Optic nerve head and retinal nerve fiber layer analysis - A report by the American Academy of Ophthalmology
Optic nerve head and retinal nerve fiber layer analysis - A report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2007.07.005
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发表时间：
2007-10-01
期刊：
影响因子：
13.7
通讯作者：
Minckler, Don S.
中科院分区：
文献类型：
--
作者：
Lin, Shan C.;Singh, Kuldev;Minckler, Don S.
目的：评估目前发表的文献中使用的视神经乳头（ONH）和视网膜神经纤维层（RNFL）测量设备在诊断开角型青光眼和检测progression.Methods：同行评议的文献进行了搜索，2006年2月15日在PubMed和科克伦图书馆为2003年1月至2006年2月。该检索仅限于英文期刊上的成人研究，并产生了442篇引文。专家组审查了这些文章的摘要，并选择了159篇可能具有临床相关性的文章进行审查。在这159篇全文文章中，有82篇被确定为第一作者和方法学家根据证据质量进行审查和评级。结果：没有研究被归类为具有最高证据等级（1级）。基于11级证据，本评估中审查的ONH和RNFL成像仪器被确定为在区分具有昏迷性视野（VF）丧失的眼睛与没有VF丧失的正常眼睛方面非常有效。此外，一些研究表明，ONH或RNFL成像的参数预测青光眼嫌疑人中VF缺陷的发展。检测青光眼进展的研究表明，虽然经常有协议的结构和功能（VF）测试之间的进展，一个显着比例的青光眼患者进展的结构或功能testalong.Conclusions：ONH和RNFL成像设备为临床医生提供定量信息。根据直接比较各种可用技术的研究，在区分青光眼患者和对照组方面，没有一种成像设备优于其他设备。成像和相关软件的不断进步，以及与获得和评估视神经立体照片相关的不切实际性，使得成像在许多实践环境中变得越来越重要。当与定义青光眼诊断和进展的其他相关参数结合分析时，从成像设备获得的信息在临床实践中是有用的。
Objective: To evaluate the current published literature on the use of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) measurement devices in diagnosing open-angle glaucoma and detecting progression.Methods: A search of peer-reviewed literature was conducted on February 15, 2006 in PubMed and the Cochrane Library for the period January 2003 to February 2006. The search was limited to studies of adults in English-language journals and yielded 442 citations. The panel reviewed the abstracts of these articles and selected 159 articles of possible clinical relevance for review. Of these 159 full-text articles, 82 were determined to be relevant for the first author and methodologist to review and rate according to the quality of evidence.Results: There were no studies classified as having the highest level of evidence (level 1). The ONH and RNFL imaging instruments reviewed in this assessment were determined to be highly effective in distinguishing eyes with glaucomatous visual field (VF) loss from normal eyes without VF loss, based on level 11 evidence. In addition, some studies demonstrated that parameters from ONH or RNFL imaging predicted the development of VF defects among glaucoma suspects. Studies on detecting glaucoma progression showed that although there was often agreement on progression between the structural and functional (VF) tests, a significant proportion of glaucoma patients progressed by either the structural or the functional test alone.Conclusions: The ONH and RNFL imaging devices provide quantitative information for the clinician. Based on studies that have compared the various available technologies directly, there is no single imaging device that outperforms the others in distinguishing patients with glaucoma from controls. Ongoing advances in imaging and related software, as well as the impracticalities associated with obtaining and assessing optic nerve stereophotographs, have made imaging increasingly important in many practice settings. The information obtained from imaging devices is useful in clinical practice when analyzed in conjunction with other relevant parameters that define glaucoma diagnosis and progression.