Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Mount Sinai School of Medicine, New York, New York.
Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology, New York Medical College, Valhalla, New York.
Ophthalmology. 2013 Mar;120(3):520-527. doi: 10.1016/j.ophtha.2012.08.018. Epub 2012 Nov 11.
To characterize the progression pattern of initial parafoveal scotomas (IPFSs) using cross-sectional and longitudinal 10-2 visual field (VF) data.
Retrospective, observational study.
Glaucoma patients with an IPFS in either hemifield based on 2 reliable 24-2 Swedish interactive threshold algorithm standard VFs (≥3 adjacent points with P<0.05 within the central 10° of fixation, 1 point or more with P<0.01 lying at the innermost paracentral points, and no scotoma outside the central 10°) and at least 2 10-2 VFs (first and last VFs 1 year or more apart).
To simulate a cohort with an extended follow-up, eyes with an IPFS were divided into subgroups based on the severity of glaucoma using their 10-2 VF pattern standard deviation (PSD). Cross-sectional data were used to create an average pattern deviation map that was generated by averaging pattern deviation map values of 10-2 VF point-by-point within each subgroup. Longitudinal data (eyes with 5 or more 10-2 VFs) was used to perform pointwise linear regression analysis of pattern deviation values. Patterns of IPFS progression were identified from these cross-sectional and longitudinal assessments.
Average pattern deviation maps (cross-sectional) and maps of progression rates (longitudinal) in different disease severity subgroups.
Eighty eyes (80 patients) and 40 eyes (40 patients) with an IPFS were included for cross-sectional and longitudinal analyses, respectively. The mean age ± standard deviation, 24-2 VF mean deviation, and 24-2 VF PSD for all eyes were 63±10 years, -3.27±2.18 dB, and 5.46±2.40 dB, respectively. Based on maps generated in both cross-sectional and longitudinal analyses, IPFS in the superior hemifield had an arcuate pattern initially that later deepened approximately 3° to 5° above fixation. The scotoma then elongated toward the physiologic blind spot and spread toward the nasal periphery, sparing the area corresponding to the papillomacular bundle. The IPFS in the inferior hemifield had a similar pattern, but was slightly farther from fixation.
Superior and inferior IPFS have a similar characteristic pattern of progression, although the latter tend to be farther from fixation. Understanding these patterns should help in the management of such patients and in improving VF testing algorithms.
利用横断和纵向 10-2 视野（VF）数据，描述初始旁中心暗点（IPFS）的进展模式。
回顾性、观察性研究。
根据 2 个可靠的 24-2 瑞典交互式阈值算法标准 VF（注视中央 10°内至少 3 个相邻点，P<0.05，最内旁中心点 1 个或更多点，P<0.01，中央 10°以外无暗点），且至少有 2 个 10-2 VF（第一次和最后一次 VF 间隔 1 年或以上），在每个半视野中存在 IPFS 的青光眼患者。
为了模拟一个具有扩展随访的队列，根据 10-2 VF 模式标准偏差（PSD），将存在 IPFS 的眼睛分为亚组，以模拟疾病严重程度。横断数据用于创建平均模式偏差图，该图通过在每个亚组内逐点平均 10-2 VF 点的模式偏差图值来生成。纵向数据（5 个或更多 10-2 VF 的眼睛）用于对模式偏差值进行逐点线性回归分析。从这些横断和纵向评估中确定 IPFS 进展的模式。
不同疾病严重程度亚组的平均模式偏差图（横断）和进展率图（纵向）。
共有 80 只眼（80 例患者）和 40 只眼（40 例患者）纳入横断和纵向分析，所有眼的平均年龄±标准差、24-2 VF 平均偏差和 24-2 VF PSD 分别为 63±10 岁、-3.27±2.18 dB 和 5.46±2.40 dB。基于横断和纵向分析生成的地图，上半视野的 IPFS 最初呈弓形，随后在注视上方加深约 3°至 5°。然后，暗点向生理盲点延长并向鼻侧周围扩散，避开与乳头黄斑束相对应的区域。下半视野的 IPFS 也有类似的模式，但距离注视点稍远。
上、下 IPFS 具有相似的进展特征模式，尽管后者距离注视点稍远。了解这些模式有助于管理此类患者，并改进 VF 测试算法。
