© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Visual impairment is estimated to affect 1.3 billion people worldwide, 2 over 80% for preventable or treatable reasons. Although many are curable, there are significant challenges in providing treatment to those in remote areas. Due to this, lowincome countries disproportionately shoulder visual impairment. It is therefore essential to develop lowcost and simple methods for diagnosis and treatment. Advances in technology are now providing possible solutions to achieve this, with smartphones already being used to identify those with visual impairment. In Africa, more than three times as many people have access to a mobile phone than a flushing toilet. This wellestablished technology base provides the grounding for developing diagnostic tools using the imaging and connectivity mobile phones can provide. Telemedicine has shown promise in a number of different fields, and ophthalmology lends itself particularly well to this technique as it is a highly imagebased specialty. Significant benefits have been reported using these methods for screening ophthalmic diseases such as diabetic retinopathy, and mobile phone adaptors have been validated as a tool for imaging optic disc pathology in rural areas of Kenya. Likoma Island, on Lake Malawi, is a stark example of a rural area isolated from mainland healthcare services. There is no governmentfunded hospital on the island, so the burden of healthcare for Likoma’s 10 000 residents falls on St Peter’s Hospital, which is sustained entirely by charitable donations. The hospital is severely understaffed with 12 nurses, 2 clinical officers, 1 dental clinician and 1 ambulance. There are a total of 40 beds in the hospital. Despite these limited resources, the two medical officers, and many of the other staff, have smartphones with an internet connection. This study looked at the use of inexpensive and accessible tools to either aid diagnosis directly or create images that could be sent electronically to a tertiary centre for analysis by an ophthalmologist.

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评估用于马拉维农村眼科诊断的简单、负担得起的技术：解决技能短缺的潜在工具

© 作者（或其雇主）2021 年。不得用于商业用途。查看权利和权限。由 BMJ 出版。简介 视力障碍估计影响全球 13 亿人 2 ，其中超过 80% 是由于可预防或可治疗的原因。尽管许多是可以治愈的，但在为偏远地区的人提供治疗方面存在重大挑战。因此，低收入国家不成比例地承担视力障碍。因此，开发低成本和简单的诊断和治疗方法至关重要。现在，技术进步为实现这一目标提供了可能的解决方案，智能手机已被用于识别视力障碍者。在非洲，使用手机的人数是使用冲水马桶的人数的三倍多。这一完善的技术基础为使用移动电话可提供的成像和连接性开发诊断工具奠定了基础。远程医疗已在许多不同领域显示出前景，眼科特别适合这项技术，因为它是高度基于图像的专业。据报道，使用这些方法筛查眼科疾病（如糖尿病视网膜病变）具有显着益处，并且手机适配器已被验证为肯尼亚农村地区视盘病理成像的工具。位于马拉维湖上的利科马岛是与大陆医疗保健服务隔离的农村地区的典型例子。岛上没有政府资助的医院，因此利科马 10 000 名居民的医疗负担落在了圣彼得医院，这完全由慈善捐赠维持。医院人手严重不足，有 12 名护士、2 名临床官员、1 名牙科临床医生和 1 辆救护车。医院共有床位40张。尽管资源有限，但两名医务人员和许多其他工作人员都拥有可连接互联网的智能手机。这项研究着眼于使用廉价且易于使用的工具来直接辅助诊断或创建可以以电子方式发送到三级中心供眼科医生分析的图像。