Early detection of glaucomatous damage. II. Changes in the appearance of the optic disk.
Early detection of glaucomatous damage. II. Changes in the appearance of the optic disk.
复制标题
及早发现青光眼损伤。
DOI：
10.1016/0039-6257(85)90080-3
复制
发表时间：
1985
影响因子：
5.1
通讯作者：
Quigley,HA
中科院分区：
文献类型：
--
作者：
Quigley,HA
一旦我们了解到视盘杯尺寸的增加是由于视神经纤维损失加上一些物理组织重新排列造成的，那么很明显，一旦神经损失开始，拔罐就开始了。与现有的现场测试方法相比，检测拔罐的方法对最早的青光眼损伤更敏感。这一结论得到了大型临床研究和组织学证明的支持，这些研究和组织学证明在患有异常杯状、不对称杯状或神经纤维层异常的眼睛中在视野损失之前神经纤维损失。虽然自动视野检查可能会提高检测的灵敏度，但需要更好的测试方法与计算机辅助机器的客观性相结合。椎间盘出血、神经纤维层缺陷和色觉异常是损伤的早期迹象，支持损伤在视野丧失之前就存在的结论。许多其他方法有待进一步测试以确定其有效性。如果我们将青光眼定义为具有眼压升高和视神经损伤史的眼睛，则认为青光眼疾病是由戈德曼视野上的某个视野发现来定义的想法是无效的。虽然这种视野损失是定义青光眼损伤特定阶段的便捷方法，但显然存在早期损伤阶段，无论我们是否总能检测到它们。根据特定的视野发现，任何患者都不应被告知他或她没有患有青光眼，而是患有高眼压症。随着测试和检查方法的改进，我们确定是否存在损坏的能力有望得到提高。当这种情况发生时，我们将能够更好地最合理地选择那些将从治疗中受益的患者。现场测试对最早的青光眼损伤相对不敏感的想法可能会让怀疑者得出结论，视野检查不值得麻烦。这篇评论表明，我们现有的方法，无论是检眼镜法、心理物理法还是其他方法，都不是完美的。但省略其中任何一个（尤其是现场测试）都会对青光眼患者造成极大的伤害。新型自动化仪器的最大用处在于，现在每个眼科诊所都可以以经济高效的形式进行充分的现场测试。我们需要努力更好地检测和跟踪青光眼损伤，以防止不必要的失明。
Once we understand that an increase in the size of the optic disk cup is due to loss of optic nerve fibers combined with some physical tissue rearrangements, it is quite clear that cupping begins as soon as nerve loss begins. Methods to detect cupping are more sensitive to the earliest glaucoma damage than are present field testing methods. This conclusion is supported by large clinical studies and histological demonstration of nerve fiber loss prior to field loss in eyes with abnormal cups, asymmetric cupping, or nerve fiber layer abnormalities. While automated perimetry is likely to increase the sensitivity of detection, better test methodologies are needed to combine with the objectivity of computer-assisted machines. Disk hemorrhages, nerve fiber layer defects, and color vision abnormalities are early signs of damage, supporting the conclusion that damage is present before field loss. A number of other methods await further testing to determine their effectiveness. The idea that the disease glaucoma is defined by a certain visual field finding on the Goldmann perimeter is not valid if we define glaucoma as an eye with a history of elevated IOP and optic nerve damage. While such field loss is a convenient means of defining a particular stage of damage in glaucoma, there are clearly earlier stages of damage, whether we can always detect them or not. No patient should be told that he or she does not have glaucoma, but rather has ocular hypertension, based on a particular visual field finding. As testing and examination methods improve, so, hopefully, will our ability to determine whether damage is present. As this occurs, we will be better enabled to select most rationally those patients who will benefit from therapy. The idea that field testing is relatively insensitive to the earliest glaucoma damage might lead the skeptic to conclude that perimetry is not worth the trouble. This review has indicated that none of our present methods, ophthalmoscopic, psychophysical or otherwise, is perfect. But to omit using any of them (especially field testing) does a great disservice to the glaucoma patient. The greatest usefulness of the new automated instruments is that adequate field testing is now available in a cost-effective form to every ophthalmic office. We need to strive for better detection and follow-up of glaucoma damage to prevent needless blindness.
登录
查看更多内容
荧光素血管造影：它对了解青光眼视力丧失机制的贡献。
DOI：
--
发表时间：
1975
期刊：
Transactions of the American Ophthalmological Society
影响因子：
--
作者：
G. Spaeth
通讯作者：
G. Spaeth
椎间盘出血在慢性开角型青光眼预后中的重要性。
DOI：
--
发表时间：
1977
期刊：
A M A Archives of Ophthalmology
影响因子：
--
作者：
S. Drance;M. Fairclough;D. M. Butler;M. Kottler
通讯作者：
M. Kottler
影响因子：
4.4
作者：
Anthony J. Adams;Rosemary Rodic;R. Husted;Robert;Stamper
通讯作者：
Anthony J. Adams;Rosemary Rodic;R. Husted;Robert;Stamper
神经纤维层萎缩作为青光眼视神经损伤指标的临床评价。
DOI：
--
发表时间：
1980
期刊：
A M A Archives of Ophthalmology
影响因子：
--
作者：
H. Quigley;N. Miller;T. George
通讯作者：
T. George
影响因子：
--
作者：
QUIGLEY, HA;ADDICKS, EM;MAUMENEE, AE
通讯作者：
MAUMENEE, AE