Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
Invest Ophthalmol Vis Sci. 2013 Sep 19;54(9):6234-41. doi: 10.1167/iovs.13-11680.
A variety of pointwise linear regression (PLR) criteria have been proposed for determining glaucomatous visual field progression. However, alternative PLR criteria have only been assessed on a limited basis. The purpose of this study was to evaluate a range of PLR slope and significance criteria to define a clinically useful progression decision rule for longitudinal visual field examinations.
Visual field data for each of 140 eyes (one per participant among 96 cases and 44 controls) were evaluated using the Humphrey Field Analyzer II program 24-2 Swedish interactive thresholding algorithm standard test strategy and Goldmann size III stimuli. The pointwise linear regression A2 (PLRA2) method was used to analyze the data, which included nine visual field examinations performed every 6 months for 4 years. Data from the Ocular Hypertension Treatment Study (OHTS) were used to validate the decision rule.
Several slope criteria produced specificities of 0.90 or higher, particularly slope criteria of less than -1.2 dB/y. The use of the slope criterion less than -1.2 dB/y at a significance level of P < 0.04 for classification resulted in a hit rate of 0.38, more than a 2-fold increase compared with a commonly used standard slope criterion of less than -1.0 dB/y at a significance level of P < 0.01. A similar increase in the hit rate was shown for a slope of less than -1.2 dB/y and P < 0.04 compared with the standard criterion in the independent OHTS validation data.
When systematically evaluating criteria for detecting glaucoma progression, PLR criteria can be refined by requiring a stricter slope criterion such as less than -1.2 dB/y and relaxing the significance criterion to P < 0.04. Increasing the hit rate of PLR will be useful for early detection and treatment of glaucoma.
已经提出了多种用于确定青光眼视野进展的逐点线性回归（PLR）标准。然而，替代的 PLR 标准仅在有限的基础上进行了评估。本研究的目的是评估一系列 PLR 斜率和显著性标准，以定义用于纵向视野检查的临床有用的进展决策规则。
使用 Humphrey Field Analyzer II 程序 24-2 瑞典交互式阈值算法标准测试策略和 Goldmann 大小 III 刺激物，对 96 例病例和 44 例对照中的每例 140 只眼（每位参与者 1 只眼）的视野数据进行评估。使用逐点线性回归 A2（PLRA2）方法分析数据，其中包括 4 年内每 6 个月进行的 9 次视野检查。使用眼高压治疗研究（OHTS）的数据来验证决策规则。
几种斜率标准的特异性达到 0.90 或更高，特别是斜率标准小于-1.2 dB/y。在显著性水平 P<0.04 下使用斜率标准小于-1.2 dB/y进行分类，其命中率为 0.38，与通常使用的显著性水平 P<0.01 的斜率标准小于-1.0 dB/y相比，命中率提高了两倍以上。在独立的 OHTS 验证数据中，斜率标准小于-1.2 dB/y 和 P<0.04 与标准标准相比，命中率也有类似的提高。
在系统评估用于检测青光眼进展的标准时，可以通过要求更严格的斜率标准（如小于-1.2 dB/y）和放宽显著性标准至 P<0.04 来细化 PLR 标准。提高 PLR 的命中率将有助于青光眼的早期发现和治疗。
