Hamilton Glaucoma Center, Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Invest Ophthalmol Vis Sci. 2010 Jul;51(7):3531-9. doi: 10.1167/iovs.09-4350. Epub 2010 Mar 5.
PURPOSE. To evaluate and compare rates of change in neuroretinal rim area (RA) and retinal nerve fiber layer thickness (RNFLT) measurements in glaucoma patients, those with suspected glaucoma, and normal subjects observed over time. METHODS. In this observational cohort study, patients recruited from two longitudinal studies (Diagnostic Innovations in Glaucoma Study-DIGS and African Descent and Evaluation Study-ADAGES) were observed with standard achromatic perimetry (SAP), optic disc stereophotographs, confocal scanning laser ophthalmoscopy (HRT-3; Heidelberg Engineering, Heidelberg, Germany), and scanning laser polarimetry (GDx-VCC; Carl Zeiss Meditec, Inc., Dublin, CA). Glaucoma progression was determined by the Guided Progression Analysis software for standard automated perimetry [SAP] and by masked assessment of serial optic disc stereophotographs by expert graders. Random-coefficients models were used to evaluate rates of change in average RNFLT and global RA measurements and their relationship with glaucoma progression. RESULTS. At baseline, 194 (31%) eyes were glaucomatous, 347 (55%) had suspected glaucoma, and 88 (14%) were normal. Forty-six (9%) eyes showed progression by SAP and/or stereophotographs, during an average follow-up of 3.3 (+/-0.7) years. The average rate of decline for RNFLT measurements was significantly higher in the progressing group than in the nonprogressing group (-0.65 vs. -0.11 microm/y, respectively; P < 0.001), whereas RA decline was not significantly different between these groups (-0.0058 vs. -0.0073 mm(2)/y, respectively; P = 0.727). The areas under the receiver operating characteristic (ROC) curves used to discriminate progressing versus nonprogressing eyes were 0.811 and 0.507 for the rates of change in the RNFLT and RA, respectively (P < 0.001). CONCLUSIONS. The ability to discriminate eyes with progressing glaucoma by SAP and/or stereophotographs from stable eyes was significantly greater for RNFLT than for RA measurements.
目的。评估并比较一段时间后青光眼患者、疑似青光眼患者和正常受试者的神经视网膜边缘区（RA）和视网膜神经纤维层厚度（RNFLT）测量值的变化率。
方法。在这项观察性队列研究中，从两项纵向研究（诊断创新在青光眼研究-DIGS 和非裔美国人评估研究-ADAGES）招募的患者接受标准的全色视野计（SAP）、视盘立体照相、共焦扫描激光检眼镜（HRT-3；海德堡工程，海德堡，德国）和扫描激光偏振计（GDx-VCC；卡尔蔡司 Meditec，Inc.，都柏林，CA）检查。青光眼进展通过标准自动视野计 [SAP] 的引导进展分析软件以及专家分级员对连续视盘立体照片的盲法评估来确定。随机系数模型用于评估平均 RNFLT 和全局 RA 测量值的变化率及其与青光眼进展的关系。
结果。在基线时，194 只（31%）眼为青光眼，347 只（55%）疑似青光眼，88 只（14%）正常。46 只（9%）眼通过 SAP 和/或立体照片显示进展，平均随访 3.3（+/-0.7）年。进展组的 RNFLT 测量值下降速度明显高于非进展组（分别为-0.65 和-0.11 µm/y；P<0.001），而两组之间的 RA 下降速度无显著差异（分别为-0.0058 和-0.0073 mm²/y；P=0.727）。用于区分进展眼和非进展眼的接收器操作特性（ROC）曲线下面积分别为 0.811 和 0.507，用于 RNFLT 和 RA 变化率的区分（P<0.001）。
结论。通过 SAP 和/或立体照片区分进展性青光眼眼和稳定眼的能力，RNFLT 明显优于 RA 测量值。
