蓝黄视野与标准静态视野在原发性开角型青光眼诊断中的应用观察

目的探讨蓝黄视野和标准静态视野检测在原发性开角型青光眼诊断中的应用价值。方法分别采用OCTOPUS101全自动电脑视野分析仪中蓝黄视野和标准静态视野的G2测试程序对正常组25例(36只眼)、早期23例(35只眼)、中期13例(24只眼)和晚期14例(23只眼)青光眼患者进行蓝/黄及白/白光视野检测,将中心30°视野内视网膜光敏感度均值(MS)和缺损(MD)进行比较和分析,并对两种视野检测正常组和早期青光眼组的敏感性和特异性进行分析。结果每组青光眼蓝/黄光视野平均光敏感度明显低于白/白光视野,平均缺损高于白/白光视野,有显著性差异(P<0.001);各组与正常组相比有显著性差异(P<0.05)。早期开角型青光眼组35只眼蓝/黄光视野检测阳性者30只眼,敏感性为85.7%,白/白光视野检测阳性者17只眼,敏感性为48.6%。结论在各期原发性开角型青光眼视野检测中,蓝/黄光比白/白光敏感,蓝/黄光检测出的缺损面积大而且深。在早期青光眼诊断中蓝/黄光敏感性高于白/白光。     

一种诊断青光眼早、中期视野损害的方法──上下方Bjerrum区光敏感度不对称

应用Humphrey－630型自动视野分析仪的弧形阈值程序对108只已有早期或中期视野缺损的青光眼和120只正常眼进行了视野Bjerrum区15°环上42点光阈值的测定。根据早、中期青光眼视野缺损常以水平子午线不对称的原理，配对比较同一受检限上下方Bjerrum区的平均光敏感度。结果显示：该方法检出早、中期青光眼视野缺损的敏感性为93．51％（100／108），特异性为96．67％（116／120），具有临床实用价值。     

蓝/黄视野检查法对原发性开角型 青光眼的早期诊断价值

目的探讨蓝/黄视野检查法(blue-on-yellow perimetry,B/Y PM)对青光眼的早期诊断价值。 方法利用OCTOPUS 101全自动视野计G2程序分别对16例(32只眼)正常人,25例(35只眼)白/白视野检查(white-on-white perimetry,W/W PM)异常的原发性开角型青光眼(primary open-angle glaucoma,POAG),15例(15只眼)W/W视野检查正常的早期POAG及11例 (22只眼)可疑POAG进行B/Y视野检查。结果正常人、 可疑POAG、早期、中期及晚期POAG B/Y视野检查视网膜平均敏感度分别为(23．24±1．22 )dB、(20．97±3．42)dB、(18．44±3．570dB、(11．04±1．85)dB及(8 ．55±2．29)dB。B/Y 视野检查法对检测青光眼视野损害的敏感性高于常规W/W视野检查法,敏感性为92％,特异性为 90．62％。早期和中期POAG中,B/Y视野检测出视野缺损点数明显多于W/W视野检测出的缺损点数。结论B/Y视野检查 法是检测POAG早期视野损害的敏感方法之一。(中华眼底病杂志,2001,17:125-127)     

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.     

中心视野光阈值的短期波动

借助Humphrey视野分析仪研究了正常眼和早期青光眼光阈值的短期波动，不同年龄组的正常眼短期波动有统计学差异，性别和眼别对此没有影响，有视野缺损的早期青光眼，短期波动明显增加；无视野缺损的早期青光眼，短期波动无明显增加，讲座了正常眼和早期青光眼短期波动的原因，划分了正常和异常短期波动的范围。     

光学相干断层成像与视野检查在早期青光眼诊断中的应用

目的:探讨光学相干断层成像(optical coherence tomo-graphy,OCT)自动视野检查法(standard automatic perme-try,SAP)在早期青光眼诊断中的应用。方法:青光眼患者42例68眼,双眼50眼,单眼18眼,男29例48眼,女13例20眼,左32眼,右36眼,其中开角型青光眼18眼,闭角型青光眼50眼,年龄为36～82(平均60.8±9.2)岁。应用自动视野检查法和光学相干断层扫描仪检查视盘C/D及视网膜神经纤维层的厚度。结果:自动视野检查和光学相干断层扫描(OCT)两种检测方法的阳性率分别为84.37%,93.75%,特别是对于开角型青光眼患者的早期诊断OCT的阳性率更明显。结论:青光眼患者视网膜神经纤维层的丧失或(和)变薄早于视野缺损;视野和OCT的联合应用对青光眼视野缺损进行定性、定量客观评诂。     

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.     

蓝/黄视野计与标准白色视野计在早期青光眼诊断中的意义

目的　评价蓝 /黄视野计 (blue- on- yellow perimetry B/Y又叫短波视野计 short- wavelength perime-try)与标准白色视野计 (white- on- white perim etry W/W)检测早期青光眼的敏感性。方法　采用瑞士产 Octo-pus10 1型全自动视野计对早期原发性开角型青光眼 17例 (34只眼 ) ,对照组正常人 8例 (16只眼 ) ,进行 B/Y及W/W检测 ,视野检测采用 t G2 测试程序 ,将中心 30°视野内全视网膜光敏感度均值及各象限光敏感度均值 d B进行比较分析。结果　两种视野计检测正常人 B/Y较 W/W检测全视网膜光敏感度均值低 ,两者相差 3.96 d B,差异有显著意义 (t=5 .11,P <0 .0 0 1) ,对应各象限视网膜光敏感度均值比较 ,差异均有显著意义 (P <0 .0 0 1) ,早期开角型青光眼 B/Y较 W/W检测全视网膜光敏感度均值差为 5 .34d B,差异有显著意义 (t=5 .87,P <0 .0 0 1)。早期开角型青光眼组 34只眼 B/Y检测视野阳性者 2 4只眼 ,阳性率为 70 .5 9% ,W/W检测视野阳性者 14只眼 ,阳性率为 4 1.18% ,两种视野计检测结果的异常率有显著差异 (χ2 =5 .33,P <0 .0 5 )。结论　 B/Y与 W/W检测结果有良好的一致性 ,检测早期开角型青光眼的视野改变 B/Y较 W/W敏感 ,表现为早期青光眼检测阳性率高 ,检测出的视野缺损范围大而且深     

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）     

蓝/黄视野检查法对原发性开角型青光眼正常半侧视野的检测

目的　探讨蓝/黄视野检查法( blue-on-yellowperimetry,BYP)检测早期青光眼视野异常的能力。方法　对普通白/白视野检查法(white on-white-perimetry,WWP)检查结果仅为半侧视野异常的23例23眼原发性开角型青光眼患者进行BYP检查。结果　BYP检查的平均光敏感度、平均缺损及偏离缺失值与WWP检查的平均光敏感度、平均缺损及偏离缺失分别呈明显正相关(r 分别为0.597 0,0.787 9和0.850 7,P<0.000)。WWP检查异常的半侧视野中,BYP检查的视野缺损点数明显多于WWP检查的缺损点数(t=2.1535,P=0.018 4);WWP检查正常的半侧视野中,有52.17%(12/23)的患者出现BYP检查结果异常。结论　BYP检查法能发现WWP检查法尚不能检出的视野缺损。     

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.     

Subjective detection of visual field defects using home TV set.

The usefulness of the noise-field spontaneously generated on a home television screen for subjective perception of visual field defects was studied in 196 eyes of ocular hypertensive or normal subjects, 166 eyes with primary open angle glaucoma and 124 eyes with low-tension glaucoma. All subjects had never perceived their field defects. In 290 glaucoma eyes, including 71 eyes of early glaucoma, 265 eyes (91.4%) could perceive abnormality of the noise-field which corresponded to visual field defects confirmed by static perimetry. In 6 normal eyes abnormality of the noise-field was perceived at the blind spot. The sensitivity and specificity of the test was 91% and 97%, respectively. The time required for testing one eye was 3-5 seconds. The results indicate that the Noise-Field Test using a home television set can be an excellent method for subjective perception of visual field defects, and can also be used for glaucoma screening.     

图形视网膜电图和图形视觉诱发电位同时记录青光眼及高眼压症的研究

对３０例５０只青光眼、１４例２８只高眼压症进行ＰＥＲＧ和ＰＶＥＰ同时记录。首次发现青光眼和高眼压症的ＲＣＴ延长，同时青光眼组ＡＰ５０、ＡＰ１００下降、ＬＰ１００延长，异常率分别为４６％、５２％￣５４％，高眼压症组ＡＰ５０和ＬＰ１００的异常率均为２８．５７％。青光眼组ＬＰ１００、ＲＣＴ与视野缺损、Ｃ／Ｄ在小呈正相关，ＡＰ１００与视野缺损、Ｃ／Ｄ大小呈负相关，ＡＰ５０与视野缺损呈负相关。本研究从电生理     

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／     

Friedmann 视野分析仪检查青光眼损害的评价

In order to evaluate the specificity and sensitivity of Friedmann visual field analyser (FVFA) in the detection of early glaucoma, 90 normal eyes were tested to establish the 100% specificity criteria for abnormality. The results by the Friedmann analyser were then compared with those by the tangent perimeter combined with fundal stereophotography of suspect glaucoma disc signs and RNFLD. 40 glaucoma eyes with field defects by the tangent perimeter were all positive by FVFA. Of 80 eyes suspected of glaucoma with elevated IOP and normal tangent perimetry, 20 eyes (25%) showed paracentral relative scotoma by FVFA. 17 (85%) of these 20 eyes demonstrated photographic evidences of glaucoma fundal damage. Thus, early field defects detected by FVFA in glaucoma suspects are likely indicative of glaucoma damage.     

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.     

Evaluation of VEP perimetry in normal subjects and glaucoma patients

PURPOSE: To estimate sensitivity to glaucomatous visual field loss using multifocal visual evoked potential (VEP) perimetry, to compare these findings to those of conventional achromatic perimetry and to determine specificity of VEP perimetry in normal subjects. METHODS: A total of 33 glaucoma patients with known visual field defects in at least one eye on standard computerized perimetry and 33 healthy subjects were tested with VEP perimetry. The glaucoma patients were also tested with standard computerized perimetry using the 30-2 SITA Fast program of the Humphrey Field Analyzer (HFA). Visual evoked potential perimetry classification and VEP probability maps were used to determine the sensitivity and specificity of the technique. RESULTS: Visual evoked potential perimetry classified 68% of all eyes in the glaucoma group (45/66) as pathological; sensitivity increased to 81% (38/47) when considering only those eyes with HFA field defects. It also identified more test locations with significant loss at the p < 5% level in both groups (48% and 37%, respectively) than did HFA, while HFA identified more loss at the higher significance levels p < 2%, and p < 1%. Visual evoked potential perimetry showed more significant loss in eyes with almost normal or slightly damaged standard fields, while HFA identified more significant field loss in eyes with severe conventional field damage. The mean VEP amplitude of the 66 glaucoma eyes was 1.46e(-7) V; it was 1.676e(-7) V for the 66 control eyes. This difference was significant (p = 0.0033), but the overlap between groups was large. Visual evoked potential perimetry classified 42% of the control eyes as 'outside normal limits', and VEP probability maps showed 30.0% of test segments as significantly depressed at the p < 5% level, 10.8% of sites at p < 2%, and 4.6% at the p < 1% level. CONCLUSION: Mean VEP amplitude differed significantly between normal and glaucoma eyes, but the overlap was considerable. Visual evoked potential perimetry falsely classified a large number of normal eyes as pathological and showed many more significantly depressed test locations than expected. Agreement between VEP and standard perimetry was relatively poor for the glaucoma group. Further refinements are needed before VEP perimetry can be regarded as a reliable clinical method of mapping glaucomatous visual fields.     

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.     

黄斑程序蓝/黄视野检查在青光眼早期诊断中的作用

目的:探讨黄斑程序视野检查,特别是蓝/黄视野检查(blue-on-yellow perimetry,B/YP)在青光眼早期诊断中的作用。方法:11例15眼早期青光眼,14例17眼中晚期青光眼,14例28眼可疑青光眼,应用Octopus 101全自动视野计G2程序的Dynamic分程序进行W/WP检查(Dynamic/Normal程序,dG2W/WP)及M2程序的Dynamic分程序分别进行白/白视野检查(white-on-white perimetry,W/WP)(Dynamic/Normal程序,dM2W/WP)和B/YP检查(Dynamic/BY程序,dM2B/YP)。并对3种视野检查方法的结果进行比较分析。结果:dG2W/WP,dM2W/WP,dM2B/YP检查早期POAG的敏感性分别为47%,53%,93%;dG2W/WP,dM2W/WP,dM2B/YP检测出青光眼视野损害的敏感性分别为:75%,75%,97%。dM2B/YP对青光眼早期诊断最敏感。结论:黄斑程序的B/YP检查是检测青光眼早期视野缺损的敏感方法之一。     

Pattern electroretinogram recorded by skin electrodes in early ocular hypertension and glaucoma

Diagnostic value of transient pattern electroretinogram (PERG), recorded by skin electrodes, was compared with Goldmann perimetry in cases of ocular hypertension and glaucoma. According to the assumption that the PERG mostly reflects activity of the retinal glanglion cells, and histological evidence that 30–50% atrophy of the retinal ganglion cells is necessary to cause defects in visual field, we wanted to assess if i) this method could be more sensitive in detecting early glaucomatous damage than routine Goldmann perimetry in eyes with normal or only borderline elevated intraocular pressure in the time of PERG recording (first group of patients), and ii) how the PERG amplitude corresponds to ganglion cell loss, expected in the eyes with already detectable initial glaucomatous visual field defects, according to Goldmann II/2 isopter, with normal or borderline elevated intraocular pressure in the time of PERG recording (second group).In the group with no visual field defects subnormal amplitude of the major positive component of the PERG, N1-P1, was detected in three of 30 eyes (10%), while in the group with initial visual field defects N1-P1 amplitude was subnormal in 6 of 11 eyes (54%).The amplitude of the major negative PERG component, P1-N2, was found normal in all eyes of the first group and subnormal in 5 eyes (45%) of the second group.Abbreviations PERG pattern electroretinogram - VFD visual field defect - IOP intraocular pressure