Glaucoma Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7959-65. doi: 10.1167/iovs.11-7868.
To develop an automated neurologic hemifield test (NHT) to detect visual field loss caused by chiasmal or postchiasmal lesions.
Visual field locations from 24-2 pattern automated visual fields were grouped into two symmetric regions with 16 points on either side of the vertical meridian. A scoring system similar to the Glaucoma Hemifield Test (GHT) was used to calculate point scores using the pattern deviation values from the right and left regions. The cross-vertical difference in the sum of these values was the NHT score. The NHT was evaluated using visual fields from subjects with known neurologic disease, subjects with glaucoma, and glaucoma suspects (92 pairs of eyes each). The NHT score was calculated for each eye. Four masked reviewers scored all pairs of visual fields with regard to the likelihood of neurologic and glaucomatous optic neuropathy. Both NHT score and expert field ratings were compared with clinical diagnosis by receiver operating characteristic (ROC) analysis.
The NHT effectively discriminated neurologic fields from those of glaucoma patients and glaucoma suspects (area under the ROC curve [AUC] = 0.90; 95% confidence interval [CI], 0.86-0.94). The NHT score correlated well with clinician grading (Pearson correlation estimates, 0.74-0.78). Even when field defects were subtle, the NHT had some ability to discriminate neurologic from nonneurologic fields (AUC 0.68; 95% CI, 0.56-0.79).
The NHT distinguished neurologic field defects from those of glaucoma and glaucoma suspects, rivaling the performance of subspecialist clinicians. Its implementation may help identify unsuspected neurologic disease.
开发一种自动化的神经视野测试（NHT），以检测视交叉或视交叉后病变引起的视野缺失。
将 24-2 模式自动视野的视野位置分为两个对称区域，每个区域在垂直子午线的两侧有 16 个点。使用类似于青光眼半视野测试（GHT）的评分系统，使用右侧和左侧区域的模式偏差值计算点评分。这些值的总和的纵横差就是 NHT 评分。使用已知神经疾病患者、青光眼患者和青光眼疑似患者的视野（每组 92 对眼睛）评估 NHT。计算每只眼睛的 NHT 评分。四名盲法评审员根据神经和青光眼视神经病变的可能性对所有配对视野进行评分。通过接收者操作特性（ROC）分析比较 NHT 评分和专家视野评分与临床诊断的关系。
NHT 能够有效地将神经视野与青光眼患者和青光眼疑似患者的视野区分开来（ROC 曲线下面积 [AUC] = 0.90；95%置信区间 [CI]，0.86-0.94）。NHT 评分与临床医生分级相关性良好（Pearson 相关估计值，0.74-0.78）。即使视野缺陷很细微，NHT 也有一定的能力将神经与非神经视野区分开来（AUC 为 0.68；95%CI，0.56-0.79）。
NHT 能够区分神经视野缺陷与青光眼和青光眼疑似患者的视野缺陷，与专科临床医生的表现相当。它的实施可能有助于发现未被怀疑的神经疾病。
