Foulsham W S, Fu L, Tatham A J
Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of Edinburgh, Edinburgh, UK.
Forth Valley Royal Hospital, Larbert, UK.
Eye (Lond). 2015 Oct;29(10):1353-9. doi: 10.1038/eye.2015.156. Epub 2015 Aug 28.
Trend-based analyses examining rates of visual field (VF) loss in glaucoma are useful for predicting risk of vision-related morbidity. Although patients with faster losses are likely to require treatment escalation, little is known about rates that might trigger a decision to intervene surgically. The aims of this study were to investigate prior rates of VF loss in patients attending for trabeculectomy and to estimate, in the absence of surgical intervention, lifetime risk of visual impairment, and blindness.
A retrospective analysis of 117 eyes of 86 consecutive patients with glaucoma attending for trabeculectomy, including 53 patients referred from general ophthalmology clinics and 33 patients from specialist glaucoma clinics. Rates of change in standard automated perimetry mean deviation were examined using linear regression and random coefficient models. Risk of lifetime visual impairment and blindness was calculated using life expectancy data.
Mean age at surgery was 71.0±9.7 years. Patients were followed for 10.7±7.5 years prior to surgery with an average of seven useable fields per eye. On average patients referred from general clinics lost 1.04 dB/year compared with 0.77 dB/year in those referred from glaucoma clinics (P=0.070). Patients referred from general clinics had more medication changes prior to surgery (3.4 and 2.6 changes, respectively; P=0.004). Given Scottish life expectancy data, untreated, 61 eyes (52%) would have passed the threshold for visual impairment, whereas 40 (34%) would have passed the threshold demarcating blindness.
Patients attending for trabeculectomy had faster average rates of field loss prior to surgery than published values for the general glaucoma population with over one-third of eyes studied predicted to have become blind without intervention. Those managed by glaucoma specialists had fewer changes in medication and tended to slower rates of VF loss, although the latter did not reach statistical significance.
基于趋势的分析研究青光眼患者视野（VF）丧失率，有助于预测视力相关发病风险。虽然视野丧失较快的患者可能需要加强治疗，但对于可能触发手术干预决策的丧失率知之甚少。本研究的目的是调查接受小梁切除术患者先前的视野丧失率，并在不进行手术干预的情况下估计视力损害和失明的终生风险。
对连续86例接受小梁切除术的青光眼患者的117只眼进行回顾性分析，其中包括53例从普通眼科诊所转诊的患者和33例从青光眼专科诊所转诊的患者。使用线性回归和随机系数模型检查标准自动视野计平均偏差的变化率。使用预期寿命数据计算终生视力损害和失明的风险。
手术时的平均年龄为71.0±9.7岁。患者在手术前接受了10.7±7.5年的随访，每只眼平均有7个可用视野。平均而言，从普通诊所转诊的患者每年丧失1.04dB，而从青光眼诊所转诊者为每年0.77dB（P=0.070）。从普通诊所转诊的患者在手术前有更多的用药变化（分别为3.4次和2.6次变化；P=0.004）。根据苏格兰的预期寿命数据，未经治疗的话，61只眼（52%）会超过视力损害阈值，而40只眼（34%）会超过界定失明的阈值。
接受小梁切除术的患者在手术前的平均视野丧失率比已发表的普通青光眼人群的值要快，超过三分之一接受研究的眼如果不干预预计会失明。由青光眼专科医生管理的患者用药变化较少，视野丧失率往往较慢，尽管后者未达到统计学意义。
