使用虚拟现实环境评估青光眼患者的姿势控制
Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment.
作者信息
Diniz-Filho Alberto, Boer Erwin R, Gracitelli Carolina P B, Abe Ricardo Y, van Driel Nienke, Yang Zhiyong, Medeiros Felipe A
机构信息
Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Visual Performance Laboratory, Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands.
出版信息
Ophthalmology. 2015 Jun;122(6):1131-8. doi: 10.1016/j.ophtha.2015.02.010. Epub 2015 Apr 16.
PURPOSE
To evaluate postural control using a dynamic virtual reality environment and the relationship between postural metrics and history of falls in patients with glaucoma.
DESIGN
Cross-sectional study.
PARTICIPANTS
The study involved 42 patients with glaucoma with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects.
METHODS
Patients underwent evaluation of postural stability by a force platform during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles. The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire.
MAIN OUTCOME MEASURES
Torque moments around the center of foot pressure on the force platform were measured, and the standard deviations of the torque moments (STD) were calculated as a measurement of postural stability and reported in Newton meters (Nm). The association with history of falls was investigated using Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors.
RESULTS
Patients with glaucoma had larger overall STD than controls during both translational (5.12 ± 2.39 Nm vs. 3.85 ± 1.82 Nm, respectively; P = 0.005) and rotational stimuli (5.60 ± 3.82 Nm vs. 3.93 ± 2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in explaining history of falls compared with those obtained in static and dark field condition. In the multivariable model, STD values in the mediolateral direction during translational stimulus were significantly associated with a history of falls in patients with glaucoma (incidence rate ratio, 1.85; 95% confidence interval, 1.30-2.63; P = 0.001).
CONCLUSIONS
The study presented and validated a novel paradigm for evaluation of balance control in patients with glaucoma on the basis of the assessment of postural reactivity to dynamic visual stimuli using a virtual reality environment. The newly developed metrics were associated with a history of falls and may help to provide a better understanding of balance control in patients with glaucoma.
目的
使用动态虚拟现实环境评估青光眼患者的姿势控制，以及姿势指标与跌倒史之间的关系。
设计
横断面研究。
参与者
该研究纳入了42例在标准自动视野计（SAP）检查中有可重复性视野缺损的青光眼患者和38名健康对照者。
方法
患者在佩戴立体头戴式护目镜呈现静态和动态视觉刺激时，通过测力平台进行姿势稳定性评估。动态视觉刺激呈现旋转和平移的符合生态学效度的周边背景扰动。还在完全黑暗的环境中测试姿势稳定性，以评估体感和前庭对姿势控制的贡献。通过标准问卷评估跌倒史。
主要观察指标
测量测力平台上足压力中心周围的扭矩矩，并计算扭矩矩的标准差（STD）作为姿势稳定性的指标，以牛顿米（Nm）为单位报告。使用泊松回归模型研究与跌倒史的关联。将年龄、性别、体重指数、视野缺损严重程度、最佳矫正视力和黑暗环境下的STD作为混杂因素纳入。
结果
在平移刺激（分别为5.12±2.39 Nm对3.85±1.82 Nm；P = 0.005）和旋转刺激（分别为5.60±3.82 Nm对3.93±2.07 Nm；P = 0.022）期间，青光眼患者的总体STD均大于对照组。与在静态和黑暗环境下获得的指标相比，动态视觉刺激期间获得的姿势指标在解释跌倒史方面表现更好。在多变量模型中，平移刺激期间中外侧方向的STD值与青光眼患者的跌倒史显著相关（发病率比，1.85；95%置信区间，1.30 - 2.63；P = 0.001）。
结论
该研究提出并验证了一种基于使用虚拟现实环境评估对动态视觉刺激的姿势反应性来评估青光眼患者平衡控制的新范式。新开发的指标与跌倒史相关，可能有助于更好地理解青光眼患者的平衡控制。
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