与 2008 年相比，2010 年在英国牛津，青光眼的诊断更早。

There is a trend for the diagnosis of glaucoma to be made at an earlier stage in 2010 compared to 2008 in Oxford, United Kingdom.

机构信息

Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.

出版信息

Ophthalmic Physiol Opt. 2013 Mar;33(2):179-82. doi: 10.1111/opo.12030.

DOI:10.1111/opo.12030

PMID:23406491

Abstract

PURPOSE

New guidelines on glaucoma diagnosis and management were published by the National Institute of Clinical Excellence (NICE) in 2009. The aim of this study was to determine whether these guidelines on glaucoma referral have changed the numbers of patients diagnosed with glaucoma in Oxford and whether the severity of disease at presentation has altered between 2008 and 2010.

METHODS

A retrospective study was undertaken of patients referred to a glaucoma case-finding clinic at the Oxford Eye Hospital in 2008 and 2010. Severity of glaucoma was assigned on the basis of the worse eye and defined according to mean deviation (MD) on 24-2 Humphrey visual field testing, with early glaucomatous visual field defects defined as MD less than -6 dB, moderate defects as MD between -6 and -12 dB and severe defects as MD more than -12 dB. Statistical analysis was undertaken using Chi squared and Mann Whitney tests.

RESULTS

The number of referrals to this clinic increased from 521 patients in 2008, to 895 patients in 2010. 85 (16.3%) patients were diagnosed with ocular hypertension in 2008, compared to 144 (16.1%) in 2010. The number of patients diagnosed with glaucoma increased from 94 cases in 2008 to 113 cases in 2010, although the percentage of referrals diagnosed with glaucoma fell from 18.1% to 12.6%. More patients diagnosed with glaucoma in 2010 had early disease (61.9% in 2010 vs 48.8% in 2008, p = 0.03). Patients found to have glaucoma in 2010 had less severe visual field defects than in 2008: patients presented with a lower mean deviation (-6.36 dB in 2010, -7.95 dB in 2008, p = 0.03) and lower pattern standard deviation (5.44 dB in 2010, 6.64 dB in 2008, p = 0.02). However, there was no significant difference between age of presentation (65.1 years in 2010, 65.2 years in 2008, p = 0.82), and IOP (21.62 mmHg in 2010, 23.15 mmHg in 2008, p = 0.22).

CONCLUSIONS

There has been a significant increase in number of referrals to the glaucoma case-finding clinic in Oxford between 2008 and 2010. The introduction of NICE referral guidelines in 2009 has had the benefit of increasing the absolute number of patients detected with glaucoma and has resulted in more patients being diagnosed with early disease. More effort needs to be made to reduce the number of false positive referrals. In addition, the guidelines on referral of individuals with ocular hypertension need to be reconsidered.

摘要

目的

国家临床优化研究所（NICE）于 2009 年发布了青光眼诊断和管理新指南。本研究旨在确定这些青光眼转诊指南是否改变了牛津地区被诊断为青光眼的患者数量，以及 2008 年至 2010 年间就诊时疾病的严重程度是否发生了变化。

方法

对 2008 年和 2010 年在牛津眼科医院青光眼病例发现诊所就诊的患者进行回顾性研究。根据最差眼的情况来确定青光眼的严重程度，并根据 24-2 Humphrey 视野测试的平均偏差（MD）来定义，早期青光眼视野缺损定义为 MD 小于-6 dB，中度缺损为 MD 在-6 和-12 dB 之间，严重缺损为 MD 大于-12 dB。使用卡方和曼-惠特尼检验进行统计分析。

结果

该诊所的转诊人数从 2008 年的 521 人增加到 2010 年的 895 人。2008 年有 85 例（16.3%）患者被诊断为眼压升高，而 2010 年有 144 例（16.1%）。2008 年诊断为青光眼的患者人数从 94 例增加到 113 例，但转诊被诊断为青光眼的患者比例从 18.1%下降到 12.6%。2010 年诊断为青光眼的患者中早期疾病的比例更高（61.9%，2010 年 vs. 48.8%，2008 年，p = 0.03）。2010 年被诊断为青光眼的患者视野缺损程度低于 2008 年：患者的平均偏差值较低（-6.36 dB，2010 年；-7.95 dB，2008 年，p = 0.03），模式标准差较低（5.44 dB，2010 年；6.64 dB，2008 年，p = 0.02）。然而，就诊时的年龄（65.1 岁，2010 年；65.2 岁，2008 年，p = 0.82）和眼压（21.62 mmHg，2010 年；23.15 mmHg，2008 年，p = 0.22）之间没有显著差异。