Department of Ophthalmology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Medicine (Baltimore). 2024 Nov 15;103(46):e40518. doi: 10.1097/MD.0000000000040518.
This study investigates the relationship between intraocular pressure (IOP), optical coherence tomography (OCT) parameters, and visual field (VF) outcomes in 'Green' patients-those with normal OCT findings but potential VF abnormalities. Understanding this relationship is crucial for improving early detection and management strategies for glaucoma, especially in patients who show functional loss despite normal structural findings on OCT. A cross-sectional study was conducted at Taipei City Hospital, Renai Branch, Taiwan, from July 1, 2015, to July 1, 2023. Participants were referred for suspected glaucoma and included based on normal OCT parameters ('green' coding) and completed VF tests. Patients with any ocular disease that could confound results were excluded. Logistic regression models were used to assess relationships between IOP, OCT parameters (rim area, disc area, retinal nerve fiber layer thickness, cup-to-disc ratios, and cup volume), and VF outcomes. Age, sex, and IOP status (normal or ocular hypertension) were also included in the analysis. All data were analyzed using Statistical Package for the Social Sciences version 23.0. Larger disc area was a significant predictor of VF abnormalities, with an adjusted OR of 3.72 (95% confidence interval [CI], 1.14-12.15). Neither normal IOP nor ocular hypertension significantly predicted VF loss (adjusted OR = 0.89; 95% CI, 0.27-2.96). Female sex was associated with a higher likelihood of VF abnormalities (adjusted OR = 5.68; 95% CI, 1.03-31.25). Other OCT parameters, including retinal nerve fiber layer thickness and cup-to-disc ratios, were not significantly associated with VF outcomes. Disc area plays a critical role in predicting VF abnormalities in "green" patients, suggesting the importance of integrating disc size into screening and monitoring protocols. These findings challenge the reliance on IOP alone for predicting VF loss and support the need for more comprehensive assessments. Future research should explore longitudinal studies to further assess the predictive value of disc area and investigate additional factors, such as vascular and biomechanical influences, that may contribute to VF deterioration in this population.
本研究旨在探讨“绿码”患者（即光学相干断层扫描检查结果正常，但存在潜在视野异常的患者）的眼压（IOP）、光学相干断层扫描（OCT）参数与视野（VF）结果之间的关系。了解这种关系对于改进青光眼的早期检测和管理策略至关重要，特别是对于那些尽管 OCT 检查结果正常但仍存在功能丧失的患者。本研究为横断面研究，于 2015 年 7 月 1 日至 2023 年 7 月 1 日在台湾台北市立仁爱医院进行。纳入的研究对象为疑似青光眼患者，纳入标准为 OCT 参数正常（“绿码”编码）并完成了 VF 检查。排除任何可能影响结果的眼部疾病的患者。采用逻辑回归模型评估 IOP、OCT 参数（视盘面积、视盘面积、视网膜神经纤维层厚度、杯盘比和杯容积）与 VF 结果之间的关系。同时，还将年龄、性别和 IOP 状态（正常或高眼压）纳入分析。所有数据均采用统计软件包 23.0 进行分析。较大的视盘面积是 VF 异常的显著预测因素，校正后的比值比为 3.72（95%置信区间 [CI]，1.14-12.15）。正常眼压或高眼压均不能显著预测 VF 损失（校正后的比值比=0.89；95%CI，0.27-2.96）。女性与 VF 异常的发生几率更高相关（校正后的比值比=5.68；95%CI，1.03-31.25）。其他 OCT 参数，包括视网膜神经纤维层厚度和杯盘比，与 VF 结果无显著相关性。视盘面积在“绿码”患者的 VF 异常预测中起关键作用，提示将视盘大小纳入筛查和监测方案的重要性。这些发现挑战了仅依靠 IOP 预测 VF 损失的观点，并支持更全面评估的必要性。未来的研究应开展纵向研究，以进一步评估视盘面积的预测价值，并探讨其他因素，如血管和生物力学影响，这些因素可能导致该人群的 VF 恶化。
