School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Centre for Eye Health, UNSW, Sydney, NSW, Australia.
Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, NSW, Australia.
Can J Ophthalmol. 2024 Oct;59(5):311-323. doi: 10.1016/j.jcjo.2023.07.023. Epub 2023 Aug 28.
To determine the effect of frontloading (multiple) visual field (VF) tests at the same visit for detecting mean deviation (MD) change in slowly progressive glaucoma.
This was a computer simulation study. Baseline MD (range, 0 to -12 dB) and progression rate (range, 0 to -0.4 dB/year, non-inclusive) were generated for 10,000 patients. Each patient had 6 simulated "stable" baseline VF tests. Then follow-up VFs (up to 10 years) were generated by incorporating progression rate and within-visit and between-visit variability. The independent variables were number of VF tests per visit (one non-frontloaded or two frontloaded), VF reliability (100%, 85%, or 70%), repeat testing because of unreliable results (yes or no), and follow-up interval (6-monthly or yearly). The outcomes were detection of progression (MD slope that was negative and significant at p < 0.05), MD at detection, and number of years to detection.
Frontloading identified more progressors (62.7%-79.2%) compared with non-frontloading (31.0%-36.7%) at 10 years (p < 0.0001). Six-monthly follow-ups led to greater detection than yearly intervals. Progressors detected by both methods were detected by the non-frontloaded method sooner (up to 0.26 years), but this was small and not clinically significant (MD difference, 0.06 dB). An increase (less severe) in MD, an increase (slower) in progression rate, and an increase in SD of baseline VFs decreased the likelihood of detecting progression.
Frontloading VF tests at 6-monthly intervals improve detection rates of MD progression in slowly progressive glaucoma patients compared with performing 1 test per visit at yearly intervals.
确定在同一次就诊时进行多次（多次）视野（VF）测试以检测缓慢进展性青光眼平均偏差（MD）变化的效果。
这是一项计算机模拟研究。为 10000 名患者生成了基线 MD（范围 0 至-12 dB）和进展率（范围 0 至-0.4 dB/年，不包括）。每位患者都有 6 次模拟的“稳定”基线 VF 测试。然后，通过结合进展率和就诊内和就诊间变异性，生成了后续 VF（长达 10 年）。自变量为每次就诊的 VF 测试次数（一次非加载或两次加载）、VF 可靠性（100%、85%或 70%）、因结果不可靠而重复测试（是或否）和随访间隔（每 6 个月或每年）。结果是检测到进展（MD 斜率为负且 p<0.05 有统计学意义）、检测时的 MD 和检测到的年限。
与非加载（31.0%-36.7%）相比，加载在 10 年内识别出更多的进展者（62.7%-79.2%）（p<0.0001）。每 6 个月进行随访比每年进行随访检测到更多的进展者。两种方法检测到的进展者都通过非加载方法更早（最多提前 0.26 年）检测到，但这很小，没有临床意义（MD 差异 0.06 dB）。MD 增加（更严重）、进展率增加（更慢）和基线 VF 的 SD 增加都会降低检测到进展的可能性。
与每年就诊时进行一次测试相比，在每 6 个月就诊时加载 VF 测试可提高缓慢进展性青光眼患者 MD 进展的检测率。
