Wen Yun, Chen Zidong, Zuo Chengguo, Yang Yangfan, Xu Jiangang, Kong Yang, Cheng Hui, Yu Minbin
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
School of Electronics and Communication Engineering, Sun Yat-sen University, Shenzhen, China.
Front Med (Lausanne). 2021 May 14;8:680823. doi: 10.3389/fmed.2021.680823. eCollection 2021.
The conventional visual acuity (VA) test is not sensitive enough to detect glaucoma macular damage. We aimed to investigate whether VA measurements using low-contrast high-pass optotypes are more sensitive to macular dysfunction in glaucoma and to find the potential structural basis of this difference. A total of 147 subjects were recruited, including 118 patients with glaucoma (mean age: 46.08 ± 14.64 years) and 29 healthy controls (mean age: 39.83 ± 9.81 years). For each participant, monocular best-corrected VA was measured using a conventional chart and six high-pass charts at 100, 50, 10, 5, 2.5, and 1.25% contrast levels, respectively. The macular retinal thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness of all the glaucoma patients were obtained by spectral-domain optical coherence tomography (SD-OCT). Compared with healthy subjects, glaucoma patients with normal vision demonstrated worse VAs in high-pass acuity measurements (0.22-0.93 vs. 0.28-1.08, < 0.05). Receiver operating characteristic curve (ROC) showed that 1.25% low-contrast high-pass VA was optimal for discriminating between the controls and glaucoma patients (AUC: 0.918, < 0.001; sensitivity: 77.33%; specificity: 96.55%). Compared with conventional VA, 1.25% high-pass VA correlated better with nasal-side macular retinal ganglion cell (RGC)-related parameters ( = -0.419 to -0.446 vs. = -0.538 to -0.582; Fisher's Z transformation, < 0.05). There was no difference in the strength of correlations between the VAs measured using different charts and cpRNFL thickness (Fisher's Z transformation; > 0.05). VA measurement taken with low-contrast (1.25%) high-pass acuity chart is more sensitive in detecting central visual loss in glaucoma than that taken with the conventional chart. Macular RGC damage appears to be associated with low-contrast (1.25%) high-pass visual loss in glaucomatous eyes.
传统视力（VA）测试对检测青光眼黄斑损伤的敏感度不够。我们旨在研究使用低对比度高通视标的VA测量对青光眼黄斑功能障碍是否更敏感，并找出这种差异的潜在结构基础。共招募了147名受试者，包括118例青光眼患者（平均年龄：46.08±14.64岁）和29名健康对照者（平均年龄：39.83±9.81岁）。对每位参与者，分别使用传统视力表和六种高通视力表在100%、50%、10%、5%、2.5%和1.25%对比度水平下测量单眼最佳矫正视力。所有青光眼患者的黄斑视网膜厚度和视乳头周围视网膜神经纤维层（cpRNFL）厚度通过光谱域光学相干断层扫描（SD - OCT）获得。与健康受试者相比，视力正常的青光眼患者在高通视力测量中的视力更差（0.22 - 0.93对0.28 - 1.08，<0.05）。受试者工作特征曲线（ROC）显示，1.25%低对比度高通视力对区分对照组和青光眼患者最为理想（曲线下面积：0.918，<0.001；敏感度：77.33%；特异度：96.55%）。与传统视力相比，1.25%高通视力与鼻侧黄斑视网膜神经节细胞（RGC）相关参数的相关性更好（=-0.419至-0.446对=-0.538至-0.582；费舍尔Z变换，<0.05）。使用不同视力表测量的视力与cpRNFL厚度之间的相关性强度无差异（费舍尔Z变换；>0.05）。使用低对比度（1.25%）高通视力表进行的视力测量在检测青光眼中心视力丧失方面比使用传统视力表更敏感。黄斑RGC损伤似乎与青光眼眼中低对比度（1.25%）高通视力丧失有关。
