Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada.
JAMA. 2013 May 15;309(19):2035-42. doi: 10.1001/jama.2013.5099.
Glaucoma is the second leading cause of blindness worldwide, and its insidious onset is often associated with diagnostic delay. Since glaucoma progression can often be effectively diminished when treated, identifying individuals at risk for glaucoma could potentially lead to earlier detection and prevent associated vision loss.
To quantify the diagnostic accuracy of examination findings and relevant risk factors in identifying individuals with primary open-angle glaucoma (POAG), the most common form of glaucoma in North America.
Structured Medline (January 1950-January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies.
Population-based studies of high-level methods relating relevant examination findings of cup-to-disc ratio (CDR), CDR asymmetry, intraocular pressure (IOP), and demographic risk factors to the presence of POAG.
The summary prevalence of glaucoma in the highest-quality studies was 2.6% (95% CI, 2.1%-3.1%). Among risk factors evaluated, high myopia (≥6 diopters; odds ratio [OR], 5.7; 95% CI, 3.1-11) and family history (OR, 3.3; 95% CI, 2.0-5.6) had the strongest association with glaucoma. Black race (OR, 2.9; 95% CI, 1.4-5.9) and increasing age (especially age >80 years; OR, 2.9; 95% CI, 1.9-4.3) were also associated with an increased risk. As CDR increased, the likelihood for POAG increased with a likelihood ratio (LR) of 14 (95% CI, 5.3-39) for CDR of 0.7 or greater. Increasing CDR asymmetry was also associated with an increased likelihood for POAG (CDR asymmetry ≥0.3; LR, 7.3; 95% CI, 3.3-16). No single threshold for CDR or asymmetry ruled out glaucoma. The presence of a disc hemorrhage (LR, 12; 95% CI, 2.9-48) was highly suggestive of glaucoma, but the absence of a hemorrhage was nondiagnostic (LR, 0.94; 95% CI, 0.83-0.98). At the commonly used cutoff for high IOP (≥22), the LR was 13 (95% CI, 8.2-17), while lower IOP made glaucoma less likely (LR, 0.65; 95% CI, 0.55-0.76). We found no studies of screening examinations performed by generalist physicians in a routine setting.
Individual findings of increased CDR, CDR asymmetry, disc hemorrhage, and elevated IOP, as well as demographic risk factors of family history, black race, and advanced age are associated with increased risk for POAG, but their absence does not effectively rule out POAG. The best available data support examination by an ophthalmologist as the most accurate way to detect glaucoma.
青光眼是全球第二大致盲原因，其隐匿性发病常常导致诊断延迟。由于青光眼的进展在治疗时通常可以得到有效控制，因此识别出患有青光眼的高危人群可能有助于更早地发现疾病并预防相关的视力丧失。
评估检查结果和相关风险因素对原发性开角型青光眼（北美最常见的青光眼类型）患者的诊断准确性。
通过对 Medline 进行结构检索（1950 年 1 月至 2013 年 1 月），以及对检索到的文章的参考文献和引文进行手工检索，共从 41 项研究中获得 57 篇文章。
针对杯盘比（CDR）、CDR 不对称、眼内压（IOP）和人口统计学风险因素与原发性开角型青光眼之间相关性的高水准方法的基于人群的研究。
在最高质量的研究中，青光眼的综合患病率为 2.6%（95%置信区间，2.1%-3.1%）。在评估的风险因素中，高度近视（≥6 屈光度；比值比[OR]，5.7；95%置信区间，3.1-11）和家族史（OR，3.3；95%置信区间，2.0-5.6）与青光眼的相关性最强。黑种人（OR，2.9；95%置信区间，1.4-5.9）和年龄增长（尤其是年龄＞80 岁；OR，2.9；95%置信区间，1.9-4.3）也与风险增加相关。随着 CDR 的增加，POAG 的可能性也随之增加，比值比（LR）为 14（95%置信区间，5.3-39），CDR 为 0.7 或更高。CDR 不对称的增加也与 POAG 的可能性增加相关（CDR 不对称≥0.3；LR，7.3；95%置信区间，3.3-16）。没有单一的 CDR 或不对称阈值可以排除青光眼。盘状出血的存在（LR，12；95%置信区间，2.9-48）高度提示青光眼，但出血的不存在并不能排除青光眼（LR，0.94；95%置信区间，0.83-0.98）。在通常使用的高 IOP（≥22）截断值下，LR 为 13（95%置信区间，8.2-17），而较低的 IOP 使青光眼的可能性降低（LR，0.65；95%置信区间，0.55-0.76）。我们未发现一般内科医生在常规环境中进行筛查检查的研究。
CDR 增加、CDR 不对称、盘状出血和IOP 升高的个体发现，以及家族史、黑种人和年龄增长等人口统计学风险因素与 POAG 风险增加相关，但它们的缺失并不能有效地排除 POAG。目前最好的研究数据支持眼科医生进行检查，这是检测青光眼最准确的方法。
