Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients
Frequency of Testing to Detect Visual Field Progression Derived Using a Longitudinal Cohort of Glaucoma Patients
复制标题
DOI：
10.1016/j.ophtha.2017.01.027
复制
发表时间：
2017-06-01
期刊：
影响因子：
13.7
通讯作者：
Medeiros, Felipe A.
中科院分区：
文献类型：
--
作者：
Wu, Zhichao;Saunders, Luke J.;Medeiros, Felipe A.
设计：观察性队列研究。受试者：665名青光眼患者的1,072只眼，平均随访时间为4.3年。方法：研究对象：在2-5年期间接受5次或5次以上视野检查的受试者被纳入研究对象，利用线性回归方法计算平均偏差(MD)的纵向变异性。然后使用变异性估计通过计算机模拟重建真实世界的视野数据，以评估检测不同视野损失率和不同测试频率的进展所需的时间。评估采用了类似临床实践的随访方案，需要一套2项基线测试和一项确认性测试来确定进展。主要结果衡量标准：检测进展所需的时间(以年为单位)。结果：检测统计学上显著的负MD斜率所需的时间随着测试频率的增加而减少，尽管不是成比例的。例如，当每年分别进行一次、两次和三次测试时，MD损失为-2分贝/年的眼睛中的80%将在3.3、2.4和2.1年后被检测到。对于MD损失-0.5分贝/年的眼睛，分别在7.3年、5.7年和5.0年后以80%的功率可以检测到进展。结论：本研究提供了使用不同测试频率时使用MD趋势分析检测青光眼进展所需的时间。当检测从每年两次增加到三次时，检测进展的时间收益较小，这表明在基线上获得两次可靠的检测，然后每半年进行一次检测，并在最初几年的随访中通过重复检测确认进展，可能会为检测进展提供一个很好的折衷方案，同时在临床实践中最大限度地减少卫生保健资源的负担。(C)2017年度美国眼科学会
Purpose: To determine the time required to detect statistically significant progression for different rates of visual field loss using standard automated perimetry (SAP) when considering different frequencies of testing using a follow-up scheme that resembles clinical practice.Design: Observational cohort study.Participants: One thousand seventy-two eyes of 665 patients with glaucoma followed up over an average of 4.3 +/- 0.9 years.Methods: Participants with 5 or more visual field tests over a 2- to 5-year period were included to derive the longitudinal measurement variability of SAP mean deviation (MD) using linear regressions. Estimates of variability then were used to reconstruct real-world visual field data by computer simulation to evaluate the time required to detect progression for various rates of visual field loss and different frequencies of testing. The evaluation was performed using a follow-up scheme that resembled clinical practice by requiring a set of 2 baseline tests and a confirmatory test to identify progression.Main Outcome Measures: Time (in years) required to detect progression. Results: The time required to detect a statistically significant negative MD slope decreased as the frequency of testing increased, albeit not proportionally. For example, 80% of eyes with an MD loss of - 2 dB/year would be detected after 3.3, 2.4, and 2.1 years when testing is performed once, twice, and thrice per year, respectively. For eyes with an MD loss of -0.5 dB/year, progression can be detected with 80% power after 7.3, 5.7, and 5.0 years, respectively.Conclusions: This study provides information on the time required to detect progression using MD trend analysis in glaucoma eyes when different testing frequencies are used. The smaller gains in the time to detect progression when testing is increased from twice to thrice per year suggests that obtaining 2 reliable tests at baseline followed by semiannual testing and confirmation of progression through repeat testing in the initial years of follow-up may provide a good compromise for detecting progression, while minimizing the burden on health care resources in clinical practice. (C) 2017 by the American Academy of Ophthalmology