Hammel Na'ama, Belghith Akram, Bowd Christopher, Medeiros Felipe A, Sharpsten Lucie, Mendoza Nadia, Tatham Andrew J, Khachatryan Naira, Liebmann Jeffrey M, Girkin Christopher A, Weinreb Robert N, Zangwill Linda M
Hamilton Glaucoma Center, Shiley Eye Institute, and Department of Ophthalmology, University of California, San Diego, La Jolla, California.
Harkness Eye Institute, Columbia University Medical Center, New York, New York.
Ophthalmology. 2016 Apr;123(4):760-70. doi: 10.1016/j.ophtha.2015.11.018. Epub 2015 Dec 30.
To characterize the rate and pattern of age-related and glaucomatous neuroretinal rim area changes in subjects of African and European descent.
Prospective longitudinal study.
Two hundred ninety-six eyes of 157 healthy subjects (88 patients of African descent and 69 of European descent) and 73 progressing glaucoma eyes of 67 subjects (24 patients of African descent and 43 of European descent) from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included.
Global and sectoral rim areas were measured using confocal laser scanning ophthalmoscopy. Masked stereophotograph review determined progression of glaucomatous optic disc damage. The rates of absolute rim area loss and percentage rim area loss in healthy and progressing glaucomatous eyes were compared using multivariate, nested, mixed-effects models.
Rate of rim area loss over time.
The median follow-up time was 5.0 years (interquartile range, 2.0-7.4 years) for healthy eyes and 8.3 years (interquartile range, 7.5-9.9 years) for progressing glaucoma eyes. The mean rate of global rim area loss was significantly faster in progressing glaucomatous eyes compared with healthy eyes for both rim area loss (-10.2×10(-3) vs. -2.8×10(-3) mm(2)/year, respectively; P < 0.001) and percentage rim area loss (-1.1% vs. -0.2%/year, respectively; P < 0.001), but considerable overlap existed between the 2 groups. Sixty-three percent of progressing glaucoma eyes had a rate of change faster than the fifth quantile of healthy eyes. For both healthy and progressing eyes, the pattern of rim area loss and percentage rim area loss were similar, tending to be fastest in the superior temporal and inferior temporal sectors. The rate of change was similar in progressing eyes of patients of African or European descent.
Compared with healthy eyes, the mean rate of global rim area loss was 3.7 times faster and the mean rate of global percentage rim area loss was 5.4 times faster in progressing glaucoma eyes. A reference database of healthy eyes can be used to help clinicians distinguish age-related rim area loss from rim area loss resulting from glaucoma.
描述非洲裔和欧洲裔受试者年龄相关性及青光眼性神经视网膜边缘区域变化的速率和模式。
前瞻性纵向研究。
纳入了青光眼诊断创新研究及非洲裔与青光眼评估研究中的157名健康受试者的296只眼（88名非洲裔患者和69名欧洲裔患者）以及67名受试者的73只进展期青光眼眼（24名非洲裔患者和43名欧洲裔患者）。
使用共焦激光扫描检眼镜测量整体及扇形边缘区域。通过遮盖立体照片评估来确定青光眼性视盘损害的进展情况。使用多变量、嵌套、混合效应模型比较健康眼和进展期青光眼眼中边缘区域绝对丢失率和边缘区域丢失百分比。
边缘区域随时间的丢失率。
健康眼的中位随访时间为5.0年（四分位间距，2.0 - 7.4年），进展期青光眼眼为8.3年（四分位间距，7.5 - 9.9年）。对于边缘区域丢失率（分别为-10.2×10⁻³ 与 -2.8×10⁻³ mm²/年；P < 0.001）和边缘区域丢失百分比（分别为-1.1%与-0.2%/年；P < ＜0.001），进展期青光眼眼中整体边缘区域的平均丢失率显著快于健康眼，但两组之间存在相当大的重叠。63%的进展期青光眼眼的变化速率快于健康眼的第五分位数。对于健康眼和进展期眼，边缘区域丢失模式和边缘区域丢失百分比相似，在颞上和颞下扇形区域往往最快。非洲裔或欧洲裔患者的进展期眼中变化速率相似。
与健康眼相比，进展期青光眼眼中整体边缘区域的平均丢失率快3.7倍，整体边缘区域丢失百分比的平均速率快5.4倍。健康眼的参考数据库可用于帮助临床医生区分年龄相关性边缘区域丢失和青光眼导致的边缘区域丢失。
