Bengtsson B, Villalba C, Peters D, Aspberg J
Department of Clinical Sciences, Ophthalmology in Malmö, Lund University, Lund, Sweden.
Department of Ophthalmology, Skåne University Hospital, Lund, Sweden.
Acta Ophthalmol. 2024 Mar;102(2):238-245. doi: 10.1111/aos.15777. Epub 2023 Oct 2.
In a previous study comparing the amount of visual field damage at presentation in patients having open-angle glaucoma (OAG) identified through screening and in patients diagnosed in routine clinical practice in the 1990s, the damage was considerably worse in the clinically diagnosed patients. In the present study we compare visual field damage at presentation in the same 402 screened patients with that seen in 281 newly detected previously untreated patients clinically diagnosed in the 2010s.
The perimetric visual field index mean deviation (MD) was compared in the two groups of patients.
In the clinical patients diagnosed with bilateral visual field damage the median MD was -5.1 dB in the better eye and -13.0 dB in the worse eye. In the screened patients the median MD in the better eye was -6.5 dB and -11.5 dB in the worse eye. The differences between the clinical and screened patients were non-significant, p = 0.28 and p = 0.67 respectively. More clinical patients had severe visual field loss, defined as MD less than -20 dB, in the worse eye than in the screened patients, 18.5% versus 12.7% respectively, p = 0.037.
The visual field damage at presentation in clinically diagnosed OAG patients has improved in the past 20 years, but the proportion of patients with severe visual field loss in at least one eye, almost 20%, is still unacceptably high considering that severe visual field damage at presentation is the most important risk factor for later development of glaucoma blindness.
在之前一项研究中，比较了通过筛查确诊的开角型青光眼（OAG）患者与20世纪90年代在常规临床实践中确诊的患者就诊时的视野损害程度，结果发现临床确诊患者的损害要严重得多。在本研究中，我们将这402名经筛查的患者就诊时的视野损害情况与281名2010年代临床确诊的新发现且未经治疗的患者的视野损害情况进行了比较。
比较两组患者的视野平均缺损（MD）。
在临床诊断为双侧视野损害的患者中，较好眼的MD中位数为-5.1dB，较差眼为-13.0dB。在经筛查的患者中，较好眼的MD中位数为-6.5dB，较差眼为-11.5dB。临床患者与经筛查患者之间的差异无统计学意义，p值分别为0.28和0.67。较差眼中有更多临床患者出现严重视野缺损（定义为MD小于-20dB），分别为18.5%和12.7%，p = 0.037。
在过去20年中，临床诊断的OAG患者就诊时的视野损害有所改善，但考虑到就诊时严重视野损害是青光眼致盲后期发展的最重要危险因素，至少一只眼出现严重视野缺损的患者比例近20%，仍然高得令人无法接受。
