四点阈值视野检查对快速筛查青光眼性视野缺损的诊断价值

目的探讨国产YDS301视野计（简称YDS）四点阈值程序对快速筛查青光眼性视野缺损的诊断价值。方法采用瑞士Octopus101型视野计（简称Octopus）和YDS对67例（75眼）青光眼患者分别进行视野检查。YDS选用四点阈值程序,Octopus选用G1TOP程序,分别在定性、定量和每眼检测时间方面进行对比分析。结果定性诊断：以Octopus为准,YDS敏感性和特异性分别为92.5%和86.4%。定量诊断：YDS与Octopus的平均敏感度和平均缺损的相关系数r分别为0.869和0.865。每眼检测时间分别为48.65s和141.64s（t=26.534,P〈0.01）,YDS比Octopus减少了约2/3时间。结论YDS四点阈值程序在快速筛查青光眼性视野缺损中与Octopus有很高的一致性,而且检测时间是目前国内外现有视野计中最短的。因此,YDS四点阈值程序适用于青光眼的视野筛查。     

结合视野检测确诊青光眼模式的临床研究

目的探讨提高筛选并能早期诊断青光眼效率的有效方法。方法按照临床筛选可疑青光眼患者标准,门诊筛选出可疑青光眼者。采用横断面研究设计,应用Octopus-101型计算机自动视野计的G2程序,对来我院就诊的可疑青光眼患者进行中心30°阈值视野检测。统计分析视野异常情况,并随访统计确诊青光眼病例。结果取得完整可靠视野结果可疑青光眼者共75例(150只眼),视野存在异常者45眼,视野发生可疑改变52只眼,53只眼正常。青光眼确诊病例占可疑青光眼的34.67%。结论通过可疑青光眼患者视野异常情况的临床观察,筛选可疑青光眼后进一步临床检查、视野监测而进行青光眼确诊的筛查模式具有一定的可靠性,该模式能大大提高筛选及早期诊断青光眼的效率。     

倍频视野检测在40岁以上人群中筛查青光眼的价值

目的探讨倍频视野检测(FDP)程序在40岁以上自然人群中筛查青光眼的敏感性和特异性.方法 2001年5至10月对北京市大兴区榆垡乡3个自然村及市区北部4个社区40岁以上居民4439人进行青光眼筛查.所有受试者均用倍频视野计的C-20-1筛查程序检测视野.对可疑青光眼者在非筛查日进行Octopus阈值视野、前房角镜及视乳头立体照相检查.根据Octopus视野检测的平均缺损(MD)值,将筛查出的青光眼分为轻、中、重三级.FDP的分析指标包括FDP检测时间、异常位点数、FDP计分、4个象限FDP计分等.正常人随机选一只眼的数据用于分析;双眼青光眼患者选择视神经或Octopus视野损害较轻的眼用于分析.结果 4330例(97.5%)用于FDP分析.以FDP结果≥1个点异常为临界点,将人群分为正常人与青光眼两组,则FDP检查青光眼的敏感性为50.7%(72/142),特异性为96.6%(2260/2340),受试者工作特征曲线下面积(AUC)为0.7,阳性预测值47.7%,阴性预测值96.9%,阳性似然比14.8,阴性似然比0.5.若除外无青光眼性视神经与Octopus视野损害的青光眼,则FDP检测青光眼的敏感性为76.4%,AUC为0.9, 阳性预测值为40.7%,阴性预测值99.2%,阳性似然比22.3,阴性似然比0.2.检测轻、中、重度青光眼的敏感性分别为54.2%、76.0%、100.0%.FDP视野的4个象限计分与Octopus视野4个相应象限的MS呈显著负相关(Rs分别为-0.732、-0.628、-0.639、-0.679,均P＜0.01).结论 C-20-1 FDP筛查程序适用于在大规模人群中筛查青光眼,具有较高的特异性;对中、重度青光眼性视野缺损患者具有良好的敏感性.     

多点静态定量视野计检查开角型青光眼

目的 比较采用多点静态定量视野分析仪（Ｆｒｉｅｄｍａｎｎ ｖｉｓｕａｌ ｆｉｅｌｄ ａｎａｌｙｓｅｒ,ＦＶＦＡ）与中心平面视野屏检查视野在青光眼诊断中的作用。方法 应用两种视野计对４８例（９５只眼）开角型青光眼患者进行视野检查。结果 ２６只眼在视野屏上用２／１０００视标查出小的视野缺损,而用ＦＶＦＡ检查出完全相似者２３只眼（８８％）;２６只眼在ＦＶＦＡ查出早期青光眼视野缺损,而在视野屏上必须用１／     

可疑青光眼患者视野检测异常的临床观察

目的 观察可疑青光眼患者中心30°阈值视野检测的异常情况.方法 按照临床筛选可疑青光眼患者标准,门诊筛选出可疑青光眼者.采用横断面研究设计,应用Octopus-101型计算机自动视野计的G2程序,对就诊的可疑青光眼患者进行中心30°阈值视野检测.统计分析视野异常情况,并进行可疑青光眼筛选指标的相关分析.结果 取得完整可靠视野结果可疑青光眼者共75例150眼,视野存在异常者45眼,视野发生可疑改变52眼,53眼正常.不同可疑指标的可疑青光眼者视野异常情况存在不同x2=27.71,P＜0.05(x20.05为9.49).青光眼确诊病例占可疑青光跟的34.67％.结论 通过可疑青光眼患者视野异常情况的临床观察,进一步寻求提高筛选并能早期诊断青光眼效率的有效方法,以进行青光眼的有效筛查.该研究提示在临床筛查中要特别重视存在异常眼压和眼底杯/盘比者,并可进一步筛查其视野情况,对该群体做好相关随访工作.     

趋势导向视野检查与常规阈值视野检查的比较研究

目的比较趋势导向视野检查程序(Tendency Oriented Peri metrey,TOP)与常规视野检查程序对青光眼病人视野检查结果的差异,对IOP程序检查结果进行评价。方法用Ocutopus101电脑视野计对36例青光眼患者共46眼分别用常规阈值程序(Normal/Normal)和趋势导向(TOP)视野检查程序进行检查。将两种方法的视野检查结果进行分析比较。结果①36例青光眼患者共46眼,常规阈值程序检查均有视野损害,其中早期青光眼15眼,中晚期31眼。早期患者用TOP程序检查的阳性率为73%(11/15),中晚期患者TOP程序均能够发现视野损害,视野损害的部位两种程序有较高的一致性。②视野指数的比较,青光眼患者TOP程序和Normal程序检查MS分别为15.78±4.81,13.33±4.24,P=0.008;MD分别为13.36±4.89,14.31±4.18,P=0.02;LV分别为65.40±37.55,50.77±34.24,P<0.001;两种程序检查RF值均小于15%。③两种检查方法所费时间,TOP程序为4.10±0.59分Normal程序为11.01±3.15分。结论①TOP视野检查程序可大大地缩短检查时间,可用于大规模人群的筛查,但是TOP视野检查程序对早期青光眼检测敏感性偏低,仅为73%。②对中晚期病例,TOP程序与Normal程序相比较,MS高于正常阈值程序检查的结果,MD和LV低于正常阈值程序检查结果,也就是TOP视野检查程序的发现的视野缺损较小,暗点更浅。     

蓝黄和自动视野检查法在原发性开角型青光眼诊断中的对比研究

目的 对比蓝黄视野检查法(Blueon Yellow Perimetry,BYP)和自动视野检查法(Standard Automatic Perimerty,SAP)在原发性开角型青光眼(Primary Open Angle Glaucoma,POAG)诊断中的应用.方法 选择POAG患者72例120只眼,男性46例76只眼,女性26例44只眼,左50只眼,右70只眼,年龄16～79岁,平均(43.87±17.53)岁,应用HUMPHERY750Ⅱ-i电脑自动视野计的标准检测程序和蓝黄视野榆测程序分别进行SAP和BYP的检测.结果 POAG早期SAP和BYP检测中,BYP更能在视野缺损深度和缺损范围上反映青光眼的视功能损害程度.POAG进展期BYP检测出部分SAP所不能检测出的缺损部位,检测到的缺损深度和SAP相同.POAG晚期的SAP和BYP检测到相同的缺损范围和缺损深度.视野指数中异常阈值点数最能反映POAG早期视野损害.结论 BYP比SAP更加适用于POAG的早期视野损害的筛查,在视功能出现广泛的受损时,BYP反映视野缺损的能力与SAP相当.     

趋势导向视野检查法与常规阈值视野检查法的对比研究

目的 评价趋势导向视野检查法(tendency-oriented perimetry, TOP)在青光眼视功能检测中的应用价值。 方法 利用Octopus 101全自动视野计分别对20名正常人的20只正常眼、32例原发性开角型青光眼(primary open angle glaucoma, POAG)患者的32只患眼和14例可疑POAG患者的14只眼分别进行常规阈值视野检查(Normal/Normal程序)和TOP视野检查(TOP/Normal程序)。所有受检眼在2周内再次分别进行常规阈值视野检查和TOP视野检查。将两种视野检查的结果、视野检查指数、点对点阈值变异及视野缺损点数进行比较和分析。 结果 TOP视野检查正常人的阴性检出率为90%，POAG的阳性检出率为75%，其中检测中晚期POAG的阳性检出率达100％。2种视野检查的视野指数呈明显正相关，平均敏感度(mean sensitivity, MS)的相关系数为0.9335，平均缺损(mean defect, MD)的相关系数为0.9189，偏离缺失(loss variance, LV)的相关系数为0.9621。点对点阈值变异和视野缺损点数TOP视野检查结果略高于常规阈值视野检查结果，但二者间差异均无显著性的意义(P＝0.2019，P＝0.4448)。 结论 TOP视野检查指数与常规阈值视野检查指数呈明显正相关，其检测中晚期POAG的敏感性及可重复性高。 (中华眼底病杂志, 2002, 18: 169-272)     

中心视野检查联合周边视野检查在青光眼诊断中的价值

目的探讨中心视野检查联合周边视野检查是否能减少青光眼诊断的漏诊率。方法病例组（青光眼患者）84例（165只眼）与对照组（按性别、年龄、文化程度与病例组相配比的正常人群）110例（220只眼）分别使用Octopus101自动电脑视野计进行中心视野检查和周边视野检查,将中心视野检查及中心与周边视野检查的联合结果请三位医生在盲法的情况下独立进行分析评价,最后将评价结果进行统计学的分析,计算出漏诊率。结果病例组中中心视野检查结果异常的有129只眼,而中心视野检查联合周边视野检查结果异常的有153只眼;对照组中中心视野检查结果异常的有17只眼,而中心视野检查联合周边视野检查结果异常的有36只眼。将其中的中心视野检查结果与联合视野检查结果相比较,使用SPSS11.5统计软件进行分析可知：中心视野检查联合周边视野检查漏诊率为7.3%,单独的中心视野检查的漏诊率为21.8%,P=0.000〈0.05,具有统计学意义。结论使用Oc-topus101自动电脑视野计中心视野检查联合周边视野检查能减少青光眼诊断的漏诊率。     

蓝色视野检测早期青光眼的临床研究

目的 探讨蓝色(蓝/白)视野检测早期青光眼的敏感性.方法 采用美国HumphreyⅡ-740型全自动视野计,对32例(32只眼)早期青光眼患者(其中早期原发性开角型青光眼患者16例(16只眼),早期原发性慢性闭角型青光眼患者16例(16只眼)及38例(38只眼)正常对照组进行蓝色(蓝/白)及白色(白/白)视野检测,两组的年龄及性别相匹配.视野检查采用全阈值C-30-2程序,将中心30°内全视网膜光敏感度均值及各象限光敏感度均值(dB值)进行组间比较和分析.结果 两种视野检测方法检测正常人,蓝色视野比白色视野全视网膜光敏感度均值低,差异有显著意义(t=43.46,P<0.001);白色视野检测各点的视网膜光敏感度均值>蓝色视野检测的各对应点,差异有非常显著意义(t=74.642,P<0.001).两种视野检测方法检测早期青光眼,白色视野检测全视网膜光敏感度均值(23.71±4.05)dB;蓝色视野检测全视网膜光敏感度均值(14.16±4.55)dB,较白色视野检测值低,差异有显著意义(t=15.81,P<0.001).两种检测结果有明显相关性(r=0.678,P<0.001).32只眼中,蓝色视野检测异常者29只眼,阳性率84%(27/32);白色视野检测异常者25只眼,阳性率63%(20/32);两种视野计检测的阳性率比较,差异有显著意义(x2=3.864,P=0.049).结论 蓝色与白色视野检测结果有良好的符合性.检测早期青光眼性视野改变,蓝色较白色敏感,表现为早期青光眼的检出率高.     

Role of frequency doubling perimetry in detecting neuro-ophthalmic visual field defects

PURPOSE: To report the ability of frequency doubling perimetry to detect "neuro-ophthalmic" field defects, characterize them as hemianopic or quadrantanopic, and differentiate glaucomatous from "other" neuro-ophthalmic field defects. METHODS: Sixty eyes of 30 normal subjects, 50 eyes of 29 patients with glaucomatous defects, and 138 eyes of 103 patients with "typical" neuro-ophthalmic field defects underwent automated perimetry using the Swedish Interactive Threshold Algorithm and frequency doubling perimetry. The sensitivity and specificity for identification of a field defect (frequency doubling perimetry 20-5 and 20-1 screening tests), or to characterize hemianopia/quadrantanopia (full threshold test) were determined. Ability to discriminate glaucomatous defects was determined by comparing frequency doubling perimetry full threshold test in glaucoma to pooled results of normal and neuro-ophthalmic groups. RESULTS: On frequency doubling perimetry, a single point depressed to less than 1% probability had a sensitivity of 97.1% (20-5 test) and 95.7% (20-1 test) for detecting a neuro-ophthalmic visual field defect. The corresponding specificities were 95% using pooled results in normal subjects and patients with glaucoma and "other" neuro-ophthalmic field defects.In 20-5 screening a single abnormal point depressed to less than 2% probability level had a sensitivity of 98.6% (specificity 85%). Two abnormal points in the 20-1 screening depressed to less than 1% probability level had a specificity of 100% (sensitivity 84.8%).In frequency doubling perimetry full threshold, sensitivity and specificity for detection of hemianopia were 86.8% and 83.2%; for quadrantanopia they were 79.2% and 38.6%. The sensitivity and specificity for categorizing a defect as glaucomatous were 86% and 74.7%. CONCLUSIONS: Frequency doubling perimetry is a sensitive and specific test for detecting "neuro-ophthalmic" field defects. The presence of two abnormal points (20-1 screening program) "rules in" the presence of a field defect. A normal 20-5 program (absence of a single abnormal point) almost "rules out" a defect. Frequency doubling perimetry could not accurately categorize hemianopic, quadrantanopic, or glaucomatous defects.     

Study of the contralateral eye in patients with glaucoma and a unilateral perimetric defect

PURPOSE: To study the unaffected fellow eye in patients with glaucoma and unilateral visual field defect, using conventional automated achromatic perimetry, blue-yellow short-wavelength automated perimetry (SWAP), and a nerve fiber layer analyzer (GDx; Laser Diagnostic Technologies, San Diego, CA). METHODS: Eighteen patients in whom a unilateral visual field defect was detected on conventional computerized threshold perimetry were selected. The contralateral eyes of these patients were studied with normal conventional threshold perimetry using blue-yellow perimetry and also were studied with the nerve fiber layer analyzer. Also, 18 eyes of 18 sex- and age- (+/-3 years) matched persons without glaucoma were selected as a control group. RESULTS: Of the 18 contralateral eyes, seven (38.8%) showed a visual field defect on blue-yellow conventional perimetry, and 10 (55.5%) showed a defect of the nerve fiber layer when evaluated with the nerve fiber analyzer. Of the 10 eyes with abnormal visual fields on the nerve fiber analyzer, six (60.0%) also showed a defect on blue-yellow perimetry. In the control group, no eyes showed visual field defect on SWAP, but three eyes (16.6% false positive rate) showed a visual field defect on the nerve fiber layer analyzer. CONCLUSION: These findings suggest that what appeared to be unilateral visual field defects may in fact have been bilateral in at least 33.3% of our patients (n = 6) for whom there was agreement between results of SWAP and the nerve fiber layer analyzer.     

The usefulness of frequency doubling technology perimetry in glaucoma screening in health-check program

PURPOSE: Visual field testing has not been used as a screening procedure because it requires too much testing time and manpower. We evaluated the usefulness of Frequency Doubling Technology(FDT) visual field testing as a screening procedure for glaucoma in a health-check screening program. METHODS: A total of 800 eyes of 400 persons were examined for visual acuity, noncontact tonometry, slit-lamp biomicroscopy, funduscopy, and FDT testing of visual fields (N-30-5). The initial screening result was considered positive for glaucoma if any abnormality of FDT perimetry was detected, the intraocular pressure exceeded 21 mmHg, or funduscopy showed glaucomatous disc cupping or retinal nerve fiber layer defect. The re-examination comprised several ophthalmic examinations such as automatic perimetry 9 Humphrey field analyzer). RESULTS: Glaucoma was suspected in 118 eyes; 16 eyes were thus diagnosed after re-examination. FDT detected visual field abnormalities in 15 eyes. There were 40 eyes that were not diagnosed although FDT detected visual field abnormalities. CONCLUSIONS: FDT detected visual field abnormalities in glaucoma patients with high sensitivity and specificity. FDT is a useful screening test for glaucoma.     

Reversibility of glaucomatous defects of the central visual field

We analyzed more than 4 consecutive measurements of the central area of the visual field in 1,004 eyes of 533 subjects with various types of glaucoma as diagnosed by the Octopus 201 and its examination program No. 31. We used a non-repeated analysis of variance to determine the statistical relationship between the mean sensitivity measurements for individual quadrants of the central visual field. We made the series of measurements used in this statistical analysis during repeated examinations that took place over a follow-up period of 1 year. Out of 1,004 eyes, 53 eyes (5.3%) were shown to have an improved mean sensitivity of the central 30 degrees of the visual field. We adopted the degree of sensitivity improvement [(final mean sensitivity - initial mean sensitivity)/follow-up period] as the indicator of the degree of reversibility in the central visual field to determine which factors might influence changes in the visual field. In patients under 50 years of age, who were at an early stage of the disease, as opposed to those over 50 years of age, who were at an intermediate or advanced stage of this disease or who had undergone reduction of intraocular pressure, a relatively high degree of sensitivity improvement was more frequently observed. In the cases with primary open angle glaucoma which includes low tension glaucoma, we think treatment for abnormality in the aqueous humor dynamics is very important. We concluded, that the reversibility of the central visual field defect in glaucomatous eyes is possible, though it can only be clearly detected by careful follow-up examinations employing computerized perimetry.     

倍频视野计检测青光眼性视野缺损能力的研究

目的评估倍频视野计检测青光眼性视野缺损的能力以及与OCTOPUS101全自动视野计检查结果之间的相关性。方法应用倍频视野计的C-20—5筛选程序以及OC—TOPUS101全自动视野计的G2-TOP程序对23例正常对照者、20例早期青光眼患者、35例中晚期青光眼患者、11例高眼压患者及13例疑似青光眼患者进行视野检测。正常对照组、高眼压组及疑似青光眼组随机选择一眼进行测试，青光眼组选择具有较严重视野缺损的一眼进行测试。结果倍频视野计的C-20—5筛选程序在检测青光眼时ROC曲线下面积为0．925（敏感性85％，特异性91％），与OCTOPUS视野指数-平均缺损、偏离缺失之间的Pearson系数分别为0．702与0．429（P〈0．001），倍频视野计与OCTOPUS101视野计检查平均所需时间分别为1．00min与2．33min．2者之间有明显差异（P〈0．001）。结论倍频视野计检测青光眼性视野缺损具有良好的敏感性与特异性，与OCTOPUS101视野计的视野指数之间亦存在理想的相关性，而且前者比后者检测速度更快，使大规模人群筛查成为可能。     

Combined use of frequency doubling perimetry and polarimetric measurements of retinal nerve fiber layer in glaucoma detection

PURPOSE: The aim of this study was to evaluate the diagnostic usefulness of the combined use of frequency-doubling technology (FDT) perimetry and polarimetry of the retinal nerve fiber layer. DESIGN: Cross-sectional study. METHODS: Seventy ocular hypertensive patients (normal optic disk and standard perimetry, elevated intraocular pressure [>21 mm Hg]), 59 patients with "preperimetric" open-angle glaucoma (glaucomatous optic disk atrophy, elevated intraocular pressure [>21 mm Hg], no visual field defect in standard perimetry), 105 patients with "perimetric" open-angle glaucoma (glaucomatous optic disk atrophy and clearly marked visual field defect), and 73 control subjects had FDT screening (protocol: C-20-5) and polarimetric measurements (GDx). Criteria for exclusion: optic disks larger than 4 mm(2), media opacities, patients younger than 33 years or older than 66 years. None of the subjects had earlier FDT perimetry. One eye of each patient and control subject entered the statistical evaluation. Database and statistical software were used for case-wise recalculation of all missed localized probability levels to create a FDT screening score. RESULTS: At a predefined specificity of 94.5% in control eyes, discrimination between "perimetric" glaucoma and normal subjects is superior using the FDT perimetry (sensitivity = 84.8%) in comparison to polarimetry (sensitivity = 63.8%), whereas sensitivity is similar with both methods in "preperimetric" patients (GDx, FDT: 25.4%). In several cases, patients classified as glaucomatous by the GDx are not the same patients as identified by the FDT perimetry. Therefore, a two-dimensional discrimination analysis can increase correct positive classification. Using a linear combination of the present FDT screening score and polarimetry ("the number"), 92.4% of "perimetric" glaucoma eyes and 44.1% of "preperimetric" glaucoma eyes have been classified as glaucomatous. CONCLUSION: Joint usage of polarimetry and FDT perimetry indicate that a combination of different techniques which can uncover different glaucoma properties, might be helpful in early glaucoma detection.     

The distribution of visual field defects per quadrant in standard automated perimetry as compared to frequency doubling technology perimetry

To test the ability of frequency doubling technology (FDT) perimetry to reveal defects in the same field quadrants as detected by standard automated perimetry (SAP). Ninety-two eyes with open-angle glaucoma and documented visual field defects by threshold SAP (Octopus Dynamic strategy) also underwent threshold FDT testing after successfully passing the FDT screening test. All eyes revealed varying stages of SAP defects while only 80 revealed FDT damage: 31:21 eyes in the early field loss stage, 36:35 in the moderate field loss stage, and 25:24 in the severe field loss stage in SAP versus FDT, respectively. SAP was able to detect abnormalities in 74 and 79% of the superotemporal, and inferotemporal quadrants, respectively, while the corresponding FDT figures were 70 and 69% for the same quadrants (P < 0.05 each). With regards to the nasal hemifield, SAP detected defects in 73 and 81% of the superonasal and inferonasal quadrants, respectively, compared to 69 and 66% for FDT (P < 0.001 each). The test duration per individual eye was significantly shorter with FDT than with SAP (P < 0.05). As well as the already established lower sensitivity of FDT compared to SAP, this study also demonstrated the significantly poorer ability of FDT in detecting the same field quadrant defects, especially in the early stages of glaucomatous damage.     

Visual field assessment in glaucoma: comparative evaluation of manual kinetic Goldmann perimetry and automated static perimetry

PURPOSE: To compare the detection and assessment of progression of visual field defects in primary open-angle glaucoma with manual suprathreshold perimetry on Goldmann perimeter and automated static threshold perimetry on Humphery visual field (HVF) analyzer. METHODS: 105 eyes of 54 patients of primary open-angle glaucoma were followed up with 3-monthly perimetry on Goldmann perimeter and HVF analyzer, for a period of 9 months. RESULTS: HVF analyzer picked up visual field defects in 48 (46%) eyes whereas Goldmann perimeter picked up visual field defects in 26 (25%) eyes. HVF analyzer demonstrated progression in 14 eyes whereas Goldmann perimeter detected progression in 7 eyes during follow up of 9 months. CONCLUSIONS: HVF analyzer is superior to Goldmann perimeter to document and to demonstrate progression of visual field defects in primary open-angle glaucoma.