Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California, USA.
Ophthalmology. 2013 Aug;120(8):1533-40. doi: 10.1016/j.ophtha.2013.01.032. Epub 2013 May 1.
To evaluate the role of corneal hysteresis (CH) as a risk factor for the rate of visual field progression in a cohort of patients with glaucoma followed prospectively over time.
Prospective observational cohort study.
The study group included 114 eyes of 68 patients with glaucoma followed for an average of 4.0 ± 1.1 years. Visual fields were obtained with standard automated perimetry. Included eyes had a median number of 7 (range, 5-12) tests during follow-up.
The CH measurements were acquired at baseline using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Evaluation of rates of visual field change during follow-up was performed using the visual field index (VFI). Linear mixed models were used to investigate the relationship between rates of visual field loss and baseline CH, baseline intraocular pressure (IOP), and central corneal thickness (CCT), while adjusting for potentially confounding factors. An interaction term between IOP and CH was included in the model to investigate whether the effect of IOP on rates of progression depended on the level of CH.
Effects of CH, IOP, and CCT on rates of VFI loss over time.
The CH had a significant effect on rates of visual field progression over time. In the univariable model including only CH as a predictive factor along with time and their interaction, each 1 mmHg lower CH was associated with a 0.25%/year faster rate of VFI decline over time (P<0.001). The multivariable model showed that the effect of IOP on rates of progression depended on CH. Eyes with high IOP and low CH were at increased risk for having fast rates of disease progression. The CH explained a larger proportion of the variation in slopes of VFI change than CCT (17.4% vs. 5.2%, respectively).
The CH measurements were significantly associated with risk of glaucoma progression. Eyes with lower CH had faster rates of visual field loss than those with higher CH. The prospective longitudinal design of this study supports the role of CH as an important factor to be considered in the assessment of the risk of progression in patients with glaucoma.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
评估角膜滞后（CH）作为前瞻性随时间随访的青光眼患者视野进展率的风险因素的作用。
前瞻性观察性队列研究。
研究组包括 68 例患者的 114 只眼，平均随访 4.0±1.1 年。使用标准自动视野计获得视野。纳入的眼睛在随访过程中有中位数为 7（范围为 5-12）次测试。
在基线时使用眼反应分析仪（Reichert Instruments，Depew，NY）获取 CH 测量值。使用视野指数（VFI）评估随访期间视野变化的速度。线性混合模型用于研究基线 CH、基线眼压（IOP）和中央角膜厚度（CCT）与视野丧失率之间的关系，同时调整潜在的混杂因素。模型中包含了 IOP 和 CH 之间的交互项，以研究 IOP 对进展速度的影响是否取决于 CH 的水平。
CH、IOP 和 CCT 对随时间变化的 VFI 丧失率的影响。
CH 对随时间的视野进展速度有显著影响。在仅包括 CH 作为预测因素以及时间及其交互作用的单变量模型中，CH 每降低 1mmHg，VFI 每年下降速度就会增加 0.25%（P<0.001）。多变量模型显示，IOP 对进展速度的影响取决于 CH。高眼压和低 CH 的眼睛发生疾病快速进展的风险增加。CH 比 CCT 更能解释 VFI 变化斜率的变异性（分别为 17.4%和 5.2%）。
CH 测量值与青光眼进展风险显著相关。CH 较低的眼睛比 CH 较高的眼睛视野丧失速度更快。本研究的前瞻性纵向设计支持 CH 作为评估青光眼患者进展风险的重要因素的作用。
