Jung Kyoung In, Kim Eun Kyoung, Park Chan Kee
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Medicine (Baltimore). 2017 Jun;96(24):e6855. doi: 10.1097/MD.0000000000006855.
The standard automated perimetry (SAP) 24-2 test cannot adequately test the paracentral region because test points are located sparsely in macular area where is crowded with retinal ganglion cells (RGCs), even though paracentral scotoma is clinically related to a risk of losing visual function. More sensitive visual field (VF) tests are needed to assess paracentral VF defects precisely. We investigated the structure-function relationship on the SAP 10-2 test and the frequency doubling technology (FDT) 24-2 test as well as the SAP 24-2 test in glaucoma with parafoveal scotoma (PFS). Glaucoma patients with PFS (134 patients) were included in this cross-sectional study. Sub-analysis was performed with isolated PFS (51 patients). Global and sectoral mean sensitivities (MS) were evaluated using SAP 24-2, 10-2, and FDT 24-2 program. MS was analyzed as dB or unlogged 1/lambert (SAP) or 1/Michelson contrast (FDT). Ganglion cell-inner plexiform layer (GCIPL) thickness was measured using spectral domain optical coherence tomography. Topographic relationships between the structure and the function were analyzed. In the total PFS group, good structure-function correlations were found in all zones with SAP 24-2, 10-2, and FDT 24-2 test. For glaucoma with isolated PFS, average GCIPL thickness was significantly correlated with central cluster MS (dB) using the SAP 10-2 test (r = 0.279, P = .047) and the FDT 24-2 test (r = 0.289, P = .039), but not the SAP 24-2 test (r = 0.264, P = .061). Topographically, the FDT 24-2 test showed significant correlations in all sectors between sectoral MS and corresponding GCIPL thickness. With regard to the SAP 10-2 test, there was significant topographical structure-function correlations for the superotemporal, inferotemporal, and inferonasal sectors. For SAP 24-2, only inferonasal GCIPL thickness was correlated with the corresponding VF sensitivity. Topographical structure-function on the macula was better with the SAP 10-2 test (superotemporal sector) and the FDT 24-2 test (superotemporal sector) than with the SAP 24-2 test in glaucoma with isolated PFS. In conclusion, FDT 24-2 and SAP 10-2 tests performed more favorably than the SAP 24-2 test in the structure-function relationship of glaucoma patients with isolated paracentral scotoma. FDT 24-2 tests can be another good option for detecting and monitoring RGC loss on the macular area while not missing VF defects outside the central 10°.
标准自动视野计（SAP）24-2检测无法充分检测旁中心区域，因为检测点在黄斑区分布稀疏，而黄斑区聚集着视网膜神经节细胞（RGC），尽管旁中心暗点在临床上与视功能丧失风险相关。需要更敏感的视野（VF）检测来精确评估旁中心VF缺陷。我们研究了SAP 10-2检测、频率加倍技术（FDT）24-2检测以及SAP 24-2检测在伴有中心凹旁暗点（PFS）的青光眼患者中的结构-功能关系。患有PFS的青光眼患者（134例）被纳入这项横断面研究。对孤立性PFS患者（51例）进行了亚分析。使用SAP 24-2、10-2和FDT 24-2程序评估全局和扇形平均敏感度（MS）。MS以分贝或未记录的1/朗伯（SAP）或1/迈克尔逊对比度（FDT）进行分析。使用光谱域光学相干断层扫描测量神经节细胞-内网状层（GCIPL）厚度。分析结构与功能之间的地形关系。在整个PFS组中，SAP 24-2、10-2和FDT 24-2检测在所有区域均发现了良好的结构-功能相关性。对于孤立性PFS的青光眼患者，使用SAP 10-2检测（r = 0.279，P = 0.047）和FDT 24-2检测（r = 0.289，P = 0.039）时，平均GCIPL厚度与中心簇MS（分贝）显著相关，但与SAP 24-2检测（r = 0.264，P = 0.061）无关。在地形上，FDT 24-2检测显示扇形MS与相应的GCIPL厚度在所有扇形中均存在显著相关性。对于SAP 10-2检测，颞上、颞下和鼻下扇形存在显著的地形结构-功能相关性。对于SAP 24-2检测，仅鼻下GCIPL厚度与相应的视野敏感度相关。在孤立性PFS的青光眼患者中，黄斑区的地形结构-功能在SAP 10-2检测（颞上扇形）和FDT 24-2检测（颞上扇形）中比在SAP 24-2检测中更好。总之，在孤立性旁中心暗点的青光眼患者的结构-功能关系方面，FDT 24-2和SAP 10-2检测比SAP 24-2检测表现更优。FDT 24-2检测可以是检测和监测黄斑区RGC丢失的另一个良好选择，同时不会遗漏中心10°以外的视野缺陷。
