Incidence and Rates of Visual Field Progression after Longitudinally Measured Optic Disc Change in Glaucoma
Incidence and Rates of Visual Field Progression after Longitudinally Measured Optic Disc Change in Glaucoma
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DOI：
10.1016/j.ophtha.2009.04.031
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发表时间：
2009-11-01
期刊：
影响因子：
13.7
通讯作者：
Artes, Paul H.
中科院分区：
文献类型：
--
作者：
Chauhan, Balwantray C.;Nicolela, Marcelo T.;Artes, Paul H.
目的：确定进行性视盘改变的青光眼患者是否比无视盘改变的患者有更早和更快的视野进展。设计：前瞻性、纵向、队列研究。参与者和对照：81例开角型青光眼患者。方法：患者每6个月进行一次激光共聚焦扫描断层扫描和标准自动视野检查。完整的随访分为初始和后续两个阶段。使用了两个初始阶段--前3年(《A议定书》)和总后续行动的前半部分(《B议定书》)，其余时间分别为后续后续行动。根据地形改变分析的自由、适度或保守标准确定初始随访期间的椎间盘改变。随后的视野进展通过>；=3个位置的显著模式偏差改变来确定(早期显性青光眼试验中使用的标准)。作为一项对照分析，在最初的随访中，确定了视野变化，其中>；=1，>；=2，或>；=3个部位有显著的模式偏差改变。主要观察指标：随后的视野进展的生存时间，平均偏差(MD)变化率，以及正负似然比。结果：总共随访22(18-24)次，中位数(四分位数范围)为11.0(8.0-12.0)年。在最初的随访中，与视野改变相比，更多的患者出现了椎间盘改变。在既往有椎间盘改变的患者中，平均进展期持续较短(A方案，0.8-1.7年；B方案，0.3-0.7年)。在对照分析中，既往视野改变的患者在统计学上有更早的视野进展(A方案，2.9-3.0年；B方案，0.7-0.9年)。类似地，既往有椎间盘或视野改变的患者随后MD改变的平均比率总是更差，尽管分布有很大的重叠。与无视野改变的患者相比，有后续视野进展的患者以前发生视盘改变的可能性高达3倍，与无视野进展的患者相比，先前有视野改变的患者有高达5倍的可能性。结论：纵向测量的视盘变化可以预测随后的视野进展，并可能成为临床研究和青光眼试验中功能结果的有效终点。财务披露(S)：作者对本文讨论的任何材料都没有专利或商业利益。眼科2009；美国眼科学会116：2110-2118(C)2009。
Objective: To determine whether glaucoma patients with progressive optic disc change have subsequent visual field progression earlier and at a faster rate compared with those without disc change.Design: Prospective, longitudinal, cohort study.Participants and Controls: Eighty-one patients with open-angle glaucoma.Methods: Patients underwent confocal scanning laser tomography and standard automated perimetry every 6 months. The complete follow-up was divided into initial and subsequent periods. Two initial periods-first 3 years (Protocol A) and first half of the total follow-up (Protocol B)-were used, with the respective remainder being the subsequent follow-up. Disc change during the initial follow-up was determined with liberal, moderate, or conservative criteria of the Topographic Change Analysis. Subsequent field progression was determined with significant pattern deviation change in >= 3 locations (criterion used in the Early Manifest Glaucoma Trial). As a control analysis, field change during the initial follow-up was determined with significant pattern deviation change in >= 1, >= 2, or >= 3 locations.Main Outcome Measures: Survival time to subsequent field progression, rates of mean deviation (MD) change, and positive and negative likelihood ratios.Results: The median (interquartile range) total follow-up was 11.0 (8.0-12.0) years with 22 (18-24) examinations. More patients had disc changes during the initial follow-up compared with field changes. The mean time to field progression was consistently shorter (protocol A, 0.8-1.7 years; protocol B, 0.3-0.7 years) in patients with prior disc change. In the control analysis, patients with prior field change had statistically earlier subsequent field progression (protocol A, 2.9-3.0 years; protocol B, 0.7-0.9). Similarly, patients with either prior disc or field change always had worse mean rates of subsequent MD change, although the distributions overlapped widely. Patients with subsequent field progression were up to 3 times more likely to have prior disc change compared with those without, and up to 5 times more likely to have prior field change compared with those without.Conclusions: Longitudinally measured optic disc change is predictive of subsequent visual field progression and may be an efficacious end point for functional outcomes in clinical studies and trials in glaucoma.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2009; 116:2110-2118 (C) 2009 by the American Academy of Ophthalmology.