基层眼科医生青光眼诊疗能力现状、影响因素及提升策略研究进展

Research Progress on Current Status, Influencing Factors and Improvement Strategies of Glaucoma Diagnosis and Treatment Capacity among Primary Ophthalmologists

摘要: 青光眼是全球首要不可逆性致盲眼病，因其早期症状隐匿、病程进展缓慢，常在视功能出现不可逆损害后才被发现。基层医疗机构是居民眼健康服务和慢病管理的重要入口，基层眼科医生对青光眼危险人群识别、初步检查、规范转诊及长期随访的能力，直接影响患者的早诊率和致盲防控效果。现有研究提示，基层医生在青光眼危险因素识别、眼压及房角评估、视野检查判读、光学相干断层扫描(optical coherence tomography, OCT)应用和转诊决策等方面仍存在不足；医生个体特征、设备可及性和继续医学教育机会是重要影响因素。本文围绕青光眼疾病负担、基层管理重要性、基层医生诊疗认知现状、影响因素及能力提升策略进行综述，并对人工智能和智慧医疗支持下的基层青光眼防控模式进行展望。

Abstract: Glaucoma is the leading irreversible blinding eye disease worldwide. Characterized by insidious early symptoms and slow disease progression, it is often diagnosed only after irreversible visual function damage has occurred. Primary medical institutions serve as a critical gateway for residents’ eye health services and chronic disease management. Primary ophthalmologists’ proficiency in identifying glaucoma high-risk populations, conducting preliminary examinations, implementing standardized referrals, and carrying out long-term follow-up directly affects the early diagnosis rate of patients and the effectiveness of blindness prevention and control. Existing studies indicate that primary physicians still have deficiencies in recognizing glaucoma risk factors, assessing intraocular pressure and anterior chamber angle, interpreting visual field examinations, applying optical coherence tomography (OCT), and making referral decisions. Individual physician characteristics, equipment accessibility, and access to continuing medical education are key influencing factors. This paper reviews the disease burden of glaucoma, the significance of primary care management, the current status of primary physicians’ cognition and clinical capacity for glaucoma diagnosis and treatment, relevant influencing factors, and capacity improvement strategies. It also prospects the primary glaucoma prevention and control model supported by artificial intelligence and smart healthcare.