Otarola Francisco, Chen Andrew, Morales Esteban, Yu Fei, Afifi Abdelmonem, Caprioli Joseph
Jules Stein Eye Institute, Glaucoma Division, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Fundacion Oftalmologica los Andes, Universidad de los Andes, Santiago, Chile.
Jules Stein Eye Institute, Glaucoma Division, David Geffen School of Medicine at UCLA (University of California, Los Angeles).
JAMA Ophthalmol. 2016 May 1;134(5):496-502. doi: 10.1001/jamaophthalmol.2016.0118.
Identifying the course of glaucomatous visual field (VF) loss that progresses from normal to perimetric blindness is important for treatment and prognostication.
To model the process of glaucomatous VF decay over the entire perimetric range from normal to perimetric blindness.
DESIGN, SETTING, AND PARTICIPANTS: A post hoc, retrospective analysis was performed using data from the Advanced Glaucoma Intervention Study and the UCLA (University of California, Los Angeles) Jules Stein Eye Institute Glaucoma Division. Patients with open-angle glaucoma and VFs obtained from reliable examinations (defined as <30% fixation losses, <30% false-positive rates, and <30% false-negative rates) were recruited. All tests were performed with standard automated perimetry and a 24-2 test pattern. Linear, exponential, and sigmoid regression models were used to assess the pattern of threshold sensitivity deterioration at each VF location as a function of time. Visual field locations of interest included those with a mean of the initial 2 sensitivities of 26 dB or greater and a less than 10-dB mean of the final 2 sensitivities. Root mean squared error (RMSE) was used to evaluate goodness of fit for each regression model. The error was defined as the difference between the sensitivities modeled by the function and the observed sensitivities. The Advanced Glaucoma Intervention Study was conducted from 1998 to 2006; the present post hoc analysis was conducted from March 1, 2014, to March 1, 2015.
The RMSE of the residuals (fitted minus observed values) for the 3 regression models was used to evaluate goodness of fit.
A total of 798 eyes from 583 patients (mean [SD] age, 64.7 [10.7] years; 301 [51.6%] women) who had more than 6 years of follow-up and underwent more than 10 VF examinations were included in this analysis. Mean (SD) follow-up time was 8.7 (2.2) years, and each eye had a mean of 15.2 (4.9) VF tests. For the VF locations with an initial sensitivity of 26 dB or greater and final sensitivity of less than 10 dB (309 locations), the sigmoid best-fit regression model had the lowest RMSE in 248 (80.3%) of the locations, the exponential function in 39 (12.6%), and the linear function in 22 (7.1%). The means (SDs) of RMSE were sigmoid, 4.1 (1.9); exponential, 6.0 (1.5); and linear 5.8 (1.6).
Pointwise sigmoid regression had a better ability to fit perimetric decay into a subset of locations that traverse the entire range of perimetric measurements from near normal to near perimetric blindness compared with linear and exponential functions. These results support the concept that the measured behavior of glaucomatous VF loss to perimetric blindness is nonlinear and that its course of deterioration may change with the course of disease.
明确青光眼性视野（VF）从正常进展至周边视野失明的过程，对治疗和预后判断具有重要意义。
构建青光眼性VF在从正常到周边视野失明的整个视野范围内衰退过程的模型。
设计、设置和参与者：利用来自高级青光眼干预研究及加州大学洛杉矶分校朱尔斯·斯坦因眼科研究所青光眼科的数据进行事后回顾性分析。招募开角型青光眼患者且其视野检查结果可靠（定义为注视丢失<30%、假阳性率<30%、假阴性率<30%）。所有检查均采用标准自动视野计及24 - 2检查模式。采用线性、指数和S形回归模型评估每个视野位置阈值敏感度随时间恶化的模式。感兴趣的视野位置包括初始2次敏感度均值为26 dB或更高且最终2次敏感度均值小于10 dB的位置。均方根误差（RMSE）用于评估每个回归模型的拟合优度。误差定义为函数模拟的敏感度与观察到的敏感度之间的差异。高级青光眼干预研究于1998年至2006年开展；本次事后分析于2014年3月1日至2015年3月1日进行。
3种回归模型残差（拟合值减去观察值）的RMSE用于评估拟合优度。
本分析纳入了583例患者的798只眼（平均[标准差]年龄为64.7[10.7]岁；301例[51.6%]为女性），这些患者随访时间超过6年且接受了超过10次视野检查。平均（标准差）随访时间为8.7（2.2）年，每只眼平均进行了15.2（4.9）次视野检查。对于初始敏感度为26 dB或更高且最终敏感度小于10 dB的视野位置（309个位置），S形最佳拟合回归模型在248个（80.3%）位置的RMSE最低，指数函数在39个（12.6%）位置最低，线性函数在22个（7.1%）位置最低。RMSE的均值（标准差）分别为：S形，4.1（1.9）；指数函数，6.0（1.5）；线性函数，5.8（1.6）。
与线性和指数函数相比，逐点S形回归在拟合从接近正常到接近周边视野失明的整个视野测量范围内的视野衰退子集方面具有更强的能力。这些结果支持青光眼性视野丧失至周边视野失明的测量行为是非线性的这一概念，且其恶化过程可能随疾病进程而变化。
