From the Department of Ophthalmology, The Jikei University School of Medicine (E.N., K.S., T.N., S.O., S.O., and T.N.), Nishi-Shimbashi, Tokyo, Japan.
Department of Preventive Medicine, Tokai University School of Medicine (K.F. and M.T.), Isehara, Japan.
Am J Ophthalmol. 2024 Dec;268:275-284. doi: 10.1016/j.ajo.2024.07.024. Epub 2024 Aug 2.
This study sought to identify the most effective testing program for detecting visual-field defects in mild-stage glaucoma with central visual-field defects.
A multicenter, retrospective diagnostic testing evaluation.
The study involved 93 eyes (83 patients) with mild-stage glaucoma (median mean deviation [interquartile range]: -1.79 [2.16] dB) with central visual-field defects and 69 eyes (63 patients; median mean deviation, -1.38 [2.31] dB) with mild-stage glaucoma without central visual-field defects, from Jikei University School of Medicine and Tajimi Iwase Eye Clinic.
Patients underwent 10-2 Swedish Interactive Thresholding Algorithm (SITA) Standard, 24-2 SITA Standard, and 24-2C SITA Faster tests. Central visual-field defects were defined using 10-2 SITA Standard and optical coherence tomography (OCT). A detection power of 4 points in the 24-2 that coincided with 10-2 (Center4), 12 points that lie within 10° (24-2-12), and 22 points that lie within 10° of 24-2C (24-2C-22) were analyzed using receiver operating characteristic (ROC) curves based on logistic regression analysis, using total deviation (TD) and pattern deviation (PD) probability plots.
Area under the receiver operating characteristic curve (AUC) of the Center4, 24-2-12, and 24-2C-22 tests.
In the upper-central visual field, AUCs of the TD plot were 0.50 (0.40-0.58) for the Center4, 0.75 (0.67-0.83) for 24-2-12, and 0.85 (0.78-0.91) for 24-2C-22, with 24-2C-22 AUC significantly exceeding 24-2-12 AUC. For the PD plot, AUCs were 0.53 (0.44-0.63), 0.81 (0.74-0.89), and 0.84 (0.77-0.90), respectively. In the lower-central visual field, using a total plot, AUCs were 0.27 (0.18-0.36), 0.57 (0.47-0.69), and 0.57 (0.46-0.68) for the Center4, 24-2-12, and 24-2C-22, respectively. Using the PD plot in the upper field, AUCs were 0.27 (0.19-0.36), 0.64 (0.53-0.75), and 0.81 (0.72-0.90), respectively, with the AUC of the 24-2C-22 significantly exceeding that of 24-2-12. The 24-2C test was significantly faster than both the 24-2 and 10-2 tests, reducing testing duration by 46% and 52%, respectively.
The 24-2C SITA Faster test is highly effective and efficient for detecting mild-stage glaucoma with central visual-field defects. This, and its reduced duration, makes it a valuable tool in clinical settings.
本研究旨在确定最有效的检测程序，以检测有中央视野缺损的轻度青光眼的视野缺陷。
多中心、回顾性诊断检测评估。
该研究涉及来自日本顺天堂大学医学院和 Tajimi Iwase 眼科诊所的 93 只眼（83 例患者），这些眼患有轻度青光眼（中位数平均偏差[四分位距]：-1.79 [2.16] dB）和中央视野缺损，以及 69 只眼（63 例患者；中位数平均偏差，-1.38 [2.31] dB），患有轻度青光眼但无中央视野缺损。
患者接受了 10-2 瑞典交互阈值算法（SITA）标准、24-2 SITA 标准和 24-2C SITA 更快测试。使用 10-2 SITA 标准和光学相干断层扫描（OCT）定义中央视野缺损。基于逻辑回归分析的接收者操作特性（ROC）曲线，分析了与 10-2 相吻合的 24-2 的 4 个点（Center4）、位于 10°内的 12 个点（24-2-12）和位于 24-2C 内的 10°的 22 个点（24-2C-22），使用总偏差（TD）和模式偏差（PD）概率图。
Center4、24-2-12 和 24-2C-22 测试的接收器操作特性曲线下面积（AUC）。
在上中央视野中，Center4 的 TD 图的 AUC 为 0.50（0.40-0.58），24-2-12 的 AUC 为 0.75（0.67-0.83），24-2C-22 的 AUC 为 0.85（0.78-0.91），24-2C-22 的 AUC 显著高于 24-2-12 的 AUC。对于 PD 图，AUC 分别为 0.53（0.44-0.63）、0.81（0.74-0.89）和 0.84（0.77-0.90）。在下中央视野中，使用总图时，Center4、24-2-12 和 24-2C-22 的 AUC 分别为 0.27（0.18-0.36）、0.57（0.47-0.69）和 0.57（0.46-0.68）。在上部视野中使用 PD 图时，AUC 分别为 0.27（0.19-0.36）、0.64（0.53-0.75）和 0.81（0.72-0.90），24-2C-22 的 AUC 显著高于 24-2-12 的 AUC。24-2C 测试明显快于 24-2 和 10-2 测试，分别缩短了 46%和 52%的测试时间。
24-2C SITA 更快测试对检测有中央视野缺损的轻度青光眼非常有效和高效。由于其持续时间缩短，因此它是临床环境中的一种有价值的工具。
