Prager Alisa J, Hood Donald C, Liebmann Jeffrey M, De Moraes C Gustavo, Al-Aswad Lama A, Yu Qi, Cioffi George A, Blumberg Dana M
Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York2Department of Psychology, Columbia University, New York, New York.
JAMA Ophthalmol. 2017 Jul 1;135(7):783-788. doi: 10.1001/jamaophthalmol.2017.1659.
Little is known about the association between structural macular damage and self-reported visual function of people with glaucoma.
To determine the association between vision-related quality of life among patients with primary open-angle glaucoma with structural macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) loss identified by spectral-domain optical coherence tomography (SD-OCT) machine-generated deviation maps and thickness measurements.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional prospective study was conducted from March 1, 2014, to March 30, 2015, at the Department of Ophthalmology at Columbia University Medical Center. The participants were 107 patients who were enrolled in the study and represented the entire range of glaucomatous damage. All 214 eyes of the 107 participants underwent 10-2 visual field tests and SD-OCT scans, and all participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). They also received ophthalmologic examination, including medical history review, best-corrected visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, gonioscopy, dilated ophthalmoscopy, and standard automated perimetry. Macular RGC+IPL loss was determined by diffuse or focal patterns on SD-OCT-generated deviation maps (probability map that compared patients with aged-matched normative database) and thickness measurements.
Regression analyses to assess the association of NEI VFQ-25 scores (score range: 41.9-99.5; higher scores indicate better functioning) with patterns of RGC+IPL loss and with RGC+IPL thickness measurements.
Of the 107 patients, 48 (45%) were men and the mean (SD) age was 65 (11) years. The self-reported race/ethnicity of participants consisted of 45 (46%) black, 47 (48%) white, and 6 (6%) "other" individuals. In the univariable analyses, patients with diffuse macular RGC+IPL loss had mean composite Rasch-calibrated NEI VFQ-25 scores that were 6.15 points lower than the scores of patients with focal damage (β = -6.15; 95% CI, -11.7 to -0.59; P = .03). The effect remained significant even after controlling for mean RGC+IPL thickness (β = -7.64; 95% CI, -14.2 to -1.03; P = .02).
Characteristic patterns of glaucoma-related macular RGC+IPL loss appeared to be more important predictors of vision-related quality of life than thickness measures, with diffuse RGC+IPL loss as an indicator for diminished vision-related quality of life.
关于青光眼患者黄斑结构损伤与自我报告的视觉功能之间的关联，目前所知甚少。
通过光谱域光学相干断层扫描（SD-OCT）机器生成的偏差图和厚度测量，确定原发性开角型青光眼患者视网膜神经节细胞加内丛状层（RGC+IPL）结构黄斑损伤与视力相关生活质量之间的关联。
设计、地点和参与者：这项横断面前瞻性研究于2014年3月1日至2015年3月30日在哥伦比亚大学医学中心眼科进行。参与者为107名患者，他们代表了青光眼损伤的整个范围。107名参与者的所有214只眼睛均接受了10-2视野测试和SD-OCT扫描，所有参与者均完成了25项美国国立眼科研究所视觉功能问卷（NEI VFQ-25）。他们还接受了眼科检查，包括病史回顾、最佳矫正视力、裂隙灯生物显微镜检查、眼压测量、前房角镜检查、散瞳眼底检查和标准自动视野检查。黄斑RGC+IPL损伤通过SD-OCT生成的偏差图（将患者与年龄匹配的正常数据库进行比较的概率图）上的弥漫性或局灶性模式以及厚度测量来确定。
进行回归分析，以评估NEI VFQ-25评分（评分范围：41.9-99.5；分数越高表明功能越好）与RGC+IPL损伤模式以及RGC+IPL厚度测量之间的关联。
107名患者中，48名（45%）为男性，平均（标准差）年龄为65（11）岁。参与者自我报告的种族/族裔包括45名（46%）黑人、47名（48%）白人以及6名（6%）“其他”个体。在单变量分析中，黄斑RGC+IPL弥漫性损伤的患者，其经Rasch校准的NEI VFQ-25综合平均评分比局灶性损伤患者的评分低6.15分（β=-6.15；95%可信区间，-11.7至-0.59；P=0.03）。即使在控制了RGC+IPL平均厚度后，该效应仍然显著（β=-7.64；95%可信区间，-14.2至-1.
