Horn F K, Velten I M, Jünemann A, Korth M
Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany.
Graefes Arch Clin Exp Ophthalmol. 1999 Aug;237(8):621-8. doi: 10.1007/s004170050288.
The purpose of this study was to evaluate how temporal contrast sensitivity (TCS) determined with full-field flicker stimuli is influenced by intraocular pressure and whether TCS is reduced in glaucoma patients with diffuse perimetric losses as well as in patients with localized visual field deficits.
TCS was determined with sinusoidally flickering light (37.1 Hz) in a full-field bowl. Perimetric mean defect (MD) and cumulative defect curves (Octopus G1) were used to distinguish between patients with localized and diffuse field deficits. Normal subjects (296), low-tension glaucoma patients (98) and open-angle glaucoma patients with previously elevated intraocular pressure (541) were classified into five subgroups taking into account the depth of their visual field losses.
No significant correlation between full-field flicker sensitivity and prevailing intraocular pressure was found in normals (Y=1.36+0.006 X) or in patients (Y=0.95-0.0002 X). Analyses of validity at a predefined specificity of 90% reveal a reduction of TCS in patients with early (MD<5 dB) diffuse perimetric losses (sensitivity 69%) as well as in those showing localized visual field defects (sensitivity 65%). Sensitivity was 87% in patients with diffuse perimetric defects (MD 5-10 dB), 93% in a group of patients with both types of losses, and 100% in advanced glaucomas (MD>20 dB). The lack of TCS is similar in open-angle glaucomas and in field-loss-matched normal-tension glaucoma patients.
Significantly reduced TCS in patients with early diffuse perimetric losses as well as in those showing localized visual field defects indicates that localized damages can be associated with general deterioration of the ability to perceive flickering stimuli. Thus, this flicker test can be performed in a full-field bowl with no need for fixation. Considering its other clinical qualities (photopic conditions, low influence of prevailing intraocular pressure and media opacity) the test may be a useful, convenient supplementary procedure in glaucoma screening.
本研究旨在评估通过全视野闪烁刺激测定的时间对比敏感度（TCS）如何受眼压影响，以及在患有弥漫性视野缺损的青光眼患者和局限性视野缺损患者中TCS是否降低。
在全视野碗中用正弦闪烁光（37.1Hz）测定TCS。视野平均缺损（MD）和累积缺损曲线（Octopus G1）用于区分局限性和弥漫性视野缺损患者。将正常受试者（296例）、低眼压性青光眼患者（98例）和既往眼压升高的开角型青光眼患者（541例）根据其视野缺损深度分为五个亚组。
在正常受试者（Y = 1.36 + 0.006X）或患者（Y = 0.95 - 0.0002X）中，未发现全视野闪烁敏感度与当前眼压之间存在显著相关性。在预定义特异性为90%时的有效性分析显示，早期（MD < 5dB）弥漫性视野缺损患者（敏感度69%）以及显示局限性视野缺损的患者（敏感度65%）的TCS降低。弥漫性视野缺损（MD 5 - 10dB）患者的敏感度为87%，两种类型缺损患者组的敏感度为93%，晚期青光眼（MD > 20dB）患者的敏感度为100%。开角型青光眼和视野缺损匹配的正常眼压性青光眼患者中TCS缺乏情况相似。
早期弥漫性视野缺损患者以及显示局限性视野缺损的患者中TCS显著降低，表明局限性损害可能与感知闪烁刺激能力的总体下降有关。因此，该闪烁测试可在全视野碗中进行，无需固视。考虑到其其他临床特性（明视条件、当前眼压和介质混浊的低影响），该测试可能是青光眼筛查中一种有用、便捷的辅助检查方法。
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