JP7082730B1 - Home monitoring system for age-related macular degeneration - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a home monitoring system for age-related macular degeneration, which can detect recurrence early or in a timely manner while the patient is at home without imposing a heavy burden on the patient with age-related macular degeneration. SOLUTION: A home monitoring system S for age-related macular degeneration is equipped with a home OCT10 which is an optical interference tomometer for photographing a macular region of the patient's eyeball, and a dedicated application is installed. A mobile terminal 20 that is connected to the home OCT 10 via a local network to acquire imaging data of the macular region of the patient's eyeball, and a mobile terminal 20 that is connected to the mobile terminal 20 via a wide area network and acquired via the mobile terminal 20. It includes a cloud server 30 that automatically determines the progress state of age-related macular degeneration based on the imaging data, and a terminal device 40 that transmits at least the imaging conditions of the home OCT 10 for the patient to the cloud server 30 by a doctor. [Selection diagram] Fig. 1

Description

The present invention relates to a home monitoring system that effectively monitors the progression and recurrence of age-related macular degeneration, and more particularly to a home monitoring system for age-related macular degeneration that allows a patient to monitor the progression and recurrence of symptoms while staying at home.

What is age-related macular degeneration (macular degeneration)? With aging, waste products accumulate in the macula, which is a small tissue with a diameter of about 1.5 mm to 2 mm located in the central part of the retina that controls vision in the eyeball. It is a disease in which it becomes difficult to see things due to the formation of new choroidal blood vessels in the macula or damage (see FIG. 10 (a)). The number of patients with age-related macular degeneration in recent years is estimated to be about 700,000 in Japan and about 200 million worldwide, and as shown in Fig. 10 (b), the cause of blindness in Japan in FY2018. It is the 4th place of.

Age-related macular degeneration is roughly divided into two types, atrophic type and exudative type. In the atrophic type, the tissue of the retina atrophies due to aging, which damages the retina and the macula in it, and the visual acuity gradually deteriorates. .. The exudative type is a disease in which the retina is damaged by new blood vessels formed in the choroid under the retina, which causes blood components to leak to the retina, or the new blood vessels are torn and bleeding occurs.

Various diagnostic methods for age-related macular degeneration are known, but in recent years, optical coherence tomography (OCT) has become the mainstream. In the examination using this optical coherence tomography, it is possible to take a cross section of the retina and examine the state of blood vessels in the retina and choroid, and the presence or absence of new blood vessels. In addition, there is an advantage that the burden on the patient is small because the examination can be performed in a short time without using a contrast medium.

There is currently no cure for the atrophic form of age-related macular degeneration. On the other hand, exudative treatments include drug therapy, photodynamic therapy, laser coagulation, and surgery. As shown in FIG. 11A, drug therapy is a method of directly injecting a drug that inhibits vascular endothelial growth factor called VFGF into the eyeball in order to suppress the activity of new blood vessels. This anti-VEGF drug vitreous injection therapy can prevent the death of photoreceptor cells due to the retraction of new blood vessels and prevent the loss of visual acuity. In addition, as shown in FIG. 11 (b), usually, after three injections into the eye at intervals of 4 weeks, regular examinations are continued to examine the condition of the retina and the state of new blood vessels, and additional injections are made. It is an injection, and the effect and recurrence are followed up and managed by diagnosis using an optical coherence tomography.

By the way, as an optical coherence tomometer, an optical coherence tomometer capable of satisfactorily acquiring data based on scanning of measurement light using a galvanometer mirror is disclosed (see, for example, Patent Document 1). In addition, as the work of the inventor of the present application, a document on the progress of the optical interference tomography in ophthalmology and a book on the macula of the eye are also disclosed (see, for example, Non-Patent Documents 1 and 2).

Japanese Unexamined Patent Publication No. 2018-121888

"Advances in Optical Coherence Tomography in Ophthalmology, by Masaki Itaya" [Searched on October 29, 3rd year of Reiwa], <URL: https://www.jstage.jst.go.jp/article/jslsm/28/2 / 28_2_146 / _pdf ＞ Masanori Itaya, "Doubt the bottom of your eyes if you have trouble with your eyes. The power of" yellow spots "that support" seeing "", December 2019, Gentosha Co., Ltd.

As mentioned above, in recent years, vitreous injection therapy of anti-VEGF drugs has been established and is currently the standard treatment method of the first choice. As mentioned above, the effect of the vitreous injection therapy of this VEGF drug lasts only about 1 month and relapses, so it is necessary to inject repeatedly and it is necessary to continue the treatment for about 3 years. If the treatment is left untreated or procrastinated and recurrence is repeated, the macula, which is the central part of the retina and controls the visual acuity, is destroyed and the visual acuity is lost. Therefore, as shown in FIG. 12, it is important to detect the recurrence of the subretinal fluid 121 occurring in the retina in a timely manner, and ideally to inject the injection as soon as the recurrence is about to occur.

However, under the present circumstances, for the diagnosis of age-related macular degeneration, patients must visit a medical institution (ophthalmology) on a regular basis because a retinal tomographic image is taken with a photointerference tomometer and the doctor diagnoses the symptoms based on the results. I have to see a doctor. In reality, it is difficult for patients to see a doctor frequently, and the limit is to see a doctor once a month, and there is a problem that recurrence cannot be detected early or in a timely manner.

In addition, since the effect of the anti-VFGF drug is about one month and the risk of recurrence is high, it is desirable to inspect it every month and inject it at the timing of recurrence. However, the degree of progression of symptoms varies from patient to patient, and in reality, it is not possible to accurately grasp the timing of recurrence by monthly examination. As a result, the timing of injection is delayed, and the number of photoreceptor cells that sense the light of the macula decreases, and in the worst case, the eyesight is lost in some patients.

The present invention has been made in view of the above problems. Age-related macular degeneration that can detect recurrence early or in a timely manner while the patient is at home without imposing a heavy burden on the patient with age-related macular degeneration. The purpose is to provide a home monitoring system for.

In order to achieve the above object, the present invention is a home monitoring system for age-related macular degeneration, which is an optical coherence tomometer that is installed in a patient's home and photographs the macular region of the patient's eyeball. OCT (Optical Coherence Tomography) and a dedicated application for the home monitoring system are installed, and the home OCT is connected via a local network to acquire imaging data of the macula region of the patient's eyeball from the home OCT. A server connected to the mobile terminal via a wide area network and automatically determining the progress state of age-related macular degeneration based on the imaging data acquired via the mobile terminal, and the server and a wide area. A terminal device connected via a network and transmitting at least the imaging conditions of the home OCT to the patient by a doctor to the server, the home OCT is a communication module that realizes a communication connection with the mobile terminal. The imaging unit includes a communication unit and an imaging unit that irradiates the macula region of the patient's eyeball with measurement light based on the imaging conditions acquired via the communication unit to acquire imaging data. As the imaging data, imaging data identifying the three layers of the macula, the macula, and the retina of the eyeball are imaged, and the home OCT further determines the success or failure of the imaging acquired from the mobile terminal and the need for consultation with a medical institution. It is characterized by including a display unit that displays the result in different colors based on the information of whether or not .

In the home monitoring system for age-related macular degeneration according to the present invention, the server automatically determines the progress of age-related macular degeneration by performing image analysis using AI on the imaging data received from the mobile terminal. It is preferable to include an imaging data analysis unit, an imaging data storage unit that stores the imaging data, and a user information storage unit that stores at least the analysis results of the imaging data analysis unit and the imaging conditions of the home OCT.

In the home monitoring system for age-related yellow spot degeneration according to the present invention, the imaging data analysis unit is based on the imaging data: (1) segmentation of the anterior surface of the retina, (2) segmentation of the posterior surface of the retina, and (3) retinal pigment epithelium. It is preferable to automatically determine the timing of re-examination by detecting the subretinal fluid between the posterior surface of the retina and the retinal pigment epithelium after performing the segmentation.

In the home monitoring system for age-related macular degeneration according to the present invention, the imaging unit has a light source that irradiates the macula region of the patient's eyeball with measurement light and a scan region in which measurement light from the light source is set in advance. It is preferable to have an optical scanner for scanning in a predetermined range of the macula and a detection unit for detecting interference between the reference light and the scattered light reflected in the macula region.

In the home monitoring system for age-related macular degeneration according to the present invention, the mobile terminal obtains analysis results from the server via a communication processing unit, which is a communication module that realizes a communication connection to the Internet, and the communication processing unit. When received, it is preferable to include a screen display unit that is displayed to the user by GUI, and a storage unit that stores the analysis result and at least one of the dedicated application programs.

In the home monitoring system for age-related macular degeneration according to the present invention, it is preferable that the dedicated application program has an imaging command function that automatically displays on the screen display that it is time to image the home OCT to the patient. ..

In order to achieve the above object, the present invention is an application program used for a home monitoring system for age-related yellow spot degeneration, wherein the home monitoring system is provided in a patient's home and is provided in the yellow spot region of the patient's eyeball. The home OCT (Optical Coherence Tomography), which is an optical coherence tomography, and the application program are installed, and the home OCT is connected to the home OCT via a local network to the area of the yellow spot of the patient's eyeball. A server that is connected to the mobile terminal that acquires the imaging data of the above via a wide area network and automatically determines the progress state of age-related macular degeneration based on the imaging data acquired via the mobile terminal. And a terminal device connected to the server via a wide area network and transmitting at least the imaging conditions of the home OCT to the patient by the doctor to the server, and the home OCT is a communication connection with the mobile terminal. It is provided with a communication unit which is a communication module that realizes the above, and an imaging unit that irradiates the yellow spot region of the patient's eyeball with measurement light based on the imaging conditions acquired via the communication unit to acquire imaging data. As the imaging data, the imaging unit captures imaging data that identifies the three layers of the vitreous body, choroidal membrane, and retina of the eyeball, and the home OCT further captures the success or failure of the imaging acquired from the mobile terminal, and medical treatment. The application program includes an imaging command step that automatically displays to the patient that it is time to image the home OCT, and a display unit that displays the result in a color-coded manner based on the information on the necessity of consultation with the institution . When the imaging data is acquired from the home OCT, it includes a transfer step of transferring the imaging data to the server and a display step of displaying the analysis result received from the server on the display unit . ..

The home monitoring system for age-related macular degeneration according to the present invention is equipped with a home OCT, which is an optical interference tomometer that is installed in the patient's home and photographs the macular region of the patient's eyeball, and a dedicated application for the home monitoring system. At the same time, a mobile terminal connected to the home OCT via a local network to acquire imaging data of the macular region of the patient's eyeball, and a mobile terminal connected to the mobile terminal via a wide area network and acquired via the mobile terminal. A server that automatically determines the progress of age-related macular degeneration based on imaging data, and a terminal device that is connected to the server via a wide area network and transmits at least the imaging conditions of home OCT to the patient by a doctor to the server. Be prepared. With this configuration, according to the present invention, recurrence can be detected early or in a timely manner while the patient is at home without imposing a heavy burden on the patient with age-related macular degeneration.

It is an overall system block diagram of the home monitoring system of age-related macular degeneration according to the embodiment of this invention. Same as above It is an overall configuration diagram of the home monitoring system. Same as above This is an example of imaging data of the macula region using the home OCT provided in the home monitoring system. (A) An explanatory diagram of the service outline of the home monitoring system of the same as above, and (b) a diagram showing an example of screen display of a mobile terminal owned by a contractor of the service. It is explanatory drawing of (a) and (b) existing type OCT. It is a figure for demonstrating (a) and (b) the image pickup region of the same home OCT. It is a figure which shows an example of the scanning method of (a) and (b) home OCT. (A) to (c) is the figure which shows an example of the image analysis of age-related macular degeneration in the cloud server provided in the home monitoring system. Same as above. It is an operation sequence diagram of the home monitoring system. It is explanatory drawing of (a) and (b) age-related macular degeneration. It is explanatory drawing of the vitreous injection therapy of the anti-VEGF drug in (a) and (b) age-related macular degeneration. It is a photograph figure of the subretinal fluid which occurs at the time of recurrence of age-related macular degeneration.

(Embodiment)
A home monitoring system (hereinafter referred to as a home monitoring system) for age-related macular degeneration (AMD) according to an embodiment of the present invention will be described with reference to the drawings.

<Overall system diagram>
First, the overall configuration of the home monitoring system for age-related macular degeneration according to the present embodiment will be described with reference to FIGS. 1 and 2. The home monitoring system S allows a patient to monitor the progress of age-related macular degeneration early or in a timely manner while staying at home. As shown in FIG. 1, Home-OCT (Optical Coherence Tomography) ) 10, a mobile terminal 20, a cloud server 30, and a terminal device 40.

<Functional configuration of home OCT10>
Home OCT10 is an optical coherence tomography device for detecting age-related macular degeneration, which is a small and inexpensive device that is installed in the patient's home and specializes in the function of imaging the macular region of the patient's eyeball. Is. The home OCT 10 according to the present embodiment includes a control unit 11, an image pickup unit 12, a storage unit 13, a communication unit 14, a display unit 15, and an operation input unit 16.

The control unit 11 controls the components of the home OCT 10 by using a processor such as a CPU or a memory to realize various functions (here, mainly an imaging function of the macula region of the eyeball).

The imaging unit 12 irradiates the tissue of the eye to be inspected (here, the macula region) with the measurement light to acquire imaging data. The imaging unit 12 particularly captures imaging data that identifies the three layers of the vitreous body, choroid, and retina of the eyeball as shown in image 50 of FIG. 3 (specializing in imaging of these three layers). The imaging unit 12 has a light source 12a that irradiates the yellow spot region of the patient's eyeball with measurement light (laser light), and a predetermined region (for example, 6 × 6 mm) of the yellow spot portion that is a scan region in which the laser light from the light source 12a is preset. It is provided with an optical scanner 12b for scanning in the range of) and a detection unit 12c for detecting interference between the reference light and the scattered light reflected in the yellow spot region.

The storage unit 13 is a memory such as RAM, and stores information such as imaging conditions of the home OCT 10, a unique identification number (terminal ID), and a function start date and time. The communication unit 14 is a communication module that realizes a communication connection to a local network in the home such as wifi (registered trademark) or Bluetooth (registered trademark), and is an image pickup data with the mobile terminal 20 and an image pickup condition of the home OCT 10. , Sends and receives information such as success / failure of imaging and necessity of consultation with a medical institution.

The display unit 15 color-codes the results using LEDs or the like based on information such as success / failure of imaging and necessity of consultation acquired from the mobile terminal 20 (for example, blue for successful imaging, flashing red for failed imaging, doctor). The request for consultation to is displayed in red, etc.). The operation input unit 16 notifies the control unit 11 of operation information by the user, and is, for example, a physical button or a touch panel at the time of imaging. The above result may be conveyed to the patient by voice.

<Functional configuration of mobile terminal 20>
The mobile terminal 20 is connected to the home OCT 10 via a local network to acquire image pickup data of the patient's luteal region while the dedicated application program of the home monitoring system S is installed. Specifically, the mobile terminal 20 is a terminal such as a smartphone or a personal computer of a patient (contractor), and a dedicated application of the home monitoring system S created by a software development company or the like is displayed on the screen. The mobile terminal 20 according to the present embodiment includes a control unit 21, a storage unit 22, a communication processing unit 23, a screen display unit 24, and an operation input unit 25.

The control unit 21 controls the components of the mobile terminal 20 to realize various functions by using a processor such as a CPU and a memory, and has an image processing unit 21a and a request generation unit 21b. The image processing unit 21a uses a processor such as a GPU or a dedicated circuit and a memory, and executes image processing in response to a control instruction from the control unit 21. The control unit 21 and the image processing unit 21a are configured as one piece of hardware (SoC: System on a Chip) in which a processor such as a CPU and GPU, a memory, and a storage unit 22 and a communication processing unit 23 are integrated. You may.

The request generation unit 21b generates a request request or the like to be transmitted to the cloud server 30. For example, using the terminal ID transmitted from the home OCT 10, the destination address is specified by referring to the table stored in the storage unit 22, and the destination information and the source information are added to the header unit. Create packet data by assigning a command including the terminal ID and request request to the data part. Requests include "imaging conditions" and "analysis results".

The storage unit 22 is a memory such as RAM, and stores the address information of the home OCT 10 and the cloud server 30 in the home monitoring system S, the application program that exerts the function as the user interface (UI) of the home monitoring system S, and the like. There is.

The communication processing unit 23 is a communication module that realizes a communication connection to a communication network such as the Internet. Here, for example, the communication processing unit 23 of the mobile terminal 20 and the transmission / reception unit 44 of the terminal device 40 refer to the cloud server 30 that discloses the analysis function based on the home OCT 10 of age-related macular degeneration via the Internet. For example, send the request contents in the request format of Http. Then, this processing result is returned to the requesting mobile terminal 20 or the terminal device 40 in the response format of Http. There are various formats for this data to be sent and received, but use XML (Extensible Markup Language), HTML (Hyper Text Markup Language), JSON (JavaScript (registered trademark) Object Notation), and various image file formats that are often used on the web. Can be done. The communication processing unit 23 receives the analysis result, the image pickup condition of the home OCT 10, the user information, and the like, which are the responses transmitted from the cloud server 30.

The screen display unit 24 is a liquid crystal panel, an organic EL (Electro Luminescence) display, or the like, and displays a user interface for exerting the home monitoring system S by processing by the image processing unit 21a according to the instruction of the control unit 21. When the screen display unit 24 receives the success / failure of imaging and the necessity of consultation from the cloud server 30, the screen display unit 24 displays the GUI in a form that is easy for the user to understand. Therefore, the patient can refer to the result by himself / herself to understand the progress state of age-related macular degeneration, that is, whether or not it has recurred and whether or not a medical examination is necessary. If the patient wants to see his or her retinal tomographic image, he or she can view it by selecting the menu of the app. In addition, when the cloud server 30 determines that a medical examination is necessary, the patient can clearly grasp the medical examination time by receiving a request for a medical examination from a medical institution.

The operation input unit 25 notifies the control unit 21 of the operation information by the user, and includes a touch panel and the like. A physical button provided on the housing of the mobile terminal 20 may be used. The user of the mobile terminal 20 can also operate the home OCT 10 and the application via the operation input unit 25.

The dedicated application installed on the mobile terminal 20 has an imaging command function that automatically displays on the screen display unit 24 that the patient has reached the imaging time of the home OCT 10. With this image pickup command function, a warning can be displayed on the screen display unit 24 of the patient's mobile terminal 20 to prompt the patient to perform periodic imaging of the home OCT 10 (for example, daily, every other day, or regular period). Further, the application program includes an imaging command step that automatically displays to the patient that the imaging time of the home OCT 10 has come, a transfer step that transfers the imaging data to the server 30 when the imaging data is acquired from the home OCT 10, and a server. A display step for displaying the analysis result received from 30 may be included.

<Functional configuration of cloud server 30>
The cloud server (server) 30 is connected to the mobile terminal 20 and the terminal device 40 via a wide area network such as the Internet, and the progression of age-related macular degeneration is based on the image data of the patient acquired via the mobile terminal 20. It has a function to automatically determine the state. The cloud server 30 according to the present embodiment includes a transmission / reception unit 31, a control unit 32, an image pickup data analysis unit 33, an image pickup data storage unit 34, and a user information storage unit 35.

The transmission / reception unit 31 transmits / receives data to / from the mobile terminal 20 and the terminal device 40, and receives a request request and image pickup data from the mobile terminal 20. Further, the result of the automatic analysis is transmitted to the mobile terminal 20.

When the control unit 32 receives a request request from the mobile terminal 20 or the terminal device 40, the control unit 32 performs a control process of transmitting the response information according to the request request to the mobile terminal 20 or the terminal device 40.

The image pickup data analysis unit 33 determines the progress of age-related macular degeneration based on the image analysis using AI (Artificial Intelligence) of the image pickup data received from the mobile terminal 20. That is, the retinal data taken by the patient using the home OCT 10 is automatically transferred to the cloud server 30 via the mobile terminal 20, and the imaging data analysis unit 33 (cloud AI) operating there is constructed by machine learning or the like. The progress of age-related macular degeneration is automatically determined by a predetermined algorithm. An example of this image determination method will be described later. The AI analysis function may be provided in another server other than the cloud server 30.

The image pickup data storage unit 34 is a database for accumulating image pickup data of a patient (user contractor) imaged using the home OCT 10. The user information storage unit 16 stores, for example, the imaging conditions, analysis results, user contractor ID, password, and the like of the home OCT 10 of the patient (user contractor).

<Functional configuration of terminal device 40>
The terminal device 40 is connected to the cloud server 30 via a wide area network, and at least transmits the imaging conditions of the home OCT 10 for the patient by the doctor to the cloud server 30. Specifically, the terminal device 40 is a personal computer owned by a doctor connected to the cloud server 30 via a network, and the doctor diagnoses the patient and stores the home OCT 10 of each patient in the cloud server 30. Specify the imaging conditions of. The imaging conditions are, for example, left and right eye settings, scan mode, scan position, scan size, scan interval, and the like. Basically, the doctor can register and use this service on the cloud server 30. The doctor can also obtain and refer to the analysis data of the eye to be inspected regarding the age-related macular degeneration of his / her patient (when the patient is designated as the doctor in charge in his / her registration information) from the cloud server 30.

The terminal device 40 transmits imaging conditions and analyzes imaging data and analysis of the patient's eye through an input unit 41 such as a keyboard that accepts input from a doctor, an application execution unit 42 that executes a dedicated application on a Web browser, and an input unit 41. It includes a request generation unit 43 for acquiring results, a transmission / reception unit 44, a calculation unit 45 for performing GUI display processing when imaging data and analysis results are acquired, and a storage unit 46.

Here, the application execution unit 42 executes a Web browser used to display the execution result of the application on the screen. The request generation unit 43 makes a processing request (Http request) to the cloud server 30 via the Http protocol in response to an input from a doctor via the input unit 41. Here, the data format at the time of the Http request transmitted from the transmission / reception unit 44 is, for example, XML.

<Service details of home monitoring system S>
Next, the service content of the home monitoring system S according to the present embodiment will be described with reference to FIG. In order to operate the home monitoring service S, a cloud system is provided to patient P (monthly usage fee is collected). In the home monitoring system S, the home OCT 10 has a sales license to sell as an approved medical device, is purchased from a manufacturing contractor, and is lent to the patient P.

Patient P who wishes to use this service applies for registration of service use by himself / herself. After registration, patient P and operating company K exchange service use contracts, including rental contracts for home OCT10, online. Next, the operating company K sends the home OCT 10 to the patient P's home. The service usage fee here is a monthly system, and the patient P pays the usage amount to the operating company K. Patient P discontinues and cancels the service when the treatment is completed. It is possible to cancel the contract halfway regardless of the completion of treatment, and the home OCT 10 will be returned to the operating company K after the contract period expires or the contract is canceled.

The contracted patient P images the condition of the retina (macula) daily (or regularly) using the Home OCT 10 in a predetermined manner. The imaging at this time is performed using the application installed in the home OCT 10 and the mobile terminal 20. This application communicates with the home OCT 10 to control its function and sends the shooting result to the cloud server 30. Then, the AI on the cloud server 30 automatically analyzes the shooting result, and informs the patient P of the result of the necessity of consultation to the application of the mobile terminal 20 and the home OCT 10. In this way, in this home monitoring system S, the imaging data is automatically transmitted to the cloud server 30, and the analysis result is expressed in a report in a fixed format on the screen display unit 24 of the mobile terminal 20 connected to the Internet. You can refer to it.

<Comparison between existing OCT and home OCT10>
Next, regarding the optical coherence tomography, the differences between the "existing OCT" and the "home OCT 10" according to the present embodiment will be described.

Optical coherence tomography is a technique for photographing the internal structure of a sample with high resolution and high speed by utilizing the coherence of light. It can be imaged in a non-contact and non-invasive manner by irradiating it with near-infrared rays, and is used for tomographic imaging of various organs of the human body without fear of being exposed to the bomb. With the optical interference tomographic meter, a three-dimensional tomographic image can be captured with high image quality, and an image of an arbitrary tomographic surface (two-dimensional) can be cut out and shown by image manipulation of another software. The most popular application for optical interference imagers is ophthalmic diagnostic equipment. These can be applied for various purposes such as diagnosis of diabetic retinopathy, age-related macular degeneration, and various retinal diseases.

Here, the basic configuration of the existing OCT will be described. The existing OCT is a laser light source centered at 800 nm or 1300 nm, and a special optical system is used to operate the light source from the patient's pupil to the retina so that the light source is in focus, and the laser light is within a preset scan area. The scattered light obtained from the retina is captured by a light receiver, and the retinal tomography is imaged from the optical interference data.

Since the existing OCT is compatible with various applications, it is necessary to make various settings when shooting, for example, left and right eyes, scan mode, scan position, scan size, scan interval, added average number of sheets, automatic. Settings such as mode / manual mode, selection of internal fixation light / external fixation light, size of internal fixation light, and position of internal fixation light are required. Among these, there are multiple scan modes, and multiple methods for scanning the laser are prepared, and the appropriate scan method is selected according to the patient's condition and disease. For example, in the case of Macura 3D (three-dimensional yellow spot) mode, the laser light source (point light source) is moved from the point light source as a surface by moving the focal position from X to Y at one point intervals using the mirror optical system. In addition, the depth direction of the retina is obtained by the depth resolution of the point light source laser, and as a result, three-dimensional information can be obtained. The width in the X direction and the width in the Y direction can be changed by setting. The obtained information constructs an image from the light intensity (light brightness) information of the scattered light, and as a result, in the line scan, the tomographic structure of the retina is obtained from the lightness (light intensity) of the image. In this way, although the conventional OCT has high analysis performance, the longer the distance, the more complicated the mechanism such as the optical system becomes, and the optical system is required to improve the accuracy (such as making a clear image with less noise). There is a problem that the precision of the drive system is required and the manufacturing cost is high.

Further, the existing type OCT is composed of an OCT product main body 51 and a PC 52 as shown in FIG. The OCT product body 51 is composed of mechanical parts such as a power supply, a control circuit, a drive unit, an optical system, a base or a cover, and software for control, image generation, and image analysis is installed on the PC 52, and various images are displayed. Reference and analysis applications are available. In addition, it is equipped with a database of normal subjects for comparison between patients and normal subjects, and various functions such as a function to visually display normal and abnormal conditions by comparing the retina of the photographed patient with the data of normal subjects. To. The OCT product main body 51 and the PC 52 are mounted on a dedicated desk 53 and installed in an ophthalmic examination room, and the exclusive space requires a considerably large space (at least 80 cm square).

On the other hand, the home OCT 10 according to the present embodiment is an existing product OCT in order to specialize in the identification of the vitreous body, choroid, and retina of the eyeball in a predetermined region of the macula of the eye to be inspected as described above. Compact, lightweight, single function, automatic shooting, low power consumption, and easy to use. The footprint of the home OCT 10 is about 30 cm x 30 cm. Shooting in the home OCT10 is limited to extremely simple functions, and it is fully automatic (when the patient taps the "Start shooting" button on the smartphone app and the patient touches the window except for the home OCT10, the picture is automatically taken and the result is taken by the cloud server via the smartphone. It is automatically transmitted to 30).

The retina has a layered structure of 10 layers, and the thickness is about 0.3 to 0.4 mm in the central part and about 0.15 mm in the peripheral part. In the existing OCT, about 7 to 8 layers of the retina are automatically segmented, and the condition (pathology) of the patient is diagnosed by confirming not only the macula but also the condition of various places from the fundus photograph and OCT image. On the other hand, since the home OCT 10 has only a function specialized for wAMD (age-related macular degeneration), the three layers of the vitreous body, choroid, and retina of the eyeball as shown in FIG. 3 are imaged.

As shown in FIGS. 6 and 7, the scan mode for imaging using the home OCT 10 is a predetermined range of the macula centered on the fovea (for example, 6 mm wide (see FIG. 7 (a))). For example, 7 line scans (1 mm intervals, see FIG. 7 (b)) or 5 lines (1.5 mm intervals, see FIG. 7 (c)) are scanned in the lateral (X) axis direction (scan). By doing so, scattered light information is obtained on a straight line and a cross section of the retina is constructed. Also, by moving the focal position from X to Y at one point intervals, information as a surface is created from the point light source. Further, the depth direction of the retina is obtained by the depth resolution of the point light source laser, and as a result, three-dimensional information can be obtained. As described above, unlike the existing OCT, the home OCT 10 has no diagnostic function other than the use of imaging the macula, so that it is possible to realize miniaturization and low price.

<Image analysis on cloud server 30>
Next, the AI analysis in the imaging data analysis unit 33 of the cloud server 30 will be described with reference to FIG. As described above, the shooting data obtained by the home OCT 10 is automatically analyzed by the cloud server 30.

The construction of algorithms in AI applies machine learning, etc., and is a convolutional neural network (CNN) of deep learning (CNN) that uses a neural network that is applied in the field of image recognition in a multi-layered structure. Examples include learning devices and inference devices using Network) and the like.

As shown in FIG. 8, for example, the imaging data analysis unit 33 has (1) segmentation of the anterior surface of the retina 8a, (2) segmentation of the posterior surface of the retina 8b, and (3) retinal pigment epithelium based on the imaging data of the home OCT 10. Epithelium: RPE) Perform segmentation of 8c. Then, the subretinal fluid (SRF) 8d between the posterior surface of the retina 8b and the retinal pigment epithelium 8c is detected, and the timing of re-examination is automatically determined. This is because the timing of re-examination can be determined by detecting the subretinal fluid that causes the recurrence of age-related macular degeneration.
<Overall sequence diagram>

Next, the entire sequence of the home monitoring system S according to the present embodiment will be described with reference to FIG.

As a premise of this home monitoring system S, the doctor who has completed the prescription of the patient (contractor) uses the terminal device 40 to set the names of the patient and the doctor in charge and the imaging conditions of the home OCT 10 linked to the patient name on the cloud server. It is transmitted to 30 (S91). Usually, the patient's doctor decides the imaging conditions such as right eye, left eye, binocular, and multiple imaging methods (scanning methods) based on the prescription. When the cloud server 30 receives the patient name and imaging conditions from the doctor's terminal device 40, the cloud server 30 stores them in the user information storage unit 35 (S92).

On the other hand, the patient rents the home OCT 10 for a certain period based on the service use contract of the business operator. The home OCT 10 holds an identification number (terminal ID) unique to each device in the storage unit 13, and stores the date and time when the patient first turns on the power in the use start date and time and the storage unit 13 (S93). Then, when the power of the home OCT 10 is turned on, the terminal ID is notified from the home OCT 10 to the patient's mobile terminal 20 (S94).

When the mobile terminal 20 receives the terminal ID from the home OCT 10, the mobile terminal 20 transmits a user contract information associated with the terminal ID and an imaging condition request for acquiring the imaging condition to the cloud server 30 (S95).

Then, the cloud server 30 that has received the request request refers to the user information storage unit 35, and transmits the contract information and the imaging condition associated with the terminal ID (or the patient's name) to the mobile terminal 20 (S96).

Next, the home OCT 10 acquires contract information and imaging conditions through the mobile terminal 20 (S97) and stores them in the storage unit 13 (S98). The mobile terminal 20 also stores the acquired imaging conditions and contract information in the storage unit (S99). As described above, in the home monitoring system S, the condition of the patient who rents the home OCT 10 is diagnosed and known in advance. Therefore, when renting the home OCT 10, it is possible to extract the imaging method (selection between non-optometry and imaging method) corresponding to this patient from the patient information stored in the user information storage unit 35 in the cloud server 30. .. Further, the home OCT 10 notifies the patient of the expiration date by comparing the date and time and displaying on the display unit 15 that the expiration date stored in the storage unit 13 is approaching or that the expiration date has passed. After the expiration date, the shooting function does not work, and if the power is turned off after that, the home OCT 10 cannot be started again. When the contract ends, the business operator collects the home OCT10, collates the terminal ID with the contract expiration date, and manages the collection of the home OCT10 and the completion of the contract.

Then, when the imaging time (every day, every other day, regular period, etc.) set in the application of the mobile terminal 20 comes, the imaging command is displayed on the screen display unit 24 of the mobile terminal 20 (or home OCT 10) (S100). The patient who sees this imaging command performs imaging using the home OCT10. It is also conceivable that the warning of the imaging time is periodically given by using the display unit 15 of the home OCT 10.

Since the patient's imaging conditions are written in the storage unit 15 of the home OCT 10, when the patient takes an image by himself / herself, the home OCT 10 refers to these imaging conditions and automatically sets the imaging conditions. Alternatively, since the home OCT 10 has an extremely simple configuration and is equipped with only the operation input unit 16 such as the minimum necessary switch (SW) and the display unit 15 (LED etc.), the setting / operation of the home OCT 10 can be performed. You may use an app that runs on your smartphone to give shooting instructions and refer to shooting results. The imaging data (file in a dedicated format) captured by the home OCT 10 is automatically transmitted to the mobile terminal 20 (S101), and the application of the mobile terminal 20 further automatically transmits the imaging data to the cloud server 30 (S102).

Accumulation and analysis of shooting data and the result (report) are performed by the cloud server 30 operating on the Internet (S103). Functions such as a WEB server, a DB server, and an application interface server are stored in one or a plurality of servers (hardware) in the cloud server 30 and operate. The cloud server 30 stores the shooting data transmitted from the mobile terminal 20 in the image pickup data storage unit 34, and the image pickup data analysis unit 33 analyzes the image capture data using AI. The cloud server 30 may request the AI service to analyze the shooting data via the application interface server.

Next, the cloud server 30 notifies the mobile terminal 20 of the success / failure determination of imaging as to whether or not the imaging was successful and the data was transmitted without any problem, and the result of the necessity of consulting a doctor (S104). Then, it is transferred to the home OCT 10 (S105) and presented on the display unit 15 of the home OCT 10 in an easy-to-understand color (for example, red = failure, blue = success) (S106). In addition, information such as the success or failure of imaging and the necessity of seeing a doctor is also displayed on the screen display unit 24 of the mobile terminal 20 (S107). Further, the cloud server 30 stores a new analysis result in the analysis result table of the corresponding patient in the user information storage unit 35 (S108).

In this way, the analysis result in the cloud server 30 is transmitted to the mobile terminal 20 of the corresponding patient, and the application of the mobile terminal 20 notifies the patient that the analysis result has arrived by using the notification function of the smartphone. The patient who notices the notification can refer to the analysis result displayed on the application of the mobile terminal 20. The application of the mobile terminal 20 further sends the result of the necessity of consultation at a medical institution to the home OCT 10 as simple data such as OK / NG, and the home OCT 10 displays it on the display unit 15 in different colors. Therefore, the patient can know the exact time of the consultation.

The patient can use the mobile terminal 20 to send a request for the analysis result (including the imaging data) of the latest imaging data to the cloud server 30 (S201). Upon receiving this request, the cloud server 30 acquires the latest analysis result stored in the user information storage unit 35 (S202), responds to the analysis result to the mobile terminal 20 (S203), and receives the mobile terminal 20. Graphic processing is performed by the application of (S204).

The request for the analysis result can also be made from the terminal device 40 owned by the doctor (S205 and S206), displayed on the screen (S207), and the doctor who has referred to the patient information can appropriately update the imaging conditions. (S208 and S209).

<Effect of the present invention>
As described above, the home monitoring system S for age-related macular degeneration according to the present embodiment is a home, which is an optical interference tomometer provided at the patient's home and photographs the macular region of the patient's eyeball. A mobile terminal 20 and a mobile terminal 20 that are connected to the home OCT 10 via a local network and acquire image data of the macula region of the patient's eyeball from the home OCT 10 while the dedicated application of the OCT 10 and the home monitoring system S is installed. A server (cloud server) 30 that automatically determines the progress of age-related macular degeneration based on the image pickup data acquired via the mobile terminal 20 and the server 30 via the server 30 and the wide area network. The terminal device 40 is connected to the server and at least transmits the imaging conditions of the home OCT 10 to the patient by the doctor to the server 30. This configuration enables early or timely detection of recurrence of age-related macular degeneration while the patient is at home without imposing a heavy burden on the patient with age-related macular degeneration. It is possible to encourage the visit to the hospital and prevent the progression of age-related macular degeneration.

Specifically, (1) OCT, which is normally installed only in a medical institution, can be placed in the patient's home as a home OCT10, and the state of one's retina can be easily photographed and acquired every day. (2) The self-photographed retinal data is transferred to the cloud server 30 connected to the home OCT 10, and the diagnostic imaging AI operating there automatically determines the state by a predetermined algorithm. (3) The determination result is sent to the mobile terminal 20 such as the patient's smartphone so that the patient can grasp the condition by himself / herself. (4) If the AI determines that a medical examination is necessary, the patient will see a medical institution. (5) The doctor can acquire the daily data of his / her patient from the cloud server 30 using the terminal device 40 and diagnose the patient's condition.

The present invention is not limited to the configuration of each of the above embodiments, and various modifications can be made without changing the gist of the invention. Although the home monitoring of age-related macular degeneration has been described above, it goes without saying that it can also be applied as a home monitoring system for other diseases that require monitoring of the progress of daily symptoms.

S Home monitoring system for age-related macular degeneration 10 Home OCT
12 Imaging unit 12a Light source 12b Optical scanner 12c Detection unit 14 Communication unit 15 Display unit 20 Mobile terminal 22 Storage unit 23 Communication processing unit 24 Screen display unit 30 Cloud server (server)
33 Imaging data analysis unit 34 Imaging data storage unit 35 User information storage unit 40 Terminal device

Claims (7)

A home monitoring system for age-related macular degeneration,
Home OCT (Optical Coherence Tomography), which is an optical coherence tomography that is prepared at the patient's home and photographs the macular region of the patient's eyeball,
A mobile terminal that is connected to the home OCT via a local network and acquires image data of the macular region of the patient's eyeball from the home OCT while a dedicated application for the home monitoring system is installed.
A server that is connected to the mobile terminal via a wide area network and automatically determines the progress of age-related macular degeneration based on the imaging data acquired via the mobile terminal.
It is provided with a terminal device connected to the server via a wide area network and at least transmitting the imaging conditions of the home OCT to the patient by a doctor to the server .
The home OCT is
A communication unit, which is a communication module that realizes a communication connection with the mobile terminal,
An imaging unit for acquiring imaging data by irradiating the macula region of the patient's eyeball with measurement light based on the imaging conditions acquired via the communication unit is provided.
As the imaging data, the imaging unit captures imaging data that identifies the three layers of the vitreous body, choroid, and retina of the eyeball.
The home OCT is further described.
A home monitoring system for age-related macular degeneration, comprising a display unit that displays the results in different colors based on information on the success or failure of imaging acquired from the mobile terminal and the necessity of consultation with a medical institution . The server
An imaging data analysis unit that automatically determines the progression of age-related macular degeneration by performing image analysis using AI on the imaging data received from the mobile terminal.
An imaging data storage unit that stores the imaging data, and
The home monitoring system for age-related macular degeneration according to claim 1, further comprising at least a user information storage unit that stores the analysis results of the imaging data analysis unit and the imaging conditions of the home OCT. The imaging data analysis unit performs (1) segmentation of the anterior surface of the retina, (2) segmentation of the posterior surface of the retina, and (3) segmentation of the retinal pigment epithelium based on the imaging data, and then between the posterior surface of the retina and the retinal pigment epithelium. The home monitoring system for age-related macular degeneration according to claim 2, wherein the timing of re-examination is automatically determined by detecting the subretinal fluid in the retina. The image pickup unit
A light source that irradiates the macular region of the patient's eyeball with measurement light,
An optical scanner that scans the measurement light from the light source within a predetermined range of the macula, which is a preset scan area, and
The home monitoring system for age-related macular degeneration according to claim 1 , further comprising a detection unit that detects interference between the reference light and the scattered light reflected in the macula region. The mobile terminal is
The communication processing unit, which is a communication module that realizes communication connection to the Internet,
When the analysis result is received from the server via the communication processing unit, the screen display unit to be displayed to the user by GUI and the screen display unit.
The home monitoring system for age-related macular degeneration according to any one of claims 1 to 4 , further comprising a storage unit for storing at least one of the analysis result and the dedicated application program. The home for age-related macular degeneration according to claim 5 , wherein the dedicated application program has an imaging command function for automatically displaying on the screen display unit that it is time to image the home OCT to the patient. monitoring. An application program used in the home monitoring system for age-related macular degeneration.
The home monitoring system is
Home OCT (Optical Coherence Tomography), which is an optical coherence tomography that is prepared at the patient's home and photographs the macular region of the patient's eyeball,
A mobile terminal in which the application program is installed and is connected to the home OCT via a local network to acquire imaging data of the macular region of the patient's eyeball from the home OCT.
A server that is connected to the mobile terminal via a wide area network and automatically determines the progress of age-related macular degeneration based on the imaging data acquired via the mobile terminal.
It is provided with a terminal device connected to the server via a wide area network and at least transmitting the imaging conditions of the home OCT to the patient by a doctor to the server .
The home OCT is
A communication unit, which is a communication module that realizes a communication connection with the mobile terminal,
An imaging unit for acquiring imaging data by irradiating the macula region of the patient's eyeball with measurement light based on the imaging conditions acquired via the communication unit is provided.
As the imaging data, the imaging unit captures imaging data that identifies the three layers of the vitreous body, choroid, and retina of the eyeball.
The home OCT is further described.
It is equipped with a display unit that displays the results in different colors based on the information on the success or failure of imaging acquired from the mobile terminal and the necessity of consultation with a medical institution.
The application program is
An imaging command step that automatically displays to the patient that it is time to image the home OCT, and
When the imaging data is acquired from the home OCT, the transfer step of transferring the imaging data to the server and the transfer step.
An application program including a display step for displaying an analysis result received from the server on the display unit .

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