Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Ophthalmology. 2013 Nov;120(11):2217-25. doi: 10.1016/j.ophtha.2013.04.012. Epub 2013 Jun 25.
To assess the accuracy of using pupillary light reflex (PLR) in detecting glaucoma.
Glaucoma is a specific disease of the optic nerve and is often more severe in 1 eye. When large enough, this asymmetry in disease severity can cause a relative afferent pupillary defect (RAPD). Better detection of RAPDs may be one way to identify persons with glaucoma.
We searched Medline and Embase through June 2012 and searched bibliographies for relevant studies for additional references. Two authors independently reviewed all articles and selected studies that assessed PLRs in patients with glaucoma. We analyzed data using mixed-effect bivariate summary receiver operating characteristic meta-analysis models.
A total of 30 studies were included in this review. An RAPD was observed in 9% to 82% of patients with glaucoma. Eleven studies with a total of 7271 participants were included in the analysis, and the pooled estimate corresponded to a sensitivity of 0.63 (95% confidence interval [CI], 0.43-0.80) and a specificity of 0.93 (95% CI, 0.85-0.97). After excluding 2 studies that used the swinging flashlight test, the sensitivity increased to 0.74 (95% CI, 0.59-0.85) with a specificity of 0.85 (95% CI, 0.77-0.90). Study designs and different pupil measurement techniques explained part of the heterogeneity between studies.
Patients with glaucoma frequently have an abnormal PLR and comparing the responses between the 2 eyes can in part distinguish between those with glaucoma and those without the disease. Newer instruments and analytic approaches to assess pupil function may improve the performance of pupil screening.
评估瞳孔光反射（PLR）在检测青光眼方面的准确性。
青光眼是一种特定的视神经疾病，通常在 1 只眼睛中更为严重。当疾病的严重程度足够大时，这种不对称性会导致相对传入性瞳孔缺陷（RAPD）。更好地检测 RAPD 可能是识别青光眼患者的一种方法。
我们通过 2012 年 6 月在 Medline 和 Embase 上进行搜索，并通过检索相关研究的参考文献来获取其他参考文献。两位作者独立审查了所有文章，并选择了评估青光眼患者 PLR 的研究。我们使用混合效应双变量汇总受试者工作特征元分析模型分析数据。
本综述共纳入 30 项研究。9%至 82%的青光眼患者存在 RAPD。11 项研究共纳入 7271 名参与者，汇总估计的敏感性为 0.63（95%置信区间[CI]，0.43-0.80），特异性为 0.93（95%CI，0.85-0.97）。排除使用摆动闪光灯测试的 2 项研究后，敏感性增加至 0.74（95%CI，0.59-0.85），特异性为 0.85（95%CI，0.77-0.90）。研究设计和不同的瞳孔测量技术部分解释了研究之间的异质性。
青光眼患者常出现异常的 PLR，比较双眼的反应可以部分区分青光眼患者和非青光眼患者。评估瞳孔功能的新仪器和分析方法可能会提高瞳孔筛查的性能。
