采用前置法进行青光眼指南推荐的视野检查：时间与成本
The Frontloading Approach to Meet Guideline-Recommended Visual Field Testing for Glaucoma: Time and Cost.
作者信息
Wang Henrietta, Masselos Katherine, Tan Jeremy C K, Patel Nimesh B, Agar Ashish, Kalloniatis Michael, Phu Jack
机构信息
School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia; Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.
Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
出版信息
Ophthalmol Glaucoma. 2025 Sep-Oct;8(5):515-527. doi: 10.1016/j.ogla.2025.04.003. Epub 2025 Apr 11.
PURPOSE
To measure the time and clinical resources taken to obtain 6 reliable visual field (VF) tests for glaucoma in a glaucoma clinic.
DESIGN
Longitudinal, prospective study in a glaucoma clinic.
SUBJECTS
Ten thousand and ten SITA-Faster VF tests of 535 clinical subjects.
METHODS
The cumulative number of VF tests with false-positive rates ≤15% for each eye of each subject was counted over time, and from there, the time to achieve 6 VF tests was determined and compared under frontloaded (2 VFs per eye per visit) and non-frontloaded (first VF within the frontloaded set) conditions. Costs to attain 6 VF tests were modeled.
MAIN OUTCOME MEASURES
Visual field counts and costs for attainment.
RESULTS
Eight thousand nine hundred thirty-one of the 10 010 VF results had a false-positive rate of ≤15%. Approximately 90% of subjects had early or moderate open-angle glaucoma. When using the frontloading protocol, it took an average of 1.4 years to attain 6 reliable VFs for right and left eyes, respectively. For the non-frontloaded protocol, the average times were 2.6 and 2.5 years for the right and left eyes, respectively; 82.5% of right eyes and 85.4% of left eyes achieved 6 reliable VFs within 2 years when frontloaded, but the proportion was only 15.8% and 18.8% when non-frontloaded for right and left eyes, respectively. There was a significantly lower cost for obtaining 6 reliable VFs with frontloading than non-frontloading, due to fewer office visits.
CONCLUSIONS
A frontloading approach and SITA-Faster paradigm led to patients attaining 6 reliable VFs over 14 months sooner than non-frontloaded, with >84% receiving the recommended number of 6 tests in the first 2 years. The frontloading approach overall leads to savings in time and cost in comparison to non-frontloading for achieving 6 reliable VFs and thus potentially provides an avenue for earlier detection of glaucomatous change.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
测量在青光眼诊所获得6次可靠的青光眼视野（VF）检查所需的时间和临床资源。
设计
在青光眼诊所进行的纵向前瞻性研究。
研究对象
535名临床受试者的10010次SITA-Faster视野检查。
方法
随着时间的推移，统计每个受试者每只眼睛假阳性率≤15%的视野检查累积次数，据此确定在预先加载（每次就诊每只眼睛进行2次VF检查）和非预先加载（在预先加载组中进行第一次VF检查）条件下获得6次VF检查的时间并进行比较。对获得6次VF检查的成本进行建模。
主要观察指标
视野检查次数和获得检查的成本。
结果
10010次VF检查结果中有8931次假阳性率≤15%。约90%的受试者患有早期或中度开角型青光眼。采用预先加载方案时，右眼和左眼分别平均需要1.4年才能获得6次可靠的VF检查。对于非预先加载方案，右眼和左眼的平均时间分别为2.6年和2.5年；预先加载时，82.5%的右眼和85.4%的左眼在2年内获得了6次可靠的VF检查，但非预先加载时，右眼和左眼的这一比例分别仅为15.8%和18.8%。由于就诊次数较少，预先加载获得6次可靠VF检查的成本显著低于非预先加载。
结论
预先加载方法和SITA-Faster模式使患者比非预先加载提前14个月获得6次可靠的VF检查，超过84%的患者在前两年接受了推荐的6次检查。与非预先加载相比，预先加载方法总体上节省了时间和成本，从而有可能为更早发现青光眼性变化提供途径。
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