Visual fields correlate better than visual acuity to severity of diabetic retinopathy
Visual fields correlate better than visual acuity to severity of diabetic retinopathy
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DOI：
10.1007/s00125-005-0001-x
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发表时间：
2005-12-01
期刊：
影响因子：
8.2
通讯作者：
Agardh, E
中科院分区：
文献类型：
--
作者：
Bengtsson, B;Heijl, A;Agardh, E
目的/假设：我们比较了糖尿病视网膜病变患者的视力检查和视力检查的结果。方法：根据糖尿病视网膜病变早期治疗研究（ETDRS）和荧光素血管造影对59例不同程度视网膜病变的糖尿病患者进行立体眼底摄影检查。常规白对白视距仪（WWP）和短波自动视距仪（SWAP）参照正常值进行分析。用ETDRS表测量视力。结果：回归分析显示，当以最小分辨角（LogMar）分数的对数计算视力时，根据ETDRS量表，视力与视网膜病变严重程度的增加有显著相关，但当以常规读数所能看到的最小线来测量视力时，视力与视网膜病变严重程度的增加无显著相关。每ETDRS一步视力下降0.02 LogMar （p = 0.03）。根据ETDRS量表，视野丧失程度与视网膜病变严重程度的增加显著相关，使用WWP时，每ETDRS一步视野敏感度降低0.44 dB (p = 0.0001)，使用SWAP时，每ETDRS一步视野敏感度降低0.40 dB （p = 0.04）。WWP法（- 2.6 dB/mm(2), p = 0.03）和SWAP法（- 7.9 dB/mm(2), p = 0.002）测得的中央凹无血管区和邻近的中央凹周毛细血管间区（PIAs）面积也影响中央视野，但不影响视力。根据ETDRS量表对周围性视网膜病变的回归模型拟合，使用WWP测试优于SWAP或视力测试，而在测量中央凹无血管区扩大和PIAs引起的影响时，SWAP测试优于WWP和视力测试。结论/解释：在糖尿病视网膜病变的功能丧失方面，眼周检查能提供比视力更有用的信息，特别是当凹窝周围毛细血管网络受损时。
Aims/hypothesis: We compared the outcomes of perimetric and visual acuity tests in patients with diabetic retinopathy. Methods: We examined 59 diabetic patients with different degrees of retinopathy using stereo fundus photography in accordance with the Early Treatment of Diabetic Retinopathy Study (ETDRS) and fluorescein angiography. Conventional white-on-white perimetry (WWP) and short wavelength automated perimetry ( SWAP) were performed and analysed with reference to normal values. Visual acuity was measured with ETDRS charts. Results: Regression analysis revealed that visual acuity was significantly associated with increasing severity of retinopathy according to the ETDRS scale when visual acuity was estimated by counting logarithm of minimum angle of resolution (LogMar) scores, but not when visual acuity was measured by the conventional reading of the smallest line that could be seen. Visual acuity decreased by 0.02 LogMar per ETDRS step (p = 0.03). The degree of visual field loss was significantly associated with increasing severity of retinopathy according to the ETDRS scale, perimetric sensitivity decreasing by 0.44 dB per ETDRS step (p = 0.0001) using WWP, and by 0.40 dB per ETDRS step (p = 0.04) with SWAP. The size of the area of the foveal avascular zone and adjacent perifoveal intercapillary areas (PIAs) also affected the central visual field as obtained both by WWP (- 2.6 dB/ mm(2), p = 0.03), and by SWAP (- 7.9 dB/mm(2), p = 0.002), but did not affect visual acuity. The regression model fit for peripheral retinopathy according to the ETDRS scale was better using WWP than SWAP or visual acuity, while SWAP testing was superior to both WWP and visual acuity when measuring effects caused by enlarged foveal avascular zones and PIAs. Conclusions/interpretation: Perimetry can provide more useful information than visual acuity on functional loss in diabetic retinopathy, particularly when the perifoveal capillary network is damaged.