Medved N, Cvenkel B
University Medical Centre, Eye Hospital Ljubljana, Zaloska 29a, 1525 Ljubljana, Slovenia.
Eur J Ophthalmol. 2007 Mar-Apr;17(2):216-22. doi: 10.1177/112067210701700211.
This study was designed to determine the specificity and sensitivity of the Heidelberg Retina Tomograph I (HRT) using the Moorfields Regression Analysis (MRA) in differentiating healthy from glaucomatous eyes.
In this cross-sectional study, 74 eyes of 37 healthy subjects and 87 eyes of 47 glaucoma patients were examined with Octopus standard automated perimetry and HRT. Only one eye per patient was used for statistical analysis. According to visual field index mean defect (MD) glaucoma patients were divided into three groups with early (MD < 6 dB), moderate (6 dB < MD < 12 dB), and advanced visual field loss (MD > 12 dB). The sensitivity and specificity of optic nerve head examinations using the MRA of HRT were evaluated by two criteria (criteria 1, as diseased if classified by MRA as outside normal limits; criteria 2, as diseased if classified by MRA as borderline). The correlations between the topographic parameters and visual field index MD were measured by correlation coefficient and presented by scatter plot.
The specificity and sensitivity of HRT-MRA examination were, respectively, 100% and 68.1% when borderline cases were considered normal (criteria 1) and 97.3% and 85.1% when borderline cases were considered glaucomatous (criteria 2). The sensitivity of the MRA in eyes with different stages of visual field loss was 59.1% for early, 54.5% for moderate, and 92.8% for advanced visual field loss with criteria 1; the figures were, respectively, 81.8%, 72.7%, and 100% with criteria 2. The statistically significant correlations with moderate strength of association (r = 0.40-0.59) were found for rim area, rim volume, cup to disc area ratio, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area.
The MRA showed an excellent specificity and good sensitivity using criteria 2 including as glaucomatous optic discs those classified by MRA as borderline. Although correlations of moderate strength were found between rim area, rim volume, mean RNFL thickness, RNFL cross-sectional area, and visual field index MD, great interindividual variation limits the prediction of one parameter from the other. Therefore, in clinical practice both structural and functional examinations should be performed in order to characterize glaucomatous damage.
本研究旨在确定使用海德堡视网膜断层扫描仪I（HRT）的 Moorfields回归分析（MRA）区分健康眼与青光眼眼的特异性和敏感性。
在这项横断面研究中，对37名健康受试者的74只眼和47名青光眼患者的87只眼进行了 Octopus标准自动视野计和HRT检查。每位患者仅使用一只眼进行统计分析。根据视野指数平均缺损（MD），将青光眼患者分为三组，分别为早期（MD < 6 dB）、中度（6 dB < MD < 12 dB）和晚期视野缺损（MD > 12 dB）。使用HRT的MRA对视神经乳头检查的敏感性和特异性通过两个标准进行评估（标准1，若MRA分类为超出正常范围则判定为患病；标准2，若MRA分类为临界值则判定为患病）。通过相关系数测量地形参数与视野指数MD之间的相关性，并以散点图呈现。
当临界病例被视为正常时（标准1），HRT-MRA检查的特异性和敏感性分别为100%和68.1%；当临界病例被视为青光眼时（标准2），特异性和敏感性分别为97.3%和85.1%。对于标准1，MRA在不同视野缺损阶段眼中的敏感性分别为：早期59.1%、中度54.5%、晚期92.8%；对于标准2，相应数字分别为81.8%、72.7%和100%。发现视盘边缘面积、边缘体积、杯盘面积比、平均视网膜神经纤维层（RNFL）厚度和RNFL横截面积与视野指数MD之间存在中等强度的统计学显著相关性（r = 0.40 - 0.59）。
使用标准2（包括将MRA分类为临界值的视盘判定为青光眼性视盘）时，MRA显示出优异的特异性和良好的敏感性。尽管视盘边缘面积、边缘体积、平均RNFL厚度、RNFL横截面积与视野指数MD之间存在中等强度的相关性，但个体间差异较大，限制了通过一个参数预测另一个参数的能力。因此，在临床实践中，应同时进行结构和功能检查以明确青光眼性损害的特征。
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