Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia.
Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia.
Ophthalmology. 2017 Dec;124(12):1735-1742. doi: 10.1016/j.ophtha.2017.06.028. Epub 2017 Jul 29.
Recent developments in electronic technology are making it possible to home monitor the sensitivity of the central visual field using portable devices. We used simulations to investigate whether the higher test frequency afforded by home monitoring improves the early detection of rapid visual field loss in glaucoma and how any benefits might be affected by imperfect compliance or increased variability in the home-monitoring test.
Computer simulation, with parameter selection confirmed with a cohort study.
A total of 43 patients with treated glaucoma (both open-angle and closed-angle), ocular hypertension or glaucoma suspects (mean age, 71 years; range, 37-89 years), were followed in the cohort study.
We simulated series (n = 100 000) of visual fields for patients with stable glaucoma and patients with progressing glaucoma for 2 in-clinic (yearly and 6-monthly) and 3 home-monitoring (monthly, fortnightly, and weekly) schedules, each running over a 5-year period. Various percentages of home-monitored fields were omitted at random to simulate reduced compliance, and the variability of the home monitored fields also was manipulated. We used previously published variability characteristics for perimetry and confirmed their appropriateness for a home-monitoring device by measuring the device's retest variability at 2 months in a cohort of 43 patients. The criterion for flagging progression in our simulation was a significant slope of the ordinary least squares regression of a simulated patient's mean deviation (MD) data.
The sensitivity for identifying rapid visual field loss (-2 decibels [dB]/year loss of MD).
Although a sensitivity of 0.8 for rapid field loss was achieved after 2.5 years of 6-monthly testing in the clinic, weekly home monitoring achieved this by 0.9 years despite moderate test compliance of 63%. The improved performance of weekly home monitoring over 6-monthly clinical testing was retained even when home monitoring was assumed to produce more variable test results or be associated with low patient compliance.
Detecting rapid visual field progression may be improved using a home-monitoring strategy, even when compliance is imperfect. The cost-benefit of such an approach is yet to be demonstrated, however.
电子技术的最新发展使得使用便携式设备在家中监测中央视野的灵敏度成为可能。我们通过模拟研究了家庭监测提供的更高测试频率是否可以提高青光眼快速视野丧失的早期检测，以及家庭监测测试的不完美依从性或增加的可变性如何影响任何益处。
计算机模拟，使用队列研究确认参数选择。
共有 43 名接受治疗的青光眼（开角型和闭角型）、高眼压或青光眼患者（平均年龄 71 岁；范围 37-89 岁）参与了队列研究。
我们为稳定青光眼患者和进展性青光眼患者模拟了一系列视觉场（n=100000），这些患者的模拟视觉场在诊所进行了 2 次（每年和每 6 个月）和 3 次家庭监测（每月、每两周和每周），每个模拟视觉场持续 5 年。随机省略了各种比例的家庭监测视野，以模拟降低的依从性，并且还操纵了家庭监测视野的可变性。我们使用了先前发表的用于视野计的可变性特征，并通过在 43 名患者的队列中测量设备的 2 个月复测可变性来证实其适用于家庭监测设备。我们模拟患者的平均偏差（MD）数据的普通最小二乘回归的显著斜率是标记进展的标准。
识别快速视野丧失（MD 每年损失-2 分贝）的敏感性。
尽管在诊所进行每 6 个月的 2.5 年测试后，6 个月的测试达到了 0.8 的快速视野丧失敏感性，但即使测试依从性适中（63%），每周家庭监测也可以在 0.9 年内达到这一水平。即使假设家庭监测产生更多可变的测试结果或与低患者依从性相关，每周家庭监测的性能也优于每 6 个月的临床测试。
即使依从性不完美，使用家庭监测策略也可能改善快速视野进展的检测。然而，这种方法的成本效益仍有待证明。
