Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York.
Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York.
Am J Ophthalmol. 2018 Mar;187:92-98. doi: 10.1016/j.ajo.2018.01.001. Epub 2018 Jan 6.
Central visual field (VF) damage in glaucoma patients can significantly hinder daily activities. The present study investigates whether the presence of localized baseline damage to the central 10 degrees of the VF is predictive of faster global mean deviation (MD) progression.
Prospective cohort study.
Eyes from the multicenter African Descent and Glaucoma Evaluation Study (ADAGES) with established glaucoma and VF loss and a minimum of 5 24-2 VFs were eligible. Baseline central 24-2 damage was defined as any of the 12 central-most points with total deviation (TD) values at P < 0.5% on 2 consecutive examinations. Progression was determined using trend-based and event-based criteria: (1) rates of MD change significantly faster than zero and (2) >-5 dB MD loss over the entire follow-up.
A total of 827 eyes of 584 patients were studied. Mean rate of MD change of the entire sample was -0.15 dB/year (95% CI: -0.19 to -0.12, P < .001). Eyes with baseline central damage progressed faster than those without (difference: β = -0.07 dB/year, 95% CI: -0.11 to -0.01, P = .011) and were more likely to experience MD loss greater than 5 dB (hazard ratio = 3.0 [95% CI: 2.1-4.1, P < .001]). These differences remained significant after adjusting for confounders.
The presence of central VF damage at baseline is significantly associated with more rapid global progression. Detection of central VF damage aids in stratification of high-risk patients who may need intensive surveillance and aggressive treatment.
青光眼患者的中央视野（VF）损伤会严重影响日常生活。本研究旨在探讨 VF 中央 10 度的基线局部损伤是否可预测平均偏差（MD）的更快进展。
前瞻性队列研究。
符合条件的是来自多中心非洲裔美国人青光眼评估研究（ADAGES）的眼，这些眼患有已确诊的青光眼和 VF 丧失，并且至少有 5 次 24-2 VF。基线中央 24-2 损伤定义为在连续 2 次检查中，任何 12 个最中央点的总偏差（TD）值均低于 0.5%。使用基于趋势和基于事件的标准来确定进展：（1）MD 变化率明显快于零；（2）在整个随访期间 MD 损失> -5 dB。
共研究了 584 名患者的 827 只眼。整个样本的 MD 变化率平均为-0.15 dB/年（95%CI：-0.19 至-0.12，P < 0.001）。与无基线中央损伤的眼相比，有基线中央损伤的眼进展更快（差异：β= -0.07 dB/年，95%CI：-0.11 至-0.01，P = 0.011），并且更有可能出现 MD 损失大于 5 dB（风险比= 3.0 [95%CI：2.1-4.1，P < 0.001]）。在调整混杂因素后，这些差异仍然显著。
基线时中央 VF 损伤的存在与更快的全局进展显著相关。中央 VF 损伤的检测有助于分层高危患者，这些患者可能需要密集监测和积极治疗。
