Glaucoma, Singapore National Eye Centre, Singapore, Singapore.
Wilmer Eye Institute, Johns Hopkins University Department of Ophthalmology, Baltimore, Maryland, USA.
Br J Ophthalmol. 2021 Jun;105(6):789-793. doi: 10.1136/bjophthalmol-2020-316237. Epub 2020 Jul 22.
BACKGROUND/AIMS: To identify objective criteria from optical coherence tomography (OCT) and perimetry that denote a useful, specific definition of glaucomatous optic neuropathy (GON) in eyes with open-angle glaucoma for comparisons among glaucoma research studies.
A cross-sectional study of adult patients with glaucoma from nine centres on five continents evaluated de-identified physician diagnosis, OCT and perimetry results for 2580 eyes (1531 patients) in an online database. Each eye was graded by their glaucoma specialist as either definite, probable or not GON. Objective measures from OCT and perimetry, derived from an online consensus panel comprising 176 glaucoma specialists globally, were compared against the three diagnostic levels.
Diagnoses were 54% 'definite', 22% 'probable' and 24% 'not GON'. Using only OCT data or only field data had inadequate specificity (<90%). The best definitional choice for data from either the most recent or the preceding OCT/field pair had 77% sensitivity at 98% specificity and consisted of abnormal OCT superior or inferior nerve fibre layer quadrant with matching, opposite, abnormal Glaucoma Hemifield Test.
Objective criteria to define GON are practical and may be useful for comparisons among clinical studies to supplement subjective clinical assessment.
背景/目的：从光学相干断层扫描（OCT）和视野计中确定客观标准，为具有开角型青光眼的眼睛定义有用的、特定的青光眼视神经病变（GON）定义，以便在青光眼研究中进行比较。
对来自五大洲九个中心的成年青光眼患者进行横断面研究，在一个在线数据库中评估了 2580 只眼睛（1531 名患者）的未经识别的医生诊断、OCT 和视野计结果。每位青光眼专家根据他们的诊断将每只眼睛分为明确、可能或无 GON。来自 OCT 和视野计的客观指标是由全球 176 名青光眼专家组成的在线共识小组得出的，并与这三个诊断级别进行了比较。
诊断结果为 54%“明确”，22%“可能”，24%“无 GON”。仅使用 OCT 数据或仅使用视野数据特异性不足（<90%）。对于最近或之前的 OCT/视野对中的数据，最佳定义选择具有 77%的敏感性和 98%的特异性，包括异常的 OCT 上方或下方神经纤维层象限，伴有匹配的、相反的、异常的青光眼半视野测试。
定义 GON 的客观标准是实用的，可能有助于补充主观临床评估，在临床研究之间进行比较。
