Advanced Glaucoma Intervention Study. 2. Visual field test scoring and reliability.
Advanced Glaucoma Intervention Study. 2. Visual field test scoring and reliability.
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作者：
晚期青光眼干预研究（AGIS）是一项多中心、随机临床试验，旨在（1）确定当单纯药物治疗不再足以控制疾病时两种青光眼手术治疗策略中的较佳者;（2）阐明手术干预开始后开角型青光眼的临床病程和预后。本研究的研究者已经开发了定量方法来评估测试的可靠性，并使用Humphrey视野分析仪的24-2阈值程序测量昏迷性视野缺损的严重程度。本报告详细介绍了这些方法，并提供了有关在足够短的时间间隔内的长期波动的信息，以使疾病引起的变化不太可能。方法：在AGIS中，自动视野测试的可靠性评估是基于问题的数量;固定损失，假阳性反应和假阴性反应的百分比;和短期波动的量。AGIS视野缺损评分是基于上、下半视野中相邻凹陷测试点的簇数和深度以及鼻区总偏差的阈值程序单视野测试STATPAC-2分析。评分范围为0（无缺陷）至20（所有测试部位深度凹陷）。分析了在AGIS手术干预前的间隔期间（从1天到6周）对562例患者的756只眼睛进行的两次测试之间的评分波动。结果确定研究资格的第一次视野测试的分数范围为1到17。16%的眼睛在第二次测试中出现较大的正或负利率波动（绝对变化为4或更多）;评分改善（11%）多于恶化（5%）。随着测试间隔时间的增加，大波动的频率趋于增加。绝对利息波动与年龄无关。结论：对于自动视野计视野检查，AGIS研究者已经开发出客观的、定量的方法来评价视野检查的可靠性和昏迷性视野缺损的严重程度。对于16%的眼睛，长期波动足够大（>或= 4分），表明青光眼缺陷的改善或恶化，即使发生波动的时间间隔足够短（中位时间，约1周），使疾病状态的变化不太可能。
BACKGROUND The Advanced Glaucoma Intervention Study (AGIS) is a multicenter, randomized clinical trial designed (1) to determine the better of two surgical management strategies for glaucoma when medical treatment alone no longer adequately controls the disease and (2) to clarify the clinical course and prognosis of open-angle glaucoma after surgical interventions have begun. The investigators of this study have developed quantitative methods to assess the test reliability and measure the severity of glaucomatous visual field defects with the 24-2 threshold program of the Humphrey Visual Field Analyzer. This report details these methods and presents information about long-term fluctuation during a time interval short enough to render change due to disease unlikely. METHODS In AGIS, reliability assessment of automated visual field tests is based on the number of questions asked; percent of fixation losses, false-positive responses, and false-negative responses; and amount of short-term fluctuation. The AGIS visual field defect score is based on the number and depth of clusters of adjacent depressed test sites in the upper and lower hemifields and in the nasal area of the total deviation printout of the threshold program single-field test STATPAC-2 analysis. The score ranges from 0 (no defect) to 20 (all test sites deeply depressed). The fluctuation in score between two tests obtained during an interval preceding AGIS surgical interventions, ranging from 1 day to 6 weeks on 756 eyes of 562 patients, is analyzed. RESULTS The scores of the first visual field tests, which determined eligibility for the study, range from 1 to 17. Large positive or negative interest fluctuations (absolute changes of 4 or more) occurred in the second tests for 16% of eyes; more scores improved (11%) than worsened (5%). The frequency of large fluctuations tended to increase as the time interval between tests increased. Absolute interest fluctuations were independent of age. CONCLUSION For visual field tests obtained with the automated perimeter, AGIS investigators have developed objective, quantitative methods of scoring test reliability and severity of glaucomatous field loss. For 16% of eyes, long-term fluctuations were large enough (> or = 4 points) to suggest improvement or worsening of the glaucomatous defect even though the interval in which the fluctuations occurred was short enough (median time, approximately 1 week) to render changes in disease status unlikely.