Glaucoma Division, Jules Stein Eye Institute, University of California Los Angeles (UCLA), Los Angeles, California, USA.
Department of Ophthalmology, Gloucestershire Hospitals NHS, Cheltenham, UK.
Br J Ophthalmol. 2021 Mar;105(3):381-386. doi: 10.1136/bjophthalmol-2020-315980. Epub 2020 May 13.
To evaluate the relationship between the presence of an acquired pit of the optic nerve (APON) and the rate of visual field (VF) decay in primary open-angle glaucoma (POAG).
Consecutive patients with POAG were screened for APON by three glaucoma specialists. A control group of POAG eyes without APON were matched with the APON group for factors such as age, gender, baseline intraocular pressure and baseline mean deviation (MD). The pointwise rate of change (PRC) was used for pointwise comparisons between the two groups. MD rate, Visual Field Index (VFI) rate and Glaucoma Rate Index (GRI) were used for global rate comparisons. We compared the proportions of eyes progressing in the groups with event-based guided progression analysis (GPA), MD, VFI and GRI criteria.
Mean (SD) PRC was faster in the APON group -1.00 (±2.57) %/year compared with the control group -0.25 (±2.19) %/year; p<0.001. MD rate (-0.22 (±0.27) dB/year vs 0.03 (±0.41) dB/year; p=0.009), VFI rate (-0.81 (±0.86) %/year vs -0.05 (±1.0) %/year; p=0.04) and GRI (-12.27 (±16.27) vs -3.75 (±10.6); p=0.052) were all faster in the APON group compared with controls. The proportion of progressing eyes with GPA, MD, VFI and GRI was not significantly different between the two groups (p>0.1).
The presence of APON in patients with POAG is associated with focal, fast rates of VF decay. Identification of patients with APON should alert clinicians to the possibility of a fast rate of functional progression and to consider appropriately aggressive treatment of their glaucoma.
评估获得性视神经凹（APON）的存在与原发性开角型青光眼（POAG）视野（VF）下降率之间的关系。
三位青光眼专家对 POAG 患者进行了 APON 筛查。APON 组的 POAG 眼与无 APON 的 POAG 眼相匹配，以年龄、性别、基线眼压和基线平均偏差（MD）等因素进行匹配。使用逐点变化率（PRC）进行两组之间的逐点比较。MD 率、视野指数（VFI）率和青光眼率指数（GRI）用于全局速率比较。我们比较了基于事件的引导进展分析（GPA）、MD、VFI 和 GRI 标准下两组中进展眼的比例。
APON 组的平均（SD）PRC 较快，为-1.00（±2.57）%/年，而对照组为-0.25（±2.19）%/年；p<0.001。MD 率（-0.22（±0.27）dB/年对 0.03（±0.41）dB/年；p=0.009）、VFI 率（-0.81（±0.86）%/年对-0.05（±1.0）%/年；p=0.04）和 GRI（-12.27（±16.27）对-3.75（±10.6）；p=0.052）在 APON 组均快于对照组。两组 GPA、MD、VFI 和 GRI 进展眼的比例无显著性差异（p>0.1）。
POAG 患者 APON 的存在与局部、快速的 VF 衰减率相关。识别 APON 患者应提醒临床医生注意功能进展的快速率，并考虑对其青光眼进行适当的强化治疗。
