Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields.
Challenges to the Common Clinical Paradigm for Diagnosis of Glaucomatous Damage With OCT and Visual Fields.
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DOI：
10.1167/iovs.17-23713
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发表时间：
2018-02-01
影响因子：
4.4
通讯作者：
De Moraes CG
中科院分区：
文献类型：
--
作者：
Hood DC;De Moraes CG
诊断青光眼最常见的临床范例(CCP)包括具有6°测试网格的视野(VF)(例如，24-2或30-2测试模式)和视盘的光学相干断层扫描(OCT)。此外，这些测试是基于定量指标(例如，VF的模式标准差[PSD]和OCT光盘扫描的全球视网膜神经纤维厚度)进行评估的。中共面临着三大挑战。首先，黄斑区(即距视线±8°)在青光眼早期就会受到影响，CCP可能会漏掉和/或低估损害。其次，使用典型的VF和OCT指标低估了结构(OCT)和功能(VF)损伤之间的一致程度。第三，OCT扫描的分辨率提高了，局部青光眼损害可以前所未有地可视化。然而，临床医生通常不看OCT扫描图像。总而言之，这些挑战要求修改VF测试模式和OCT协议，用VF和OCT上异常区域的比较来替换指标，以及仔细检查实际的OCT扫描图像。原则上，CCP可以很容易地修改。在实践中，变革面临着许多障碍。
The most common clinical paradigm (CCP) for diagnosing glaucoma includes a visual field (VF) with a 6° test grid (e.g., the 24-2 or 30-2 test pattern) and an optical coherence tomography (OCT) scan of the optic disc. Furthermore, these tests are assessed based upon quantitative metrics (e.g., the pattern standard deviation [PSD] of the VF and the global retinal nerve fiber thickness of the OCT disc scan). This CCP is facing three challenges. First, the macular region (i.e., ±8° from fixation) is affected early in the glaucomatous process, and the CCP can miss and/or underestimate the damage. Second, use of the typical VF and OCT metrics underestimates the degree of agreement between structural (OCT) and functional (VF) damage. Third, resolution of the OCT scan has improved, and local glaucomatous damage can be visualized like never before. However, the clinician often does not look at the OCT scan image. Together these challenges argue for a modification of the VF test pattern and OCT protocol, replacement of metrics with a comparison of abnormal regions on VF and OCT, and careful inspection of actual OCT scan images. In principle, the CCP could be modified easily. In practice, change is facing a number of impediments.
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影响因子：
3
作者：
Hood, Donald C.;Chen, Monica F.;Chui, Toco Y. P.
通讯作者：
Chui, Toco Y. P.
影响因子：
2
作者：
Muhammad H;Fuchs TJ;De Cuir N;De Moraes CG;Blumberg DM;Liebmann JM;Ritch R;Hood DC
通讯作者：
Hood DC
影响因子：
2
作者：
Nelson, P;Aspinall, P;O'Brien, C
通讯作者：
O'Brien, C
影响因子：
17.8
作者：
Hood DC;Raza AS;de Moraes CG;Liebmann JM;Ritch R
通讯作者：
Ritch R
影响因子：
8.1
作者：
Traynis, Ilana;De Moraes, Carlos G.;Hood, Donald C.
通讯作者：
Hood, Donald C.