Zhang Chunwei, Tatham Andrew J, Daga Fábio B, Jammal Alessandro A, Medeiros Felipe A
Visual Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, 2310 Erwin Rd, Durham, NC, 27710, USA.
Department of Ophthalmology, the First Affiliated Hospital, Harbin Medical University, Harbin, China.
Graefes Arch Clin Exp Ophthalmol. 2018 Jul;256(7):1227-1234. doi: 10.1007/s00417-018-3963-3. Epub 2018 Apr 5.
To investigate the relationship between progression assessed by the visual field guided progression analysis (GPA) and rates of structural and functional change in glaucoma eyes.
This was a longitudinal observational study of 135 eyes of 97 patients with glaucoma followed for an average of 3.5 ± 0.9 years. All patients had standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) analysis with spectral domain optical coherence tomography (SDOCT), with an average of 6.8 ± 2.3 visits. A control group of healthy eyes followed longitudinally was used to estimate age-related change. Visual field progression was assessed using the Humphrey Field Analyzer GPA. Estimates of retinal ganglion cell counts from SAP and SDOCT were used to obtain a combined index of glaucomatous damage (RGC index) according to a previously described algorithm. Progression by SDOCT and the retinal ganglion cell (RGC) index were defined as statistically significant (P < 0.05) slopes of change that were also faster than age-related change estimated from healthy eyes.
From the 135 eyes, 15 (11%) progressed by GPA, 21 (16%) progressed by SDOCT, and 31 (23%) progressed by the RGC index. Twenty-one eyes showed progression by the RGC index that was missed by the GPA. These eyes had an average rate of change in estimated RGC counts of - 28,910 cells/year, ranging from two to nine times faster than expected age-related losses.
Many glaucomatous eyes that are not found to be progressing by GPA may actually have fast rates of change as detected by a combined index of structure and function.
研究通过视野引导进展分析（GPA）评估的进展与青光眼患者眼睛结构和功能变化率之间的关系。
这是一项对97例青光眼患者的135只眼睛进行的纵向观察性研究，平均随访3.5±0.9年。所有患者均接受标准自动视野计检查（SAP）和使用光谱域光学相干断层扫描（SDOCT）进行视网膜神经纤维层（RNFL）分析，平均就诊6.8±2.3次。使用纵向随访的健康眼睛对照组来估计与年龄相关的变化。使用 Humphrey 视野分析仪 GPA 评估视野进展。根据先前描述的算法，利用来自 SAP 和 SDOCT 的视网膜神经节细胞计数估计值来获得青光眼损伤的综合指数（RGC 指数）。SDOCT 和视网膜神经节细胞（RGC）指数的进展定义为具有统计学意义（P<0.05）的变化斜率，且该斜率也快于从健康眼睛估计的与年龄相关的变化。
在这135只眼睛中，15只（11%）通过 GPA 进展，21只（16%）通过 SDOCT 进展，31只（23%）通过 RGC 指数进展。21只眼睛显示 RGC 指数进展，但被 GPA 遗漏。这些眼睛估计的 RGC 计数平均变化率为每年-28,910个细胞，比预期的与年龄相关的损失快两到九倍。
许多未被 GPA 发现进展性的青光眼眼睛，实际上可能具有结构和功能综合指数所检测到的快速变化率。
