Babalola O E
Rachel Eye Center, Plot 897, Gimbiva Street, Garki 11, P.O. Box 4108, Garki, Abuja, Nigeria.
Afr J Med Med Sci. 2005 Jun;34(2):119-24.
Perimetry is essential in the clinical management and evaluation of glaucoma patients and other patients with diseases impacting on visual fields, but automated equipment may be too expensive for many practitioners in the developing world. I have used the Wu-Jones automated motion sensitivity system in a medium sized practice in Nigeria, a developing country, and hereby present an audit of our experience with it. The Wu-Jones Motion Sensitivity screening test is a lap-top computer based test which integrates a number of components including a test program and reporting facility, a self organizing neural network, a database management mechanism, and a menu-mouse-windowing user interface. The test is available on the public domain and is small enough (194 mb) to fit into a diskette. This test has been used at the Rachel Eye Center in Abuja since 1998, and has been applied to 339 individuals, 298 of whom are included in this analysis. Patients tested fell into four main groups: those with clinical glaucoma (intraocular pressure > 20 mmHg on at least one occasion and optic cup/disc ratio of 0.5 or more), glaucoma suspects, (i.e. ocular hypertensives >20 mmHg or c/d ratio of 0.5 or more and first degree relatives of glaucoma patients) patients undergoing routine tests for pre-employment ('normals'), and 'others'. These 'normals' were used as controls. Records are available for 531 eyes. It took an average of two minutes to complete the test. Significant field defects (Motion sensitivity less than 50%) were detected overall in 15.6% of tested eyes, 7.2% of normals but in 32.6% of glaucoma eyes. Using the 'normals' as controls, the sensitivity of the test in our hands varied from 33% to 72% and specificity from 57% to 93% at motion sensitivity cut off points from 50% to 97%. At the 83% cut off point, positive and negative predictive values were 86.0% and 47.5% respectively. Reliability averaged 70%. I find the test easy to administer and understand by patients. Results can be recalled without difficulty, facilitating the longitudinal follow up process. This test will be of value to practices in the third world unable to afford more expensive equipment in the third world. The main investment would be in form of a laptop computer and a diskette. It can also be a useful adjunct for office practice in the western world.
视野检查对于青光眼患者及其他患有影响视野疾病的患者的临床管理和评估至关重要，但对于发展中国家的许多从业者来说，自动化设备可能过于昂贵。我在尼日利亚（一个发展中国家）的一家中等规模诊所使用了吴氏自动运动敏感度系统，在此介绍我们使用该系统的经验审核情况。吴氏运动敏感度筛查测试是一种基于笔记本电脑的测试，它集成了多个组件，包括测试程序和报告工具、自组织神经网络、数据库管理机制以及菜单 - 鼠标 - 窗口式用户界面。该测试可在公共领域获取，体积小（194兆字节），可存储在软盘上。自1998年以来，这项测试一直在阿布贾的瑞秋眼科中心使用，已应用于339人，其中298人纳入本分析。接受测试的患者分为四个主要组：临床青光眼患者（至少一次眼压>20毫米汞柱且视杯/视盘比为0.5或更高）、青光眼疑似患者（即眼压>20毫米汞柱或杯盘比为0.5或更高的高眼压患者以及青光眼患者的一级亲属）、接受入职前常规检查的患者（“正常人”）以及“其他患者”。这些“正常人”用作对照。现有531只眼睛的记录。完成测试平均需要两分钟。在所有接受测试的眼睛中，总体上检测到显著的视野缺损（运动敏感度低于50%）的比例为15.6%，正常人为7.2%，但青光眼患者为32.6%。以“正常人”作为对照，在运动敏感度截止点从50%到97%时，我们使用该测试的敏感度从33%到72%不等，特异度从57%到93%不等。在83%的截止点，阳性预测值和阴性预测值分别为86.0%和47.5%。可靠性平均为70%。我发现该测试易于患者操作和理解。结果可以轻松调出，便于进行纵向随访。这项测试对于第三世界无力购买更昂贵设备的诊所具有价值。主要投资将是一台笔记本电脑和一张软盘的形式。它对于西方世界的门诊实践也可能是一种有用的辅助工具。
