Bagga Harmohina, Feuer William J, Greenfield David S
Department of Ophthalmology, University of Miami School of Medicine, Bascom Palmer Eye Institute, Miami, Fla 33418, USA.
Arch Ophthalmol. 2006 Feb;124(2):169-76. doi: 10.1001/archopht.124.2.169.
To compare the prevalence of structural and psychophysical abnormalities in normal eyes and eyes with glaucomatous optic neuropathy (GON) and normal standard automated perimetry (SAP).
Complete examination, SAP, short-wavelength automated perimetry (SWAP), frequency doubling technology (FDT), scanning laser polarimetry (GDx-VCC), and optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (RNFL), optic disc, and macula were performed. Glaucomatous optic neuropathy was defined as cup-disc asymmetry between fellow eyes of greater than 0.2, rim thinning, notching, excavation, or RNFL defect. All eyes had normal SAP. Abnormal measurements on OCT, GDx-VCC, SWAP, and FDT were defined as those outside 95% normal limits. Eyes were stratified into 3 groups based on the OCT-generated vertical cup-disc ratio: mild, moderate, and advanced cupping (cup-disc ratio of <0.4, 0.4-0.7, and >0.7, respectively). Receiver operating characteristic curves were developed to assess sensitivity and specificity of structural and functional assessments.
Forty-seven eyes of 47 patients (25 with GON and 22 normal) were enrolled (mean +/- SD age, 58 +/- 16 years; range, 25-83 years). Compared with normal eyes, eyes with GON had significantly worse mean deviation and pattern standard deviation by means of SWAP and FDT (P = .02-.05); OCT-derived mean and superior and inferior RNFL thickness (P = .008, <.001, and .05, respectively); mean macular thickness (P = .01), rim volume, rim area, cup-disc ratio, and cup area (all P<.001); and GDx-VCC nerve fiber indicator and inferior average (P = .03). There was a significantly (P = .008, .002, .003, and .01, respectively) greater prevalence of abnormalities identified by SWAP, FDT, OCT and GDx-VCC in eyes with advanced cupping (43%, 43%, 57%, and 57%, respectively) compared with mild cupping (0%) and moderate cupping (9%, 5%, 19%, and 33%, respectively).
Eyes with GON and normal results of SAP have significantly greater structural and psychophysical abnormalities than do normal eyes evaluated by means of OCT, GDx-VCC, SWAP, and FDT. Eyes with increased vertical cup-disc ratio are more likely to manifest such abnormalities on advanced diagnostic testing.
比较正常眼与患有青光眼性视神经病变（GON）且标准自动视野计（SAP）结果正常的眼睛中结构和心理物理学异常的患病率。
对患者进行全面检查、SAP、短波长自动视野计（SWAP）、频率加倍技术（FDT）、扫描激光偏振仪（GDx-VCC）以及视乳头周围视网膜神经纤维层（RNFL）、视盘和黄斑的光学相干断层扫描（OCT）。青光眼性视神经病变定义为双眼杯盘不对称大于0.2、边缘变薄、切迹、凹陷或RNFL缺损。所有眼睛的SAP结果均正常。OCT、GDx-VCC、SWAP和FDT的异常测量值定义为超出95%正常范围的值。根据OCT生成的垂直杯盘比将眼睛分为3组：轻度、中度和重度杯状凹陷（杯盘比分别为<0.4、0.4 - 0.7和>0.7）。绘制受试者工作特征曲线以评估结构和功能评估的敏感性和特异性。
纳入47例患者的47只眼睛（25只患有GON，22只正常）（平均±标准差年龄，58±16岁；范围，25 - 83岁）。与正常眼睛相比，患有GON的眼睛通过SWAP和FDT测量的平均偏差和模式标准差明显更差（P = 0.02 - 0.05）；OCT测量的平均、上方和下方RNFL厚度（分别为P = 0.008、<0.001和0.05）；平均黄斑厚度（P = 0.01）、边缘体积、边缘面积、杯盘比和杯面积（均P<0.001）；以及GDx-VCC神经纤维指标和下方平均值（P = 0.03）。与轻度杯状凹陷（0%）和中度杯状凹陷（分别为9%、5%、19%和33%）相比，重度杯状凹陷的眼睛中通过SWAP、FDT、OCT和GDx-VCC检测到的异常患病率显著更高（分别为43%、43%、57%和57%）（分别为P = 0.008、0.002、0.003和0.01）。
患有GON且SAP结果正常的眼睛与通过OCT、GDx-VCC、SWAP和FDT评估的正常眼睛相比，具有明显更多的结构和心理物理学异常。垂直杯盘比增加的眼睛在先进的诊断测试中更有可能表现出此类异常。
