Harizman Noga, Oliveira Cristiano, Chiang Allen, Tello Celso, Marmor Michael, Ritch Robert, Liebmann Jeffrey M
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York University School of Medicine, New York, NY 10003, USA.
Arch Ophthalmol. 2006 Nov;124(11):1579-83. doi: 10.1001/archopht.124.11.1579.
To determine whether the ISNT rule (that normal eyes show a characteristic configuration for disc rim thickness of inferior > or = superior > or = nasal > or = temporal), widely used for clinical evaluation of the optic nerve head, can differentiate normal from glaucomatous eyes.
All subjects underwent complete eye examination, including achromatic automated perimetry, simultaneous stereoscopic disc photography, and confocal scanning laser ophthalmoscopy. Subjects with normal eyes had no evidence of glaucoma or ocular hypertension and had normal perimetry measurements. Subjects with glaucoma had a reproducible visual field defect. One eye from each subject was randomly enrolled. The ISNT rule was assessed by masked evaluation of disc photographs at the 3, 6, 9, and 12 o'clock positions.
Sixty-six subjects with normal eyes (33 black and 33 white individuals) and 43 with open-angle glaucoma (15 black and 28 white individuals) were enrolled. The ISNT rule was intact in 52 (79%) of 66 normal eyes and 12 (28%) of 43 glaucomatous eyes (P<.001). Multiple logistic regression indicated that the odds ratio for glaucoma associated with violation of the ISNT rule was 6.04 (95% confidence interval, 1.74-20.95) after adjustment for age; race was not a confounder of this association.
The ISNT rule is useful in differentiating normal from glaucomatous optic nerves and is unaffected by race.
确定广泛用于视神经乳头临床评估的ISNT规则（即正常眼睛的视盘边缘厚度呈现下方≥上方≥鼻侧≥颞侧的特征性构型）能否区分正常眼和青光眼眼。
所有受试者均接受了全面的眼部检查，包括无色自动视野计检查、同步立体视盘照相和共焦扫描激光眼底镜检查。正常眼的受试者没有青光眼或高眼压的证据，且视野测量结果正常。青光眼受试者有可重复的视野缺损。从每个受试者中随机选取一只眼睛。通过对3点、6点、9点和12点位的视盘照片进行盲法评估来评估ISNT规则。
纳入了66名正常眼受试者（33名黑人和33名白人）和43名开角型青光眼受试者（15名黑人和28名白人）。66只正常眼中有52只（79%）ISNT规则完整，43只青光眼中有12只（28%）ISNT规则完整（P<0.001）。多因素逻辑回归分析表明，在调整年龄后，违反ISNT规则与青光眼相关的比值比为6.04（95%置信区间，1.74 - 20.95）；种族不是该关联的混杂因素。
ISNT规则有助于区分正常和青光眼性视神经，且不受种族影响。
