比较周边视网膜 OCT 扫描和视野检查检测青光眼恶化的准确性。
Comparing the Accuracy of Peripapillary OCT Scans and Visual Fields to Detect Glaucoma Worsening.
机构信息
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Malone Center of Engineering in Healthcare, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Ophthalmology. 2023 Jun;130(6):631-639. doi: 10.1016/j.ophtha.2023.01.021. Epub 2023 Feb 6.
PURPOSE
To compare the accuracy of detecting moderate and rapid rates of glaucoma worsening over a 2-year period with different numbers of OCT scans and visual field (VF) tests in a large sample of glaucoma and glaucoma suspect eyes.
DESIGN
Descriptive and simulation study.
PARTICIPANTS
The OCT sample comprised 12 150 eyes from 7392 adults with glaucoma or glaucoma suspect status followed up at the Wilmer Eye Institute from 2013 through 2021. The VF sample comprised 20 583 eyes from 10 958 adults from the same database. All eyes had undergone at least 5 measurements over follow-up from the Zeiss Cirrus OCT or Humphrey Field Analyzer.
METHODS
Within-eye rates of change in retinal nerve fiber layer (RNFL) thickness and mean deviation (MD) were measured using linear regression. For each measured rate, simulated measurements of RNFL thickness and MD were generated using the distributions of residuals. Simulated rates of change for different numbers of OCT scans and VF tests over a 2-year period were used to estimate the accuracy of detecting moderate (75th percentile) and rapid (90th percentile) worsening for OCT and VF. Accuracy was defined as the percentage of simulated eyes in which the true rate of worsening (the rate without measurement error) was at or less than a criterion rate (e.g., 75th or 90th percentile).
MAIN OUTCOME MEASURES
The accuracy of diagnosing moderate and rapid rates of glaucoma worsening for different numbers of OCT scans and VF tests over a 2-year period.
RESULTS
Accuracy was less than 50% for both OCT and VF when diagnosing worsening after a 2-year period. OCT accuracy was 5 to 10 percentage points higher than VF accuracy at detecting moderate worsening and 10 to 15 percentage points higher for rapid worsening. Accuracy increased by more than 17 percentage points when using both OCT and VF to detect worsening, that is, when relying on either OCT or VF to be accurate.
CONCLUSIONS
More frequent OCT scans and VF tests are needed to improve the accuracy of diagnosing glaucoma worsening. Accuracy greatly increases when relying on both OCT and VF to detect worsening.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
目的
在一个大型青光眼和疑似青光眼患者的样本中，比较不同数量的 OCT 扫描和视野（VF）检查在检测 2 年内中度和快速青光眼恶化的准确性。
设计
描述性和模拟研究。
参与者
OCT 样本包括 2013 年至 2021 年在威尔默眼科研究所随访的 7392 名青光眼或疑似青光眼成人的 12150 只眼。VF 样本包括来自同一数据库的 10958 名成人的 20583 只眼。所有眼在随访期间均至少进行了 5 次 Zeiss Cirrus OCT 或 Humphrey Field Analyzer 测量。
方法
使用线性回归测量视网膜神经纤维层（RNFL）厚度和平均偏差（MD）的眼内变化率。对于每个测量的速率，使用残差分布生成 RNFL 厚度和 MD 的模拟测量值。在 2 年内使用不同数量的 OCT 扫描和 VF 测试模拟变化率，以估计 OCT 和 VF 检测中度（第 75 百分位数）和快速（第 90 百分位数）恶化的准确性。准确性定义为模拟眼的真实恶化率（无测量误差的率）等于或低于标准率（例如第 75 或 90 百分位数）的百分比。
主要观察指标
在 2 年内，不同数量的 OCT 扫描和 VF 测试诊断青光眼恶化的准确性。
结果
在 2 年后，OCT 和 VF 对恶化的诊断准确率均低于 50%。OCT 对中度恶化的准确率比 VF 高 5 到 10 个百分点，对快速恶化的准确率高 10 到 15 个百分点。当同时使用 OCT 和 VF 来检测恶化时，准确率增加了 17 个百分点以上，也就是说，当依赖于 OCT 或 VF 来进行准确检测时。
结论
需要更频繁的 OCT 扫描和 VF 检查以提高诊断青光眼恶化的准确性。当依赖于 OCT 和 VF 来检测恶化时，准确性大大提高。
金融披露
作者没有在本文讨论的任何材料中拥有专有的或商业利益。
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