A Novel Stimulus to Improve Perimetric Sampling within the Macula in Patients with Glaucoma.
A Novel Stimulus to Improve Perimetric Sampling within the Macula in Patients with Glaucoma.
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DOI：
10.1097/opx.0000000000001677
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发表时间：
2021-04-01
期刊：
影响因子：
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通讯作者：
King BJ
中科院分区：
文献类型：
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作者：
Alluwimi MS;Swanson WH;King BJ
识别青光眼黄斑损伤对于青光眼患者的诊断和管理变得非常重要。在这项研究中，我们提出了一种方法，提供了更好的周边采样的黄斑区，通过测试四个位置，具有良好的结构-功能协议。我们以前提出了一个基础上定制周边的黄斑内的位置。在这项研究中，我们的目的是提高周边采样内的黄斑提出了一个刺激在四个位置，保持良好的结构-功能协议。我们测试了30名患者（年龄50至88岁）的一只眼睛。根据观察到的黄斑结构损伤选择患者，而周边缺损（使用24-2）并不能反映这种损伤的位置和程度。我们使用正面图像来显示视网膜神经纤维束缺损。为了测量周长敏感性，我们在10-2位置处使用斑点刺激（标准差为0.25°）。一个位置的周边缺陷被定义为等于或大于37个年龄相似的对照组（47至78岁）的平均灵敏度以下的-4、-5和-6 dB的任何值。我们还提出了一个细长的正弦刺激20例患者在黄斑内的四个位置，其中我们定义为周边缺陷的任何值低于2.5百分位数的控制。−4、−5和−6 dB标准分别在14、13和11例患者中识别出周边缺损。当测试与延长的刺激，18例患者被确定为周边缺损。周边缺陷与结构损伤一致。细长的刺激显示出良好的结构-功能协议，只有四个测试位置相比，68个位置使用的斑点刺激。这证明了这种新刺激在下一代视野检查中的临床潜力。
Identifying glaucomatous damage to the macula has become important for diagnosing and managing patients with glaucoma. In this study, we presented an approach that provides better perimetric sampling for the macular region, by testing four locations, with a good structure-function agreement. We previously presented a basis for customizing perimetric locations within the macula. In this study, we aimed to improve perimetric sampling within the macula by presenting a stimulus at four locations, with maintaining a good structure-function agreement. We tested one eye each of 30 patients (aged 50 to 88 years). Patients were selected based on observed structural damage to the macula, whereas perimetric defect (using 24-2) did not reflect the locations and extent of this damage. We used en face images to visualize retinal nerve fiber bundle defects. To measure perimetric sensitivities, we used a blob stimulus (standard deviation of 0.25°) at the 10-2 locations. A perimetric defect for a location was defined as any value equal to or deeper than −4, −5, and −6 dB below the mean sensitivity for 37 age-similar controls (aged 47 to 78 years). We also presented an elongated sinusoidal stimulus for 20 patients at four locations within the macula, in which we defined a perimetric defect as any value below the 2.5th percentile from controls. The −4, −5, and −6 dB criteria identified perimetric defects in 14, 13, and 11 patients, respectively. When testing with the elongated stimulus, 18 patients were identified with perimetric defect. The perimetric defects were consistent with the structural damage. The elongated stimulus showed a good structure-function agreement with only four testing locations as compared with 68 locations used with the blob stimulus. This demonstrates a clinical potential for this new stimulus in the next generation of perimetry.