Ophthalmology, Vision, Imaging and Performance (VIP) Laboratory, Duke Eye Center, Durham, North Carolina, USA.
Ophthalmology and Visual Sciences, University of Utah Health John A Moran Eye Center, Salt Lake City, Utah, USA.
Br J Ophthalmol. 2022 Aug;106(8):1115-1120. doi: 10.1136/bjophthalmol-2020-318104. Epub 2021 May 13.
BACKGROUND/AIMS: To investigate racial differences in the variability of longitudinal visual field testing in a 'real-world' clinical population, evaluate how these differences are influenced by socioeconomic status, and estimate the impact of differences in variability on the time to detect visual field progression.
This retrospective observational cohort study used data from 1103 eyes from 751 White individuals and 428 eyes from 317 black individuals. Linear regression was performed on the standard automated perimetry mean deviation values for each eye over time. The SD of the residuals from the trend lines was calculated and used as a measure of variability for each eye. The association of race with the SD of the residuals was evaluated using a multivariable generalised estimating equation model with an interaction between race and zip code income. Computer simulations were used to estimate the time to detect visual field progression in the two racial groups.
Black patients had larger visual field variability over time compared with white patients, even when adjusting for zip code level socioeconomic variables (SD of residuals for Black patients=1.53 dB (95% CI 1.43 to 1.64); for white patients=1.26 dB (95% CI 1.14 to 1.22); mean difference: 0.28 (95% CI 0.15 to 0.41); p<0.001). The difference in visual field variability between black and white patients was greater at lower levels of income and led to a delay in detection of glaucoma progression.
Black patients had larger visual field variability compared with white patients. This relationship was strongly influenced by socioeconomic status and may partially explain racial disparities in glaucoma outcomes.
背景/目的：在“真实世界”临床人群中，研究纵向视野测试变异性的种族差异，评估这些差异受社会经济地位的影响程度，并估计变异性差异对检测视野进展时间的影响。
本回顾性观察队列研究使用了来自 751 名白人个体的 1103 只眼和 317 名黑人个体的 428 只眼的数据。对每只眼随时间变化的标准自动视野计平均偏差值进行线性回归。计算趋势线残差的标准差，并将其用作每只眼变异性的度量。使用多变量广义估计方程模型评估种族与残差标准差之间的关联，并在模型中加入种族与邮政编码收入之间的交互作用。使用计算机模拟来估计两个种族群体中视野进展的检测时间。
与白人患者相比，黑人患者的视野变异性随时间增大，即使在调整邮政编码水平社会经济变量后也是如此（黑人患者的残差标准差为 1.53dB（95%置信区间 1.43 至 1.64）；白人患者为 1.26dB（95%置信区间 1.14 至 1.22）；平均差异：0.28（95%置信区间 0.15 至 0.41）；p<0.001）。收入水平较低时，黑人和白人患者的视野变异性差异更大，这导致青光眼进展的检测延迟。
与白人患者相比，黑人患者的视野变异性更大。这种关系受社会经济地位的强烈影响，可能部分解释了青光眼结局的种族差异。
