Delgado Maria F, Nguyen Ngoc T A, Cox Terry A, Singh Kuldev, Lee David A, Dueker David K, Fechtner Robert D, Juzych Mark S, Lin Shan C, Netland Peter A, Pastor Scott A, Schuman Joel S, Samples John R
Ophthalmology. 2002 Dec;109(12):2362-74. doi: 10.1016/s0161-6420(02)01726-8.
The purpose of this document is to summarize and evaluate the effectiveness of new automated perimetry tests and algorithms in diagnosing glaucoma and detecting disease progression.
A literature search on automated perimetry retrieved over 300 citations from 1994 to 2001, of which 71 were selected as relevant to this assessment. The quality of the evidence obtained from these studies was assessed by the methodologist.
The four automated perimetry techniques described in this assessment are short wavelength automated perimetry (SWAP), frequency doubling technology perimetry (FDT), high-pass resolution perimetry (HPRP), and motion automated perimetry (MAP). The algorithms described are Swedish interactive threshold algorithm (SITA) and SITA fast. With the exception of SWAP, these techniques and algorithms reduce testing time and inconsistent patient performance when compared with conventional full threshold testing.
Short wavelength automated perimetry detected visual field loss earlier than standard threshold automated perimetry, with a sensitivity and specificity of about 88% and 92% respectively. However, it is a lengthy, demanding test, is sensitive to media opacities, and has a greater magnitude of long-term fluctuation compared with standard threshold automated perimetry, which make it difficult to assess disease progression accurately. When compared to standard threshold automated perimetry, FDT perimetry showed sensitivity and specificity greater than 97% for detecting moderate and advanced glaucoma, and sensitivity of 85% and specificity of 90% for early glaucoma. As FDT perimetry has a short testing time and is resistant to blur and pupil size, it may be a useful screening tool. In a longitudinal study, high-pass resolution perimetry was more effective than standard threshold automated perimetry in monitoring progressive glaucomatous loss, detecting progression at a median of 12 months earlier in 54% of patients studied. Motion automated perimetry demonstrated usefulness in detecting early glaucomatous visual loss in a longitudinal study. Studies on SITA demonstrated greater sensitivity and reproducibility and less intertest variability when compared to standard full threshold testing and a 50% reduction in testing times. A study comparing standard full threshold, SITA, and SITA fast found a sensitivity of 95% for the first two techniques and 93% for SITA fast. Long-term follow-up studies are needed to assess the ability of these techniques to detect progression of glaucoma over time.
本文旨在总结和评估新型自动视野计检测方法及算法在青光眼诊断和病情进展监测中的有效性。
通过文献检索，从1994年至2001年共获取300多篇关于自动视野计的文献引用，其中71篇被选为与本评估相关的文献。由方法学家对这些研究所得证据的质量进行评估。
本评估中描述的四种自动视野计技术分别为短波自动视野计（SWAP）、倍频视野计（FDT）、高通分辨率视野计（HPRP）和运动自动视野计（MAP）。所描述的算法为瑞典交互式阈值算法（SITA）和SITA快速算法。除SWAP外，与传统全阈值检测相比，这些技术和算法可缩短检测时间，并减少患者表现的不一致性。
短波自动视野计比标准阈值自动视野计能更早地检测到视野缺损，其敏感度和特异度分别约为88%和92%。然而，它是一项耗时、要求高的检测，对介质混浊敏感，与标准阈值自动视野计相比长期波动幅度更大，这使得准确评估病情进展较为困难。与标准阈值自动视野计相比，倍频视野计检测中度和重度青光眼的敏感度和特异度均大于97%，检测早期青光眼的敏感度为85%，特异度为90%。由于倍频视野计检测时间短，且不受模糊和瞳孔大小的影响，它可能是一种有用的筛查工具。在一项纵向研究中，高通分辨率视野计在监测青光眼性视野缺损进展方面比标准阈值自动视野计更有效，在54%的研究患者中，能提前12个月的中位数时间检测到病情进展。运动自动视野计在一项纵向研究中证明对检测早期青光眼性视野缺损有用。关于SITA的研究表明，与标准全阈值检测相比，其敏感度更高、可重复性更好且检测间变异性更小，检测时间减少了50%。一项比较标准全阈值、SITA和SITA快速算法的研究发现，前两种技术的敏感度为95%，SITA快速算法的敏感度为93%。需要进行长期随访研究来评估这些技术随时间推移检测青光眼病情进展的能力。
