Yohannan Jithin, Wang Jiangxia, Brown Jamie, Chauhan Balwantray C, Boland Michael V, Friedman David S, Ramulu Pradeep Y
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
Ophthalmology. 2017 Nov;124(11):1612-1620. doi: 10.1016/j.ophtha.2017.04.035. Epub 2017 Jul 1.
Assess the impact of false-positives (FP), false-negatives (FN), fixation losses (FL), and test duration (TD) on visual field (VF) reliability at different stages of glaucoma severity.
Retrospective.
A total of 10 262 VFs from 1538 eyes of 909 subjects with suspect or manifest glaucoma and ≥5 VF examinations.
Predicted mean deviation (MD) was calculated with multilevel modeling of longitudinal data. Differences between predicted and observed MD (ΔMD) were calculated as a reliability measure. The impact of FP, FN, FL, and TD on ΔMD was assessed using multilevel modeling.
ΔMD associated with a 10% increment in FP, FN, and FL, or a 1-minute increase in TD.
FL had little impact on ΔMD (<0.2 decibels [dB] per 10% abnormal catch trials), and no level of FL produced ≥1 dB of ΔMD at any disease stage. FP yielded greater than expected MD, with a 10% increment in abnormal catch trials associated with a ΔMD = 0.42, 0.73, and 0.66 dB in mild (MD >-6 dB), moderate (-6 ≤MD <-12 dB), and severe (-12 ≤MD ≤-20 dB) disease, respectively, up to 20% abnormal catch trials, and a ΔMD = 1.57, 2.06, and 3.53 dB beyond 20% abnormal catch trials. FNs generally produced observed MDs below expected MDs. FN were minimally impactful up to 20% abnormal catch trials (ΔMD per 10% increment >-0.14 dB at all levels of severity). Beyond 20% abnormal catch trials, each 10% increment in abnormal catch trials was associated with a ΔMD = -1.27, -0.53, and -0.51 dB in mild, moderate, and severe disease, respectively. |ΔMD| ≥1 dB occurred with 22% FP and 26% FN in early, 14% FP and 34% FN in moderate, and 16% FP and 51% FN in severe disease. A 1-minute increment in TD produced ΔMDs between -0.35 and -0.40 dB.
FL have little impact on reliability in patients with established glaucoma. FP, and to a lesser extent FNs and TD, significantly affect reliability. The impact of FP and FN varies with disease severity and over the range of abnormal catch trials. On the basis of our findings, we present evidence-based, severity-specific standards for classifying VF reliability for clinical or research applications.
评估假阳性（FP）、假阴性（FN）、固视丢失（FL）和检查时长（TD）对不同青光眼严重程度阶段视野（VF）可靠性的影响。
回顾性研究。
来自909例疑似或确诊青光眼患者1538只眼睛的总共10262次视野检查，且视野检查次数≥5次。
通过纵向数据的多水平模型计算预测平均偏差（MD）。计算预测MD与观察到的MD之间的差异（ΔMD）作为可靠性指标。使用多水平模型评估FP、FN、FL和TD对ΔMD的影响。
与FP、FN和FL增加10%或TD增加1分钟相关的ΔMD。
FL对ΔMD影响较小（每10%异常捕捉试验<0.2分贝[dB]），在任何疾病阶段，FL水平均未产生≥1 dB的ΔMD。FP导致的MD大于预期，轻度（MD > -6 dB）、中度（-6≤MD < -12 dB）和重度（-12≤MD≤ -20 dB）疾病中，异常捕捉试验增加10%分别与ΔMD = 0.42、0.73和0.66 dB相关，直至20%异常捕捉试验，超过20%异常捕捉试验时，ΔMD = 1.57、2.06和3.53 dB。FN通常导致观察到的MD低于预期MD。在高达20%异常捕捉试验时，FN影响最小（所有严重程度水平下，每10%增加的ΔMD > -0.14 dB）。超过20%异常捕捉试验后，轻度、中度和重度疾病中，异常捕捉试验每增加10%分别与ΔMD = -1.27、-0.53和-0.51 dB相关。在早期疾病中，22%的FP和26%的FN出现|ΔMD|≥1 dB，中度疾病中为14%的FP和34%的FN，重度疾病中为16%的FP和51%的FN。TD增加1分钟产生的ΔMD在-0.35至-0.40 dB之间。
FL对已确诊青光眼患者的可靠性影响较小。FP以及在较小程度上FN和TD显著影响可靠性。FP和FN的影响随疾病严重程度以及异常捕捉试验范围而变化。基于我们的研究结果，我们提出了基于证据的、针对特定严重程度的标准，用于临床或研究应用中视野可靠性的分类。
