Brusini Paolo
Department of Ophthalmology, Santa Maria della Misericordia Hospital, Udine (Italy), Piazzale S. Maria della Misericordia, 15 33100 Udine, Italy.
Prog Brain Res. 2008;173:59-73. doi: 10.1016/S0079-6123(08)01106-0.
Monitoring progression is fundamental in managing patients with chronic open-angle glaucoma, which is as important as an early diagnosis of the disease. It is essential that both structural and functional damage be considered, in order to assure a complete and reliable assessment of progression. The optic disc and retinal nerve fiber layer damage can be evaluated using either low-tech (slit lamp biomicroscopy with a 78-diopter lens) or high-tech (HRT, OCT, GDx) methods; the latter providing a more objective and standardized analysis. The current gold standard in detecting functional damage is using standard automated perimetry (SAP). Different approaches can be used to assess SAP progression: (1) clinical judgment; (2) defect classification systems; (3) trend analysis; and, (4) event analysis. Several statistical programs are currently available to assist the ophthalmologist in the difficult task of assessing progression. Clinically relevant progression should only be considered when the change--be it structural and/or functional--is statistically significant, reproducible, and indicative of glaucomatous damage.
监测病情进展是慢性开角型青光眼患者管理的基础，这与该疾病的早期诊断同样重要。为确保对病情进展进行全面且可靠的评估，必须同时考虑结构和功能损害。视盘和视网膜神经纤维层损害可通过低技术方法（使用78屈光度透镜的裂隙灯生物显微镜检查）或高技术方法（HRT、OCT、GDx）进行评估；后者能提供更客观和标准化的分析。检测功能损害的当前金标准是使用标准自动视野计（SAP）。可采用不同方法评估SAP进展：（1）临床判断；（2）缺损分类系统；（3）趋势分析；以及（4）事件分析。目前有几种统计程序可协助眼科医生完成评估病情进展这项艰巨任务。只有当结构和/或功能变化具有统计学意义、可重复且表明青光眼损害时，才应考虑具有临床相关性的病情进展。
