正常人视野视网膜光敏感度的研究

应用国产ＱＺＳ－２型自动视野计全阈值程序对正常者５９人（１１１只眼）进行中心３０°视野和周边３０°～６０°视野视网膜光敏感度测量。被检者年龄１５．０～６８．０岁，平均３８．４岁。结果表明：正常人双眼黄斑光敏感度、中心３０°视野平均光敏感度和周边３０°～６０°视野平均光敏感度的差异均无显著性（Ｐ＞０．０５）。男、女性中心视野和周边视野平均光敏感度差异也无显著性（Ｐ＞０．０５）。平均光敏感度随年龄和视野偏心度增加呈直线下降，年龄每增加１０岁，中心视野平均光敏感度下降０．６０ｄＢ，周边视野下降０．７０ｄＢ；偏心度每增加１０°，光敏感度以２．６０ｄＢ的趋势直线下降，正常人的短期波动为１．３９±０．５６６Ｂ。     

全视野暗视敏感度对原发性开角型青光眼的早期诊断价值

为评价全视野暗视敏感度（ｗｈｏｌｅ－ｆｉｅｌｄｓｃｏｔｏｐｉｃｓｅｎｓｉｔｉｖｉｔｙ，ＷＳＳ）测定对原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）的早期诊断价值，经过３０分钟暗适应后，对１６例（１７只眼）早期ＰＯＡＧ，１２例（１４只眼）进展期ＰＯＡＧ，２５例（３２只眼）可疑ＰＯＡＧ及１５例（２０只眼）年龄匹配的正常人进行ＷＳＳ阈值测定。结果：这四组的平均ＷＳＳ阈值差异均具有显著性，分别为６．２４±２．４６ｄＢ，７．７９±２．１９ｄＢ，３．６３±２．４６ｄＢ，１．８５±１．６９ｄＢ。在可疑ＰＯＡＧ组中，随着危险因素的增加，ＷＳＳ阈值有上升趋势。ＷＳＳ阈值与ＰＯＡＧ患者的眼压最高水平值呈正相关（ｒ＝０．７６６，Ｐ＜０．００１）。结论：ＷＳＳ测定在青光眼的筛选中具有潜在性价值。     

视网膜光阈值的检测对青光眼早期诊断的价值

采用ＱＺＳ－Ⅱ型自动静态视野分析仪，对单侧原发性青光眼患者的对侧眼视乳头杯盘比大于０．６的眼的中央３０度及鼻侧视野的视网膜光阈值进行测定，结果表明，两组眼的光阈值阈值均明显高于正常眼，其中７８．５７％的单侧青光眼的对侧眼及６２．５％ 杯盘比大于０．６的眼发生了光敏感的下降，提示光敏感度下降是出现特征性视野缺损的前驱表现。评价视网膜光阈值检测对早期青光诊断的临床意义。     

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     

非胰岛素依赖型糖尿病患者中心视野早期光敏感度分析

目的 检测无糖尿病性视网膜病变的非胰岛素依赖型糖尿病患者和正常人的中心视野光敏感度，评价视野检查在糖尿病性视网膜病变早期诊断中的作用。 方法 对40例，75只眼,年龄46～71岁，眼底正常的非胰岛素依赖型糖尿病患者及44例，76只眼,年龄45～72岁的正常人作视野检查。采用美国Dicon TKS－4000型视野分析仪，检测中心30°视野内80个点的光敏感度。 结果 正常眼底的糖尿病患者，中心视野中多个检测点显示光敏感度下降4～8 dB；有些出现了光敏感度下降偏差群；糖尿病组中心视野的三个区域内的平均光敏感度分别与正常组的平均光敏感度比较，差异均有显著性的意义(P＜0.001)。 结论 糖尿病患者在出现视网膜病变之前视网膜神经感觉功能已在一定程度上受到了损害，而且视网膜光敏感度的下降与血视网膜屏障有无渗漏并不相关。电脑视野检测在糖尿病性视网膜病变的早期诊断中有一定的临床价值。 (中华眼底病杂志, 2002, 18: 218-220)     

正常人中心视野视网膜光敏感度的定量分析

目的：为了解我国正常人群中央３０度视野视网膜光敏感度的定量值,并对研究青光眼的视野损害提供有益的经验。方法：应用北京市眼科研究所和航空航天部一０二所联合研制的ＱＺＳ－２型全自动静态视野分析仪,采用全阈值程序对４８例９６只正常眼进行中央３０度视野光敏度的测定。结果：９６只正常眼中央及鼻上、下,颞上、下视野的平均光敏度均随着年龄的增加而降低,其降低的幅度及变异均随着年龄的增加而增大,年龄（ｘ）与平均光     

一种评价青光眼视野损害的新方法——上下方Bjerrum区静态光阈值不对称

鉴于早期青光眼视野缺损具有上下方视野不对称特点,根据不对称视野计分可能发现早期青光眼视野损害。通过比较同一跟上下Bjerrum区相对应点群的平均光敏感度,分析54只已有早期或中期视野缺损的青光眼和105只正常眼的自动视野计资料。94.44%(51/54)的青光眼和92.38%(97/105)的正常眼被正确鉴定。此分析方法简单,对于检测青光眼视野缺损有较高的敏感性和特异性。     

正常人黄斑区视觉细微矩阵图的研究

应用Ｈｕｍｐｈｒｅｙ视野分析仪和细微矩阵方法测定了１４例正常人，以中心凹为中心，１°空间间隔，由１００个位点构成的９°×９°矩阵的蓝光明视和暗视阈值，并应用此方法研究了屈光效应。结果表明，在明视情况下，黄斑区的平均敏感度改变小于１，０ｄＢ，而在暗视情况下，旁中心４°的敏感性较中心凹升高１５．０ｄＢ。由１．００Ｄ屈光度所致非聚焦效应使敏感度下降近１．２ｄＢ。此项技术对黄斑视功能测定提供了一种高空间分辨的敏感的方法。     

弱视儿童黄斑光敏感度的研究

目的　探讨儿童弱视眼黄斑光敏感度的特点。方法　采用ＱＺＳ－ Ⅱ型自动视野计对１０５ 例（１８３ 眼） 弱视儿童进行黄斑区６°光敏感度（ ＭＬＳ） 的检测。结果　轻、中、重度弱视眼ＭＬＳ 的平均值分别为２３．２４３ ±１．０８ｄＢ、２１．８５９ ±１．７２７ｄＢ、１９．１０９ ±１．０９１ｄＢ。经统计学处理， 轻、中、重度弱视眼ＭＬＳ 的平均值有显著性差异， 中、重度弱视眼ＭＬＳ 明显低于轻度弱视眼， 而轻度弱视眼ＭＬＳ与正常眼无明显差异。结论　提示ＭＬＳ 对中、重度弱视的筛选有一定临床意义。     

青光眼静态阈值不对称

通过比较双眼Ｂｊｅｒｒｕｍ区平均光敏感度（ＭＳ），分析３６名至少１眼有早或中期视野缺损的青光眼和４２名正常人自动视野检查资料，应用自定的标准，获得８０．６％（２９／３６）的敏感性和８８．１％（３７／４２）的特异性。在青光眼组，较低ＭＳ眼多为较高眼压眼，在有不对称Ｄ／Ｄ值或相对性传入瞳孔障碍者，较大青光眼杯或传入性瞳孔障碍眼ＭＳ恒低于对侧眼。     

Diffuse loss of sensitivity in early glaucoma

PURPOSE: To establish whether there is significant diffuse loss of sensitivity in a population of patients with early glaucoma. METHODS: The differential light sensitivities at the 10 most sensitive locations from within the central 24 degrees of program 30-2 of the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA) were compared in 38 pairs of age-matched subjects, one of each pair with early primary open-angle glaucoma (POAG) and the other with normal eyes. All subjects had had experience with automated perimetry and had clear media, visual acuity of 20/25 or better, and one or fewer false-positive or false-negative responses to catch trials. RESULTS: The mean difference in age between the subjects with glaucoma and normal subjects was 29 days (P = 0.44, maximum 1.42 years). The mean paired difference in pupil size was 0.16 mm (P = 0.26), and visual acuity was higher in the glaucoma-affected subjects (P = 0.044). The 10 highest sensitivity measurements in the POAG-affected subjects were found to be lower by a median of between 1.0 and 2.0 dB than those in the normal pair members (0.0001相似文献   

Neural losses correlated with visual losses in clinical perimetry

PURPOSE: The validity of clinical perimetry for evaluation of the pathology of glaucoma is based on correlated losses in retinal ganglion cells and visual sensitivity, but procedures to quantify neural losses from visual field defects have not been developed. The purpose of the present study was to investigate the neural and sensitivity losses from experimental glaucoma to establish the framework for a quantitative model for the structure-function relationships of standard clinical perimetry. METHODS: Perimetry, by behavioral testing, and retinal histology data were obtained from rhesus monkeys with significant visual field defects caused by experimental glaucoma. Ganglion cell densities were obtained from sections of retina that corresponded to 16 perimetry test locations. Perimetry sensitivity as a function of ganglion cell density at corresponding retina/visual field locations was analyzed. RESULTS: The structure-function relationships were linear on log-log coordinates, with parameters that varied systematically with eccentricity. The slope value varied from 1.25 dB/dB at 4.2 degrees from fixation to a value of 2.32 dB/dB at 24 degrees from fixation, whereas the intercept value varied from -25.2 dB to -55.7 dB over the same range of eccentricities. The structure-function relationships produced a model to predict the ganglion cell density underlying a given level of visual sensitivity and location in the visual field. The model, with no free parameters, produced an accurate and relatively precise quantification of retinal ganglion cell losses caused by experimental glaucoma in monkeys. However, because the early detection of glaucoma is limited by intersubject variability, ganglion cell losses of 40% to 50% were necessary before visual sensitivity losses exceeded the normal 95% confidence limits. CONCLUSIONS: With retinal eccentricity as a factor, the neural losses from glaucoma are predictable from visual sensitivity measurements by clinical perimetry. The relationships derived from experimental glaucoma in monkeys also accurately predict the rate of age-related losses of retinal ganglion cells in humans, based on the normative perimetry data for age-related reductions in visual sensitivity. The success of the model in this study suggested that it is potentially applicable to the clinical interpretation of the state of glaucomatous optic neuropathy.     

Visual field defects in high myopic glaucoma compared with moderate myopic glaucoma

PURPOSE: To demonstrate the visual field defects characteristic of high myopic glaucoma eyes. METHODS: Eighty-one high myopic glaucoma eyes (< or = -8 diopter(D)) and eighty moderate myopic glaucoma eyes(-3 D approximately -6 D) from patients under the age of 60 were enrolled in this study. Visual acuity, Mean Deviation (MD) of Humphrey visual field analyzer (HFA) central 30-2 program, and the pattern of central visual field defect especially at the early stage of glaucoma (MD > or = -10 dB) were compared between high and moderate myopic groups. RESULTS: HFA examination revealed significant differences in MD values between the high and moderate myopic groups (-11.8 +/- 8.9 dB and -8.4 +/- 6.9 dB, respectively, p = 0.02). Average logMAR visual acuity of the high myopic group was significantly worse than that of the moderate myopic group. The analyses of the pattern of visual field defects especially at an early glaucoma stage demonstrated that there was no specifically damaged area, such as cecocentral scotoma, in high myopic glaucoma subjects. The nasal upper area of the fixation point was the area most affected in both groups. CONCLUSIONS: High myopic glaucoma eyes demonstrated significantly lower MD and visual acuity compared to those of moderate myopic glaucoma eyes. However, at an early stage of glaucoma, no visual field defect characteristic of high myopia was observed.     

Risk of sudden visual loss following filtration surgery in end-stage glaucoma

PURPOSE: To evaluate the effect of filtration surgery on visual acuity and visual fields in patients with end-stage glaucoma during the immediate postoperative period and to assess the risk of sudden visual loss. DESIGN: Prospective interventional, consecutive case-series. METHODS: The study prospectively included consecutive patients with end-stage glaucoma who underwent trabeculectomy with mitomycin-C. The inclusion criterion was a preoperative visual field with Advanced Glaucoma Intervention Study score over 16. Main outcome measures included change in best corrected logMAR visual acuity, in mean deviation (MD) of visual field test, in number of points among the four central visual field points with a sensitivity less than 5 dB and in mean sensitivity of the four central visual field points after surgery. The incidence of intraoperative and postoperative complications was also recorded. RESULTS: Twenty-one patients (21 eyes) were enrolled. Mean age was 64 years (range 31 to 78). Surgery resulted in a reduction of preoperative intraocular pressure (IOP) by 14.1 +/- 9.2 mm Hg (P < .001) and a decrease in postoperative antiglaucoma medication use (P < .001). Preoperatively the mean visual acuity was 0.77 +/- 0.78, and the mean value of the mean deviation at the visual field test was -27.94 +/- 2.7 dB. Three months after surgery, there was no significant difference in visual acuity (0.74 +/- 0.79, P = .73) and mean deviation (-27.50 +/- 2.6 dB, P = .1). Similarly there was no significant change in the visual field parameters tested to assess central visual field sensitivity. There were no intraoperative complications. Transient hypotony occurred in three eyes while one eye presented more extended hypotony. Three of these eyes experienced bleb leak (seidel). CONCLUSIONS: In our case-series of consecutive patients with end-stage glaucoma, followed for 3 months after filtration surgery IOP was reduced effectively and vision was preserved with no occurrences of "wipe-out" phenomenon.     

Multifocal objective perimetry in the detection of glaucomatous field loss.

PURPOSE: To test the ability of a new type of multifocal objective perimetry to identify glaucomatous visual field defects. METHODS: A multichannel visual evoked potential was recorded using the ObjectiVision Accumap perimeter. One hundred patients (age, 62.2 +/- 9.8 years, mean MD -6.5 +/- 4.17 dB) with open-angle glaucoma and confirmed glaucomatous visual field defects were tested and compared with the normal database of 100 normal subjects (age, 58.9 +/- 10.7 years). Both eyes were tested, but for determining sensitivity the eye with the lesser field defect was chosen if both qualified. The amplitude and intereye asymmetry coefficient for each zone of the field were calculated. A mean amplitude and multifocal objective perimetry severity index was calculated for each subject. RESULTS: In 95 of 100 (95%) patients with glaucoma Humphrey field defects were correlated with visual evoked potential amplitude reductions identifying a cluster of three or more abnormal zones. In two of five remaining patients with glaucoma the defect was detected on the intereye asymmetry analysis. Topographic location was well correlated with Humphrey fields. Mean amplitude was significantly reduced in 86 of the glaucoma cases (86%). The glaucoma severity index was abnormal in 93 glaucoma cases and showed a correlation with Humphrey MD (r = 0.67 right eyes, 0.69 left eyes). In 37 glaucoma cases with no scotoma by definition in the fellow eye, 22 (59.4%) had an abnormal multifocal objective perimetry, whereas only eight had some other aspect of their Humphrey visual field flagged as abnormal. CONCLUSIONS: Multifocal objective perimetry can assess the visual field and identify glaucomatous visual field defects. It may have the potential for identifying defects earlier than conventional perimetry.     

Contrast sensitivity changes due to glaucoma and normal aging: low-spatial-frequency losses in both magnocellular and parvocellular pathways

PURPOSE: To explore the effects of glaucoma and aging on low-spatial-frequency contrast sensitivity by using tests designed to assess performance of either the magnocellular (M) or parvocellular (P) visual pathways. METHODS: Contrast sensitivity was measured for spatial frequencies of 0.25 to 2 cyc/deg by using a published steady- and pulsed-pedestal approach. Sixteen patients with glaucoma and 16 approximately age-matched control subjects participated. Patients with glaucoma were tested foveally and at two midperipheral locations: (1) an area of early visual field loss, and (2) an area of normal visual field. Control subjects were assessed in matched locations. An additional group of 12 younger control subjects (aged 20-35 years) were also tested. RESULTS: Older control subjects demonstrated reduced sensitivity relative to the younger group for the steady (presumed M)- and pulsed (presumed P)-pedestal conditions. Sensitivity was reduced foveally and in the midperiphery across the spatial frequency range. In the area of early visual field loss, the glaucoma group demonstrated further sensitivity reduction relative to older control subjects across the spatial frequency range for both the steady- and pulsed-pedestal tasks. Sensitivity was also reduced in the midperipheral location of "normal" visual field for the pulsed condition. CONCLUSIONS: Normal aging results in a reduction of contrast sensitivity for the low-spatial-frequency-sensitive components of both the M and P pathways. Glaucoma results in a further reduction of sensitivity that is not selective for M or P function. The low-spatial-frequency-sensitive channels of both pathways, which are presumably mediated by cells with larger receptive fields, are approximately equivalently impaired in early glaucoma.     

Comparison of Swedish interactive threshold algorithm and full threshold algorithm for glaucomatous visual field loss

PURPOSE: To compare the prevalence of visual field loss, the sensitivity distribution, and the size and depth of glaucomatous visual field defects using the standard full threshold (FT) and the Swedish interactive threshold algorithm (SITA) standard (SS) procedures in patients with early or suspected glaucoma. METHODS: Automated perimetry findings were retrospectively evaluated in 53 patients (105 eyes) with early or suspected glaucoma. RESULTS: The number of eyes judged to have glaucomatous visual field loss by SS (48 eyes) was significantly larger than what was found with FT (35 eyes), and 70 eyes were classified as pre-perimetric glaucoma. In these 70 eyes, there were many locations where the sensitivity was significantly higher with SS than with FT (intrasubject difference), and SS had less intersubject variability than FT at most locations. The cumulative decibel scores at the region of glaucomatous defects were larger with SS (206.2+/-103.3 dB) than with FT (162.1+/-87.5 dB) (p=0.02), which indicated that the depth of defects measured by SS was shallower than that by FT. The sizes of defects were significantly larger with SS (11.2+/-5.6) than with FT (9.7+/-5.1) (p<0.05). CONCLUSIONS: Glaucomatous defects were measured as being significantly shallower and larger with SS than with FT. In addition, the prevalence of visual field defect was higher with SS according to some of the criteria for glaucomatous visual field defects. These results might be related to the fact that SS strategy has a lower variability and to the Bayesian statistical properties of the SITA algorithm.     

Comparison of retinal nerve fiber layer measurements between NTG and HTG using GDx-vCC

PURPOSE: To compare quantitative polarimetric measurements in eyes with NTG and HTG using GDx-VCC. Both groups were matched by age and glaucoma stage based on the Humphrey visual field test. METHODS: We retrospectively reviewed the records of 146 patients who underwent Humphrey field analysis (HFA) and GDx-VCC. We compared outcomes of retinal nerve fiber layer (RNFL) parameters among the three groups by ANOVA and between each pair of groups using the Tukey-Kramer Post-Hoc test. We also evaluated the sensitivity and specificity of GDx-VCC in detecting glaucoma in each group. RESULTS: The mean age and HFA mean deviation (MD) were 55.6 +/- 9.5 years and -0.8 +/- 1.5 dB in 47 control patients, 59.4 +/- 9.0 years and -5.77 +/- 4.38 dB in 49 NTG patients, and 59.4 +/- 11.7 years and -8.09 +/- 6.77 dB in 51 HTG patients, respectively. All thickness parameters were lower in HTG patients compared to NTG patients, but there were no significant differences in ratio parameters between age-matched early HTG and NTG patients. The sensitivity of GDx-VCC was significantly higher in both early and total HTG patients compared to the respective groups of NTG patients. CONCLUSIONS: Compared to eyes with NTG, eyes with HTG showed reduced RNFL thickness and ratio parameters when patients were age and visual field matched. GDx-VCC appeared to be more sensitive in detecting RNFL damage in HTG patients.     

Temporal contrast sensitivity loss in primary open-angle glaucoma and glaucoma suspects

The need for more sensitive tests for the early detection of compromised visual function in glaucoma is established by anatomic and psychophysical evidence of damage occurring to optic nerve fibers in eyes with normal visual fields. The results are reported of temporal frequency testing on 51 glaucoma suspects without visual field loss in either eye, 52 glaucoma patients with visual field deficits in the tested eye, and 11 normal subjects. Modulation transfer functions were obtained using a sinusoidally flickering 5 degrees spatially uniform white field viewed with central fixation and plotted at six frequencies from 5-30 Hz. The results showed a frequency-specific sensitivity loss centered at 15 Hz and a nonfrequency-specific mean sensitivity loss, that was greater, on average, in glaucoma patients than in suspects. Sensitivity losses of both kinds were seen in most glaucoma patients, but only in a minority of glaucoma suspects. About 12% of suspects were indistinguishable from the lowest performing one third of these glaucoma patients. A smaller number of suspects appeared to form a second mode in the frequency distribution for temporal sensitivity at 15 and 25 Hz. In patients with glaucoma, age was found to be a significant factor associated with the magnitude of mean sensitivity loss. Age was not a significant factor contributing to sensitivity loss in individual suspect data as measured by regression analysis, but it contributed to a small and consistent sensitivity loss across frequency for group-averaged data in those older than 55 years of age.