青光眼快速进展者：基于全球和中央视野损失的患病率。
Fast Progressors in Glaucoma: Prevalence Based on Global and Central Visual Field Loss.
机构信息
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia; John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom.
出版信息
Ophthalmology. 2023 May;130(5):462-468. doi: 10.1016/j.ophtha.2023.01.008. Epub 2023 Jan 21.
PURPOSE
To determine the prevalence of fast global and central visual field (VF) progression in individuals with glaucoma under routine care.
DESIGN
Observational study.
PARTICIPANTS
Six hundred ninety-three eyes of 461 individuals with glaucoma followed up over a median of 4.5 years.
METHODS
This study included (1) patients at a private ophthalmology clinic in Melbourne, Australia, and (2) individuals in 2 prospective longitudinal observational studies across 3 sites in the United States. All individuals had a diagnosis of glaucoma and were under routine care, and had performed 5 or more reliable 24-2 VF tests over a 1- to 5-year period. Ordinary least squares regression analyses were used to calculate the rate of global mean deviation (MD) change over time and the rate of the mean total deviation values of the 12 test locations within the central 10° region (MTD) for each eye.
MAIN OUTCOME MEASURES
Prevalence of progression based on the rate of MD and the MTD change across various fixed cutoffs and cutoffs based on the estimated normal distribution (from the positive slopes).
RESULTS
Based on the MD and the MTD, 12.5% and 11.7% of the eyes, respectively, exhibited a rate of change that was less than -1.0 dB/year (being a rate that typically is defined as "fast progression" for MD values), and 29.0% of the eyes showed a change of less than -0.5 dB/year on MTD. Furthermore, 12.7% and 9.1% of the eyes exhibited a rate of change that exceeded the 1% cutoff of the estimated normal distribution MD and the MTD values, respectively.
CONCLUSIONS
This study found that approximately 1 in 8 eyes with glaucoma receiving routine care showed fast progression based on global MD values (< -1.0 dB/year) and that nearly 1 in 3 eyes showed a < -0.5 dB/year decline centrally. These findings highlight the clinical importance of assessing progressive central VF loss and reinforce the need for new therapies to prevent functional disability in a notable proportion of individuals who continue to exhibit fast progression.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
目的
在常规护理下，确定青光眼患者的快速全局和中央视野（VF）进展的患病率。
设计
观察性研究。
参与者
461 名青光眼患者的 693 只眼，中位随访时间为 4.5 年。
方法
本研究包括（1）澳大利亚墨尔本一家私人眼科诊所的患者，以及（2）美国三个地点的两项前瞻性纵向观察研究中的个体。所有患者均诊断为青光眼，处于常规护理中，并在 1 至 5 年内进行了 5 次或更多次可靠的 24-2 VF 测试。使用普通最小二乘回归分析计算全局平均偏差（MD）随时间的变化率，以及中央 10°区域内 12 个测试位置的平均总偏差值（MTD）的变化率。
主要观察指标
基于 MD 和 MTD 的各种固定截止值和基于估计正态分布的截止值（从正斜率）的进展患病率。
结果
基于 MD 和 MTD，分别有 12.5%和 11.7%的眼的变化率小于-1.0 dB/年（通常被定义为 MD 值的“快速进展”），29.0%的眼的 MTD 变化率小于-0.5 dB/年。此外，分别有 12.7%和 9.1%的眼的变化率超过了估计正态分布 MD 和 MTD 值的 1%截止值。
结论
本研究发现，在接受常规护理的青光眼患者中，约有 1/8 的眼表现出基于全局 MD 值的快速进展（< -1.0 dB/年），近 1/3 的眼在中央表现出< -0.5 dB/年的下降。这些发现突出了评估进展性中央 VF 损失的临床重要性，并强调需要新的疗法来预防在相当一部分继续表现出快速进展的个体中出现的功能障碍。
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