Haggerty Helen, Richardson Sarah, Mitchell Keith W, Dickinson A Jane
Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Arch Ophthalmol. 2005 Mar;123(3):356-62. doi: 10.1001/archopht.123.3.356.
To assess the intraobserver and interobserver reliability of recording uniocular fields of fixation using a modified perimeter technique in healthy subjects and patients with Graves orbitopathy (GO). Patients with restrictive myopathies, particularly GO, require accurate measurement of monocular excursions. These ductions are recorded in 4 to 12 directions of gaze using a perimeter, producing a plot known as a uniocular field of fixation. While 4 direction plots give limited information on vertical muscles, recording 12 directions is time consuming and uncomfortable. This modified technique uses the 6 directions of gaze corresponding to the primary field of action of each muscle.
A single observer measured modified uniocular fields of fixation in 35 healthy subjects aged 20 to 60 years to establish normal and age-related ranges for all ductions. Fifteen subjects underwent measurement on 5 separate occasions by the same observer to establish intraobserver reproducibility. A second observer independently performed measurements in 10 of the subjects to determine interobserver reproducibility. Reliability was compared with that measured in 29 patients with GO.
The technique was reproducible to within 4 degrees for healthy subjects undergoing assessment by a single observer. When results of 2 observers were compared, the coefficient of repeatability was 7.9 degrees . For subjects with GO, however, maximal variability was 7.8 degrees . For clinical purposes, only a change of 8 degrees or more can be assumed to be significant.
This technique offers advantages for assessing any restrictive myopathy, including GO to within 8 degrees . This level of accuracy is likely to be similar in other centers, and has implications for interpreting GO outcome measures, where 5 degrees was previously taken to represent significant change.
使用改良周边视野技术评估健康受试者和格雷夫斯眼眶病（GO）患者记录单眼注视野的观察者内和观察者间可靠性。患有限制性肌病的患者，尤其是GO患者，需要准确测量单眼运动。这些眼球运动通过周边视野计在4至12个注视方向上记录，生成一个称为单眼注视野的图表。虽然4个方向的图表提供的关于垂直肌肉的信息有限，但记录12个方向既耗时又让人不适。这种改良技术使用与每块肌肉主要作用野相对应的6个注视方向。
一名观察者测量了35名年龄在20至60岁的健康受试者的改良单眼注视野，以确定所有眼球运动的正常范围和与年龄相关的范围。15名受试者由同一名观察者在5个不同时间进行测量，以确定观察者内的可重复性。第二名观察者对10名受试者进行测量，以确定观察者间的可重复性。将可靠性与29名GO患者的测量结果进行比较。
对于由一名观察者评估的健康受试者，该技术的可重复性在4度以内。当比较两名观察者的结果时，重复性系数为7.9度。然而，对于GO患者，最大变异性为7.8度。出于临床目的，只有8度或更大的变化才能被认为是显著的。
该技术在评估包括GO在内的任何限制性肌病方面具有优势，其准确性可达8度以内。这种准确度在其他中心可能相似，这对解释GO结局指标有影响，之前认为5度的变化具有显著意义。
