结构与功能青光眼检测的一致性频率：3D OCT 和当前临床检测的纵向研究。
Frequency of Agreement Between Structural and Functional Glaucoma Testing: A Longitudinal Study of 3D OCT and Current Clinical Tests.
机构信息
From the Boston University Chobanian & Avedisian School of Medicine (D.M.), Boston, Massachusetts, USA; Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear (D.M., K.R., J.K., E.T., M.A.M., C.L.O., T.C.C.), Boston, Massachusetts, USA; Harvard Medical School (D.M., K.R., J.K., E.T., H.L., M.A.M., C.L.O., T.C.C.), Boston, Massachusetts, USA.
Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear (D.M., K.R., J.K., E.T., M.A.M., C.L.O., T.C.C.), Boston, Massachusetts, USA; Harvard Medical School (D.M., K.R., J.K., E.T., H.L., M.A.M., C.L.O., T.C.C.), Boston, Massachusetts, USA; Center of Excellence in Glaucoma, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society (K.R.), Bangkok, Thailand.
出版信息
Am J Ophthalmol. 2024 Oct;266:196-205. doi: 10.1016/j.ajo.2024.05.018. Epub 2024 May 27.
PURPOSE
To evaluate how often tests of structure and function detect glaucoma progression at the same study visit. Tests include current glaucoma clinical tests and a new 3-dimensional (3D) optical coherence tomography (OCT) rim measurement.
DESIGN
Prospective cohort study.
METHODS
For 124 open-angle glaucoma patients at a single institution, one eye was randomly selected for each patient. Patients were included if they had open-angle glaucoma and if they had at least 4 yearly study visits. Study visits included a full dilated eye exam, disc photography (DP), Humphrey visual field (HVF 24-2) testing, 2D OCT retinal nerve fibre layer (RNFL) thickness measurements, and 3D OCT neuroretinal rim measurements (i.e., minimum distance band or MDB). For each test at each study visit, eyes were classified as progressors or non-progressors using event-based analysis. Agreement occurred if tests progressed in the same eye at the same study visit. Agreements between all compared tests were calculated as percentages of agreement.
RESULTS
The study included 124 open-angle glaucoma eyes, which had an average follow-up period of 66.9 ± 16.4 months. Structural tests (i.e., DP, global RNFL thickness, and global MDB rim thickness) progressed at the same visit as the functional test (i.e., HVF testing) in only 5.0% (3/60) to 16.0% (13/81) of eyes. Global MDB thickness and global RNFL thickness showed similar agreement with functional HVF testing (i.e., 16.0% [13/81] and 8.3% [7/84], respectively), and global MDB thickness showed better structure-function agreement with HVF testing than between DP and HVF testing (i.e., 5.0% [3/60], P = 0.04). For all paired comparisons between testing methods, eyes with moderate glaucoma showed similar or better agreement than eyes with mild or severe glaucoma.
CONCLUSIONS
Clinical tests of structure and function do not usually progress at the same clinic visit. Most of the time, glaucoma progression is only detected by one or two tests.
目的
评估结构和功能测试在同一次就诊时检测青光眼进展的频率。测试包括当前的青光眼临床测试和一种新的 3 维（3D）光学相干断层扫描（OCT）边缘测量。
设计
前瞻性队列研究。
方法
对于单机构的 124 名开角型青光眼患者，每位患者随机选择一只眼。如果患者患有开角型青光眼，并且至少有 4 次年度研究就诊，则将其纳入研究。研究就诊包括全面散瞳眼部检查、视盘照相术（DP）、Humphrey 视野（HVF 24-2）测试、2D OCT 视网膜神经纤维层（RNFL）厚度测量和 3D OCT 神经视网膜边缘测量（即最小距离带或 MDB）。对于每次研究就诊的每项测试，使用基于事件的分析将眼睛分类为进展者或非进展者。如果在同一次就诊时同一眼的测试进展，则认为存在一致性。计算所有比较测试之间的一致性百分比。
结果
该研究包括 124 只开角型青光眼眼，平均随访时间为 66.9±16.4 个月。结构测试（即 DP、整体 RNFL 厚度和整体 MDB 边缘厚度）仅在 5.0%（3/60）至 16.0%（13/81）的眼中与功能测试（即 HVF 测试）在同一次就诊时进展。全局 MDB 厚度和全局 RNFL 厚度与功能 HVF 测试的一致性相似（即 16.0%[13/81]和 8.3%[7/84]），与 DP 和 HVF 测试相比，全局 MDB 厚度与 HVF 测试的结构-功能一致性更好（即 5.0%[3/60]，P=0.04）。对于所有测试方法之间的配对比较，中度青光眼眼的一致性相似或优于轻度或重度青光眼眼。
结论
结构和功能的临床测试通常不会在同一次就诊时进展。大多数时候，只有一两种测试才能检测到青光眼的进展。
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