydriotics hand-held ophthalmoscope. But it is not a digital solution, so the doctors have to draw the eye-fundus of patients via what they have seen. The patients can’t understand what really happens in their eyes. In this thesis, we are developing a non-Mydriotics hand-held digital eye-fundus camera with a digital recording for the diagnosis. This innovative “digital hand-held eye-fundus camera” is expected to substitute for the traditional ophthalmoscope by the use of the digital photographic solution. This medical device is provided to capture the digital photograph or video of eye-fundus with retina, optic disc and macula. Following the global trend of electronic medical records and telehealthcare networks, this people-oriented medical imaging product will be widely applied in the doctors’ offices, clinics, skilled nursing facilities and healthcare stations.