正常眼压性青光眼中视盘分区指标改变与视野改变间的关系

目的探讨应用海德堡视网膜断层扫描仪Ⅱ型(HRT-Ⅱ)检测正常眼压性青光眼(NTG)患者视盘分区指标改变及其与HFA-Ⅱ视野改变间的关系。方法26例(51只眼)NTG患者分别接受HRT-Ⅱ视盘立体测量与HFA-Ⅱ中央视野30-2阈值检测。观察患者上、下半侧视野损害与视盘颞上、颞下分区间损害程度的部位对应关系,比较视野早期损害组(EP)与视野损害前期组(PP)间视盘整体与视盘分区内视杯形状测度(CSM)、盘沿面积(RA)、盘沿容积(RV)、视杯平均深度(MCD)及笔者提出的视杯容积指数(CVI)共计5项视盘指标的差异,分析视盘对应分区内上述各项指标分别与各自视野指数(MD)间的相关性。结果视盘分区与半侧视野间损害程度的部位对应关系中,CVI、RA、RV、CSM及MCD5项指标的对应率依次为92.68%、87.80%、82.93%、63.41%及53.66%;CVI、RA及RV3项与CSM和MCD2项间的差异有统计学意义(P<0.05)。视野前期组和早期损害组的MD分别为(-0.0960±1.1920)dB和(-2.4070±1.1370)dB,差异有统计学意义(P<0.05),两组视盘分区内各项指标的差异也均有统计学意义(P<0.05),但视盘整体内各项指标的差异却均无统计学意义(P>0.05)。上述5项视盘指标中仅CSM与MD呈负相关(r=-0.3002,P<0.05),RA与MD呈正相关(r=0.3105,P<0.05),但相关程度均较弱。结论对于NTG患者的早期视野损害,视盘颞上或颞下分区内CSM、RA、RV、MCD及CVI5项指标比视盘整体内相应指标有更灵敏的提示作用。临床上应用HRT-Ⅱ检查视盘分区指标,与两种视野检查结果结合及比照有助于NTG的早期诊断。(中华眼科杂志,2006,42:204-208)     

Reducing noise in suspected glaucomatous visual fields by using a new spatial filter

Visual field testing with automated perimetry is hampered by the amount of noise present in the readings. Here, we derive a physiologically accurate spatial filter to be applied to the data after patient examination. The filter was tested by a Virtual Eye computer simulation. By simulating series of stable fields it was shown that specificity of determining visual field changes was improved; while simulating progressing fields (based on a map of the optic nerve head) it was shown that sensitivity was also improved. The filter appears to reduce the noise in glaucomatous visual field data and may be clinically useful.     

Variability of visual field measurements is correlated with the gradient of visual sensitivity

Conventional static automated perimetry provides important clinical information, but its utility is limited by considerable test-retest variability. Fixational eye movements during testing could contribute to variability. To assess this possibility, it is important to know how much sensitivity change would be caused by a given eye movement. To investigate this, we have evaluated the gradient, the rate at which sensitivity changes with location. We tested one eye each, twice within 3 weeks, of 29 patients with glaucoma, 17 young normal subjects and 13 older normal subjects. The 10-2 test pattern with the SITA Standard algorithm was used to assess sensitivity at locations with 2 degrees spacing. Variability and gradient were calculated at individual test locations. Matrix correlations were determined between variability and gradient, and were substantial for the patients with glaucoma. The results were consistent with a substantial contribution to test-retest variability from small fixational eye movements interacting with visual field gradient. Successful characterization of the gradient of sensitivity appears to require sampling at relatively close spacing, as in the 10-2 test pattern.     

Progression detection in glaucoma can be made more efficient by using a variable interval between successive visual field tests

Background This study aimed to gain insight into the optimal spacing in time for visual field tests for progression detection in glaucoma. Methods Three perimetric strategies for progression detection were compared by means of simulation experiments in a theoretical cohort. In strategies 1 and 2, visual field testing was performed with fixed-spaced inter-test intervals, using intervals of 3 and 6 months respectively. In strategy 3, the inter-test interval was kept at 1 year as long as the fields appeared unchanged. Then, as soon as progression was suspected, confirmation or falsification were performed promptly. Follow-up fields were compared against a baseline assuming linear deterioration, using various progression criteria. Outcome measures were: (1) specificity, (2) time delay until the diagnosis of definite progression, and (3) number of required tests. Results Strategies 2 and 3 had a higher specificity than strategy 1. Strategies 1 and 3 detected progression earlier than strategy 2. The number of required visual field tests was lowest for strategy 3. Conclusion Perimetry in glaucoma can be optimised by postponing the next test under apparently stable field conditions and bringing the next test forward once progression is suspected. Conflict of interest: none. The author has full control of all primary data, and agrees to allow Graefe’s Archive to review the data upon request.     

原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害的比较

目的探讨原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）和低压性青光眼（ｌｏｗｔｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）早期视野损害及视网膜神经纤维层缺损的特点。方法应用ＱＺＳ－２型自动视野计全阈值程序对２６例（４１只眼）早期ＰＯＡＧ和１３例（１５只眼）早期ＬＴＧ进行定量视野测定，所有患者散瞳做视盘和视网膜神经纤维层照像，分析视网膜神经纤维层缺损的类型和程度。结果早期ＰＯＡＧ和ＬＴＧ视野损害多表现为局限性视网膜光敏感度下降，少数表现为弥漫性光敏感度下降，视野损害主要位于中心视野，少数可合并周边视野损害。中心视野平均光敏感度和短期波动与正常对照组之间差异有显著性，两型青光眼早期视野损害和视网膜神经纤维层缺损的类型及损害部位分布差异无显著性。结论早期ＰＯＡＧ和ＬＴＧ视野损害特征及视网膜神经纤维层缺损形态一致     

Disc and field damage in patients with unilateral visual field loss from primary open-angle glaucoma

To assess the temporal relationship between field and disc change in early glaucoma, 24 patients with unilateral visual field loss from primary open angle glaucoma were identified for planimetric optic disc measurements. Cross-sectional analysis of disc rim area was performed and compared to 25 age-matched normal controls. The mean (±SD) disc rim area in eyes with normal visual fields (1.10 ± 0.31 mm²) was slightly larger than that of eyes with visual field loss (0.90 ± 0.33 mm²). The mean disc rim area in the control group (1.49 ± 0.19 mm²) was significantly different from both sets of eyes in the asymmetric primary open angle glaucoma patients (p = 0.000). These findings support the hypothesis that loss of the optic disc rim can be detected before perimetric abnormalities develop in patients with glaucoma.     

早期原发性青光眼的蓝黄视野及黄斑阈值视野检测

目的 探讨蓝黄视野及黄斑阈值视野检测在早期原发性青光眼诊断中的应用价值。 方法 采用Humphrey II 750型自动视野计，对正常人60例60只眼、早期原发性青光眼患者63 例63只眼进行标准视野（white-on-white perimetry, W/W）、蓝黄视野（blue-on-yellow perimetry, B/Y）及黄斑阈值视野（macular threshold perimetry, MTP）检查,计算比较3 种检测方法在早期原发性青光眼诊断中的敏感度及特异度，并采用B/Y及MTP并联及串联实验进行分析。 结果 比较正常组与早期原发性青光眼组W/W、B/Y、MTP的平均光敏感度，差异均有显著性的意义［t=-3.01, P=0.0054 (W/W)；t=-2.95, P=0.0063 (B/Y)；t=-2.59,P=0.0150 (MTP)］。在早期原发性青光眼诊断中，MTP的敏感度最高（83%），B/Y次之（65%），W/W最低（48%）。将B/Y与MTP联合运用时，并联试验可使敏感度提高到94%；串联试验可使特异度提高到87%。 结论 在早期原发性青光眼诊断中，B/Y、MTP及两者的联合应用均可提高诊断的敏感度与特异度，有一定的应用价值。 （中华眼底病杂志，2003，19：102-105）     

晚期青光眼患者视野检查的可靠性分析

目的本文探讨晚期青光眼与早中期青光眼患者视野检测的可靠性是否存在显著性差异。方法以2002年4月至2003年12月随诊于我科的临床确诊为青光眼的患者作为研究对象,应用OCTOPUS101型视野计中G2/TOP程序对双眼进行视野检测。以每位患者有一次以上视野检查经历及裸眼视力≥0.5,瞳孔直径大于2.5mm作为入选标准。共157只眼(90位患者)入选;年龄25岁到79岁,男性29人、女性61人。结果以平均缺损指数(MD,meandefect)分组:MD≥15dB为晚期青光眼组;MD<15dB为早中期青光眼组。MD≥15dB组RF值35.73±3.69,显著高于MD<15dB组5.14±0.73(P<0.01);根据RF值进行分组:RF>15%为RF异常组;RF≤15%为RF正常组,RF异常组的MD值8.64±1.08显著高于RF正常组4.38±0.38(P<0.01)。晚期青光眼组患者假阴性率远高于早中期青光眼组。结论晚期青光眼患者视野检查的可靠性因子(RF)与早中期患者相比有显著差异,在视野损伤严重的患者,高RF值并不一定代表患者视野检查的可靠性差,相反,当青光眼损伤到一定程度,RF值随之增大,可能与损伤程度有关。高RF值来源于高的假阴性率,青光眼的加重导致假阴性率的增高。     

垂体瘤患者视野缺损和视功能特点

目的探讨垂体瘤患者视野损害、双眼视功能与垂体瘤体积的相关性及特点。方法系列病例研究。分析2013年1月至2014年8月在我院确诊为垂体瘤的42例患者的病历及视野资料。通过方差分析及线性相关分析研究视野缺损类型,平均缺损（MD）,模式标准差（PSD）和视野指数（VFI）与垂体瘤体积的关系。结果25例（占60%）患者因视力下降就诊。34例（占81%）患者视野异常,其中15例（占44%）表现为特征性的双眼颞侧偏盲。视野缺损较重眼MD、VFI与肿瘤体积呈负相关（MD：r= -0.548,P<0.01;VFI：r=-0.544,P<0.01）。以H-P-A进行分级的视野缺损中,各级之间MD、PSD、VFI、双眼整合VFI及肿瘤体积的比较差异均有统计学意义（MD：F=24.517,P<0.01;PSD：F=3.452,P<0.05;VFI：F=27.431,P<0.01;双眼整合VFI：F=21.057,P<0.01;肿瘤体积：F=2.985,P<0.05）。结论视力和视野损害是垂体瘤患者的眼部主要表现;不同大小的肿瘤造成的视野缺损类型多样,双眼视功能也有不同,随肿瘤体积增大,视野和视功能损害也逐渐加重。     

原发性青光眼晚期患者视野缺损的相关因素分析

目的探讨原发性青光眼晚期患者视野缺损的相关因素。方法回顾性病例对照研究。收集2014年1月至2019年12月在复旦大学附属眼耳鼻喉科医院眼科诊治的仅残留中心管状视野≤10°或颞侧视岛(生理盲点颞侧)的原发性青光眼晚期患者, 并按视野缺损类型分为管状视野组(对照)和颞侧视岛组。分析年龄、性别、眼别、青光眼类型、初诊青光眼分期、随访眼压、手术次数、疾病史等临床特征与晚期视野缺损类型的关系, 单因素分析采用χ2检验或独立样本t检验, 多因素分析采用logistic回归分析法。结果共纳入287例(287只眼)患者, 其中管状视野组101例, 男性48例, 女性53例, 年龄(61±15)岁;颞侧视岛组186例, 男性107例, 女性79例, 年龄(59±17)岁;两组间年龄、性别、眼别、初诊年龄、手术次数、青光眼家族史、合并全身疾病史等因素差异均无统计学意义(均P>0.05)。原发性开角型青光眼、慢性原发性闭角型青光眼(CPACG)、急性原发性闭角型青光眼在管状视野组分别有26、34、41例, 在颞侧视岛组分别有61、78、47例;初诊青光眼分期为中期、晚期者在管状视野组分别有30、71...     

The use of semi-automated kinetic perimetry (SKP) to monitor advanced glaucomatous visual field loss

PURPOSE: (i) To compare visual field (VF) results obtained with semi-automated kinetic perimetry (SKP) and automated static perimetry (ASP) in patients with advanced glaucomatous VF loss, (ii) to evaluate test-retest reliability of SKP and ASP and (iii) to assess patients' preference for SKP and ASP. METHODS: Twenty eyes of 20 patients (11 male, 9 female, aged 38 to 83 years) with advanced glaucomatous VF loss (stage III or IV according to the Aulhorn classification). Each of the 20 patients were examined in 4 sessions every 3 months with SKP (Goldmann stimulus III4e, I4e and at least one additional dimmer stimulus, within the 90 degrees visual field) and ASP within the 30 degrees VF, employing a threshold-related, supra-threshold test strategy with high spatial resolution for the same instrument (Octopus 101 perimeter, Haag-Streit Inc., Koeniz, Switzerland). RESULTS: Visual field areas (VFA) were compared by analyses of covariance (ANCOVA) with co-variable time, patient effect and their interaction. Test-retest reliability was assessed by ratios (R) of intersection and union of VFA: The mean VFA within the 30 degrees of VF at baseline was 2,344 square degrees (deg(2)) with SKP (Goldmann stimulus III4e) and 1,844 deg(2) with ASP. The patients showed stable visual fields for both SKP and ASP. Comparison of SKP with ASP of the same sessions revealed a median ratio of intersection and union of VFA of 0.78 with the III4e stimulus and of 0.79 with the I4e stimulus. When follow-up SKPs were compared with baseline SKPs the median of the ratios was between 0.80 and 0.93 for the different isopters. The corresponding ratio of ASP's follow-up and baseline VFs was 0.81 (with the size III static stimulus). Nineteen of 20 patients preferred kinetic perimetry to static perimetry. CONCLUSIONS: The comparability between SKP and ASP is satisfactory and within the range of the test-retest reliability of ASP. SKP shows slightly better test-retest reliability than ASP. The majority of patients with advanced glaucomatous visual field loss prefer SKP instead of ASP. SKP is a valuable alternative to ASP in monitoring advanced glaucomatous visual field loss.     

蓝黄视野检查与RTA后极部视网膜厚度的相关研究

目的探讨视网膜厚度分析仪获得的后极部视网膜厚度丢失程度与蓝黄视野缺损的相关性。方法对25例37眼可疑青光眼;17例26眼早期青光眼;10例16眼中晚期原发性开角型青光眼患者分别进行标准视野检查、蓝黄视野检查、并用RTA获得后极部视网膜地形图。对获得的W/W、B/Y、RTA后极部视网膜厚度损伤程度分别进行等级评分,用Spearman等级相关来评价三种检测方法的相关性,并用直线回归分析评价RTA预测青光眼损伤程度的能力。结果(1)RTA测得的后极部视网膜厚度丢失程度与W/W视野检查损伤程度的相关性相对较小(r=0.601),但回归系数具有显著的统计意义(P<0.001)。(2)RTA测得的后极部视网膜厚度丢失程度与B/Y视野检查损伤程度有较高的相关性(r=0.864)。相应的回归系数具有显著的统计意义(P<0.001)。结论RTA后极部视网膜厚度测量是一种新的评估青光眼视神经损伤的途径,与蓝黄视野检查缺损程度具有较好的相关性,两种方法结合对青光眼的早期诊断具有重要的意义。     

Stabilization and comparison of TOP and Bracketing perimetric strategies using a threshold spatial filter

Background To evaluate a new perimetric spatial filter that takes into account relations of dependence between regions of the glaucomatous visual field. Methods 51 glaucoma patients and 30 controls were examined using the Octopus 1-2-3 on four occasions using program 32; two with TOP and two with Bracketing (BRA) strategy. Each threshold was replaced by a filtered threshold, calculated as the mean of its own value and the four points best correlated with it, weighted with the correlation coefficient (r) that relates them. Results Application of the filter had minimal effect on the absolute mean defect (MD) but reduced the square root of loss variance (sLV) by 17.6% in TOP and 28.8% in BRA, increasing the similarity between their results. Filtered TOP and BRA thresholds were more similar than those obtained in the two unfiltered BRA examinations. Filtering reduced the value of short fluctuation by 28.6% in TOP and 45.4% in BRA and reduced sLV fluctuation by 14.3% in TOP and 24.2% in BRA, thus harmonizing the two strategies for these two parameters (p > 0.05). The influence of filtering on MD fluctuation was minimal (p > 0.05). In normal subjects the number of points beyond 5 dB of normality (not reproducible false scotomas) reduced from 1.5% to 0.2% in TOP and from 4.9% to 1.6% in BRA, while in glaucoma patients changes were minimal. Conclusions The proposed spatial filter stabilized perimetric results, acting with greater effect on BRA than on TOP, making their results more similar.     

Detection sensitivity to light offsets is abnormal in glaucomatous visual field

The detection thresholds in the central visual fields of glaucomatous (n=21), ocular hypertensive (n=21) and normal (n=13) individuals were tested with both light decrements (offsets=dark spots) on a cathode ray tube (CRT) and light increments (onsets=bright spots) on a bowl projection perimeter. Both types of stimuli were of equal surface area (Goldmann size IV=16 mm²) and duration (200 milliseconds) on a 10 cd/m² background intensity. Computerized threshold testing with light offsets on CRT could document the glaucomatous visual field loss with high accuracy and might indicate early glaucomatous visual field loss missed by the conventional light onset stimuli.     

应用Humphrey三区筛选法检查垂体大腺瘤患者的视野缺损

目的评价Humphrey三区筛选法检查垂体大腺瘤(pituitarymacroadenoma,PMA)患者视野缺损的临床价值.方法采用全自动Humphrey静态视野计的三区筛选法,对经MRI和CT确诊的128例PMA患者和门诊30例轻度近视患者,进行中心30°76个点视野检查.结果PMA组127例(99.2%)的患者有视野缺损,111例(86.7%)的患者以颞侧(包括单眼颞侧)视野缺损为主并且呈现或趋向中线垂直分界.其敏感性(相对检查例数的百分比)为99.2%,每眼视野平均检查时间(5.8±2.2)min,而采用全阈值方法检查中心30°76个点视野的平均检查时间为(14.8±2.8)min,两者比较差异有非常显著性(t=63.6396,P<     

后发性白内障切开孔径大小对视野的影响

目的　探讨治疗后发性白内障 2mm和 4mm不同切开孔径对视野的影响 ,并分析其相关因素。方法　将 4 0例白内障摘除人工晶状体植入术后晶状体后囊膜Ⅱ级混浊患者随机均分为 2mm切开孔径组和 4mm切开孔径组 ,行掺钕钇铝石榴石激光晶状体后囊膜切开术后 1 5个月检查中心 30°和周边 6 0°视野。以 2 1例白内障摘除人工晶状体植入术后晶状体后囊膜透明患者 (透明组 )为对照 ,对各组视野检查指标结果进行分析。结果　 2mm切开孔径组视野检查的平均偏差为 - 8 6 5± 3 96 ,样本标准差为 5 71± 2 6 0 ,中心 10°总光敏感度值为 2 89 30± 4 3 6 3,周边 6 0°总光敏感度值为 5 5 8 2 0±197 2 7,与透明组比较 ,差异均有非常显著意义 (P <0 0 0 1)。 4mm切开孔径组视野检查的平均偏差为- 4 0 8± 2 73,样本标准差为 3 0 5± 2 13,中心 10°总光敏感度值为 336 5 4± 34 32 ,周边 6 0°总光敏感度值为 94 5 95± 2 4 4 74 ,与透明组比较 ,差异均无显著意义 (P >0 0 5 )。结论　治疗后发性白内障 2mm切开孔径虽可获得较佳视力 ,但对视野影响较大 ,表现为弥漫性光敏感度下降和视岛不规则局限性压陷 ;而 4mm切开孔径对视野的影响较小 ,为较佳的晶状体后囊膜切开直径。     

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12–18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint.     

蓝/黄视野检查在预测青光眼视野变化的价值

目的　评价蓝 /黄视野检查法 (blue -on - yellow perimetry ,BYP)在预测青光眼视野缺损进展方面的价值。方法　对 1 6例原发性开角型青光眼 ( primaryopenangleglaucoma ,POAG)分别在同期内行BYP和白 /白视野检查法 (white -on -whiteperimetry ,WWP)检查 ,在同期视野检查后每年至少有 1次WWP随访检查。末次WWP检查与同期 2种视野检查的间隔时间为 1 7～ 4 0月 ,并分析WWP检查视野缺损进展情况。比较分析视野缺损进展组和未进展组的同期BYP和WWP检查的视野缺损点数和视野指数与视野缺损进展的关系。结果　 1 1例患者视野缺损无进展 ,5例患者视野缺损有不同程度的进展。进展组的BYP检查的缺损点数明显多于同期WWP检查的缺损点数 (t =4 .6 7,P =0 . 0 0 95) ;而未进展组 2种视野检查的缺损点数差异无显著性意义 (t =1 . 87,P =0. 0 91 2 ) ;BYP检查的平均敏感度 (meansensitivity ,MS)值均明显低于同期WWP检查的MS值 (P <0 . 0 5) ;BYP检查的平均缺损 (meandefect ,MD)值明显高于同期WWP检查的MD值 (P <0 . 0 5)。同期BYP和WWP视野缺损点数之比 ,进展组 ( 1 . 96± 0 .4 8)明显高于未进展组 ( 1 . 31± 0 . 4 0 ) ,两组间差异有显著性意义 (t =2 .85,P =0 . 0 1 2 9) ;同期BYP和WWP的MD值之比 ,进展     

国产YDS-201自动视野计四点阈值程序在青光眼视野筛查诊断中的应用价值

目的 探讨国产YDS-201自动视野计四点阈值程序在青光眼视野筛查诊断中的临床应用价值.方法 采用国产YDS-201自动视野计的中心52及四点阈值程序对77例(140只眼)青光眼患者在半暗室环境下检测中心30°视野.分别进行定性、定位、检测时间的对比分析.结果 定性诊断:两种程序检查结果视野缺损部位一致的119只眼(85%),不一致的21只眼(15%);定位诊断:四个象限均符合者为118只眼,约占84.3%,两个或三个象限符合者为22只眼,约占15.7%,未见四个象限均不符合者;检测耗时:中心52程序检查用时183～638s,平均(302.13±99.02)s,四点阈值程序检查用时23～101s,平均(44.11±18.00)s,P＜0.001.结论 YDS-201视野计四点阈值程序在快速筛查青光眼视野缺损中具有较高敏感性和特异性,检查用时短,适合于青光眼的视野筛查,是一种在大量人群中快速筛查青光眼的良好方法.