Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States.
Invest Ophthalmol Vis Sci. 2020 Nov 2;61(13):23. doi: 10.1167/iovs.61.13.23.
To evaluate the importance of central versus far peripheral visual field (VF) loss in assessing disability in glaucoma.
In total, 231 patients with glaucoma or suspected glaucoma completed 24-2 VF testing and automated peripheral VFs using the suprathreshold 30- to 60-degree pattern. Questionnaires assessed fear of falling (FoF), quality of life (QOL), instrumental activities of daily living (IADLs), and driving habits; nonsedentary time, reading speed, and gait were objectively measured. Multivariable regression models analyzed the effect of central VF and/or peripheral VF damage on each outcome.
In models including both central and peripheral VF damage (independent effects), greater central, but not peripheral, VF damage was associated with greater FoF, worse QOL, fewer daily steps, and difficulty with IADLs (P < 0.02 for central; P > 0.5 for peripheral). For gait measures, greater peripheral, but not central, damage was associated with shorter steps and shorter strides, as well as greater variability in step length (P < 0.03 for peripheral; P > 0.14 for central). Model R2 values were not substantially higher (less than 5% additional explained variability) for models including both central and peripheral VF damage as compared to the best models incorporating only one region of VF damage (i.e., central or peripheral).
The relative importance of central 24 degrees versus more peripheral VF damage differs across functional domains in patients with glaucoma. Central damage is more strongly associated with most disability outcomes, although peripheral damage is more associated with specific gait measures. Studies examining the relative importance of various VF regions should assess functional domain separately and eschew integrated measures of quality of life/activity limitation.
评估中央与远周边视野（VF）损失在评估青光眼残疾中的重要性。
共有 231 名青光眼或疑似青光眼患者完成了 24-2 VF 测试和使用阈上 30-60 度模式的自动周边 VF。问卷调查评估了跌倒恐惧（FoF）、生活质量（QOL）、日常生活活动能力（IADL）和驾驶习惯；非久坐时间、阅读速度和步态均进行了客观测量。多变量回归模型分析了中央 VF 和/或周边 VF 损伤对每个结果的影响。
在包括中央和周边 VF 损伤（独立影响）的模型中，更大的中央，但不是周边，VF 损伤与更大的 FoF、更差的 QOL、更少的日常步数和 IADL 困难有关（中央 P < 0.02；周边 P > 0.5）。对于步态测量，更大的周边，但不是中央，损伤与较短的步数和较短的步幅以及步长的更大变异性有关（周边 P < 0.03；中央 P > 0.14）。与仅包含一个 VF 损伤区域（即中央或周边）的最佳模型相比，包含中央和周边 VF 损伤的模型的 R2 值并没有显著提高（额外解释的可变性不到 5%）。
在青光眼患者中，中央 24 度与更周边 VF 损伤的相对重要性在不同的功能领域有所不同。中央损伤与大多数残疾结果的相关性更强，尽管周边损伤与特定的步态测量更相关。研究中央和周边 VF 区域相对重要性的研究应分别评估功能领域，并避免使用生活质量/活动受限的综合指标。
