Predicting Development of Glaucomatous Visual Field Conversion Using Baseline Fourier-Domain Optical Coherence Tomography.
Predicting Development of Glaucomatous Visual Field Conversion Using Baseline Fourier-Domain Optical Coherence Tomography.
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DOI：
10.1016/j.ajo.2015.11.029
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发表时间：
2016-03
影响因子：
4.2
通讯作者：
Advanced Imaging for Glaucoma Study Group
中科院分区：
文献类型：
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作者：
Zhang X;Loewen N;Tan O;Greenfield DS;Schuman JS;Varma R;Huang D;Advanced Imaging for Glaucoma Study Group
使用基线访视时的傅立叶域光学相干断层扫描（FD-OCT）测量值预测昏迷性视野（VF）缺损的发展。多中心纵向观察性研究。青光眼高级成像研究中疑似青光眼患者和视野检查前青光眼患者。每6个月用FD-OCT VF对视盘、视乳头周围视网膜神经纤维层（NFL）和黄斑神经节细胞复合体（GCC）进行成像。转换为周边型青光眼的定义为VF模式标准差（PSD）或青光眼半视野测试（GHT）在3次连续测试中超出正常范围。采用考克斯比例风险模型计算风险比。通过受试者工作特征曲线下面积（AUC）测量预测准确性。在513只眼睛（309名参与者）中，55只眼睛（46名参与者）在41 ± 23个月的随访期间发生了VF转换。显著（p<0.05，考克斯回归）FD-OCT风险因素包括所有GCC、NFL和椎间盘变量，水平杯盘比除外。GCC病灶丢失体积（FLV）是转换的最佳单一预测因子（AUC=0.753，p<0.001，针对AUC = 0.5进行检验）。GCC-FLV临界或异常的患者6年后转换风险增加4倍（Kaplan-Meier）。使用基于多变量考克斯回归模型的青光眼复合转换指数（GCCI）获得转换的最佳预测，该模型包括GCC-FLV、下NFL象限厚度、年龄和VF PSD。GCCI显著提高了预测准确性（AUC=0.783）超过任何单一变量（p=0.04）。NFL和GCC厚度的减少可以预测青光眼嫌疑人和视野检查前青光眼患者中青光眼性VF丧失的发展。
To predict the development of glaucomatous visual field (VF) defects using Fourier-domain optical coherence tomography (FD-OCT) measurements at baseline visit. Multi-center longitudinal observational study. Glaucoma suspects and pre-perimetric glaucoma participants in the Advanced Imaging for Glaucoma Study. The optic disc, the peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) were imaged with FD-OCT VF was assessed every 6 months. Conversion to perimetric glaucoma was defined by VF pattern standard deviation (PSD) or glaucoma hemifield test (GHT) outside normal limits on 3 consecutive tests. Hazard ratios were calculated with the Cox proportional hazard model. Predictive accuracy was measured by the area under the receiver-operating-characteristic curve (AUC). Of 513 eyes (309 participants), 55 eyes (46 participants) experienced VF conversion during 41 ± 23 months of follow-up. Significant (p<0.05, Cox regression) FD-OCT risk factors included all GCC, NFL, and disc variables, except for horizontal cup-to-disc ratio. GCC focal loss volume (FLV) was the best single predictor of conversion (AUC=0.753, p<0.001 for test against AUC = 0.5). Those with borderline or abnormal GCC-FLV had a 4-fold increase in conversion risk after 6 years (Kaplan-Meier). Optimal prediction of conversion was obtained using the glaucoma composite conversion index (GCCI) based on a multivariate Cox regression model that included GCC-FLV, inferior NFL quadrant thickness, age, and VF PSD. GCCI significantly improved predictive accuracy (AUC=0.783) over any single variable (p=0.04). Reductions in NFL and GCC thickness can predict the development of glaucomatous VF loss in glaucoma suspects and pre-perimetric glaucoma patients.