Sample P A, Bosworth C F, Blumenthal E Z, Girkin C, Weinreb R N
Department of Ophthalmology, University of California at San Diego, La Jolla 92093-0946, USA.
Invest Ophthalmol Vis Sci. 2000 Jun;41(7):1783-90.
To compare short-wavelength automated perimetry, frequency-doubling technology perimetry, and motion-automated perimetry, each of which assesses different aspects of visual function, in eyes with glaucomatous optic neuropathy and ocular hypertension.
One hundred thirty-six eyes from 136 subjects were evaluated with all three tests as well as with standard automated perimetry. Fields were not used in the classification of study groups to prevent bias, because the major purpose of the study was to evaluate each field type relative to the others. Seventy-one of the 136 eyes had glaucomatous optic neuropathy, 37 had ocular hypertension, and 28 served as age-matched normal control eyes. Glaucomatous optic neuropathy was defined by assessment of stereophotographs. Criteria were asymmetrical cupping, the presence of rim thinning, notching, excavation, or nerve fiber layer defect. Ocular hypertensive eyes had intraocular pressure of 23 mm Hg or more on at least two occasions and normal-appearing optic disc stereophotographs. Criteria for abnormality on each visual field test were selected to approximate a specificity of 90% in the normal eyes. Thresholds for each of the four tests were compared, to determine the percentage that were abnormal within each patient group and to assess the agreement among test results for abnormality, location, and extent of visual field deficit.
Each test identified a subset of the eyes with glaucomatous optic neuropathy as abnormal: 46% with standard perimetry, 61% with short-wavelength automated perimetry, 70% with frequency-doubling perimetry, and 52% with motion-automated perimetry. In the ocular hypertensive eyes, standard perimetry was abnormal in 5%, short wavelength in 22%, frequency doubling in 46%, and motion in 30%. Fifty-four percent (38/71) of eyes with glaucomatous optic neuropathy were normal on standard fields. However, 90% were identified by at least one of the specific visual function tests. Combining tests improved sensitivity with slight reductions in specificity. The agreement in at least one quadrant, when a defect was present with more than one test, was very high at 92% to 97%. More extensive deficits were shown by frequency-doubling perimetry followed by short-wavelength automated perimetry, then motion-automated perimetry, and last, standard perimetry. However, there were significant individual differences in which test of any given pairing was more extensively affected. Only 30% (11/37) of the ocular hypertensive eyes showed no deficits at all compared with 71% (20/28) of the control eyes (P < 0.001).
For detection of functional loss standard visual field testing is not optimum; a combination of two or more tests may improve detection of functional loss in these eyes; in an individual, the same retinal location is damaged, regardless of visual function under test; glaucomatous optic neuropathy identified on stereophotographs may precede currently measurable function loss in some eyes; conversely, function loss with specific tests may precede detection of abnormality by stereophotograph review; and short-wavelength automated perimetry, frequency-doubling perimetry, and motion-automated perimetry continue to show promise as early indicators of function loss in glaucoma.
比较短波长自动视野计、倍频技术视野计和运动自动视野计，这三种视野计分别评估视觉功能的不同方面，用于青光眼性视神经病变和高眼压症患者的眼睛。
对136名受试者的136只眼睛进行了上述三种测试以及标准自动视野计测试。在研究组分类中未使用视野结果，以防止偏差，因为该研究的主要目的是评估每种视野类型相对于其他类型的情况。136只眼中，71只患有青光眼性视神经病变，37只患有高眼压症，28只作为年龄匹配的正常对照眼。青光眼性视神经病变通过立体照片评估来定义。标准为不对称性视杯扩大、存在视盘边缘变薄、切迹、凹陷或神经纤维层缺损。高眼压症患者至少两次眼压≥23mmHg，且立体照片显示视盘外观正常。选择每种视野测试的异常标准，以使正常眼中的特异性接近90%。比较四种测试的阈值，以确定每个患者组中异常的百分比，并评估测试结果在视野缺损的异常情况、位置和范围方面的一致性。
每种测试都将一部分青光眼性视神经病变患者的眼睛判定为异常：标准视野计为46%，短波长自动视野计为61%，倍频视野计为70%，运动自动视野计为52%。在高眼压症患者中，标准视野计异常率为5%，短波长视野计为22%，倍频视野计为46%，运动视野计为30%。71只青光眼性视神经病变眼中，54%（38/71）的标准视野正常。然而，至少一项特定视觉功能测试可识别出90%的此类患者。联合测试提高了敏感性，但特异性略有降低。当一种以上测试出现缺损时，至少一个象限的一致性非常高，为92%至97%。倍频视野计显示的视野缺损范围更广，其次是短波长自动视野计，然后是运动自动视野计，最后是标准视野计。然而，在任何给定的配对测试中，哪一项受影响更广泛存在显著个体差异。与71%（20/28）的对照眼相比，只有30%（11/37）的高眼压症患者未显示任何视野缺损（P<0.001）。
对于检测功能丧失，标准视野测试并非最佳方法；两种或更多测试联合使用可能改善这些患者眼睛功能丧失的检测；对于个体而言，无论测试的视觉功能如何，相同的视网膜位置都会受损；立体照片显示的青光眼性视神经病变可能在某些眼中先于目前可测量的功能丧失出现；相反，特定测试的功能丧失可能先于通过立体照片检查发现异常；短波长自动视野计、倍频视野计和运动自动视野计作为青光眼功能丧失的早期指标仍有前景。
