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近视对青光眼患者局部视野缺损及进展的影响

The Impact of Myopia on Regional Visual Field Loss and Progression in Glaucoma.

作者信息

Lokhande Anagha, Song Luo, Pang Yueyin, Luo Yan, Pasquale Louis R, Wellik Sarah R, De Moraes Carlos Gustavo, Myers Jonathan S, Eslami Mohammad, Elze Tobias, Shen Lucy Q, Zebardast Nazlee, Friedman David S, Boland Michael V, Wang Mengyu

机构信息

Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA, USA.

The Warren Alpert Medical School of Brown University, Providence, RI, USA.

出版信息

Transl Vis Sci Technol. 2025 Sep 2;14(9):34. doi: 10.1167/tvst.14.9.34.

Abstract

PURPOSE

The purpose of this study was to investigate the impact of myopia on regional visual field (VF) loss and progression in glaucoma.

METHODS

We included 112,633 24-2 VFs; longitudinal analyses comprised patients with at least 5 reliable VFs over 4 years. The degree of myopia was measured by spherical equivalent (SE) extracted from VF testing. Linear and Cox regressions determined the impact of myopia on regional VF loss and progression, respectively. We calculated three VF progression outcomes: (1) mean deviation (MD) progression: MD slope <0; (2) total deviation (TD) pointwise progression: at least 3 TD locations with TD slope ≤-1 decibels (dB)/year; (3) MD fast progression: MD slope ≤-1 dB/year (P value < 0.05). Longitudinal analyses were conducted for all subjects and with exclusion of patients with high myopia (SE ≤-6.00 diopters [D]).

RESULTS

More negative SE values were associated with worse TD values in the paracentral VF region (up to -0.14 dB/D). A more negative SE is associated MD (odds ratio [OR] = 0.95), TD pointwise (OR = 0.96), and MD fast progression (OR = 0.94; P < 0.001). Results were comparable when excluding patients with high myopia (P < 0.001): MD (OR = 0.95), VFI (OR = 0.95), and MD fast progression (OR = 0.94).

CONCLUSIONS

Lower SE values are associated with worse paracentral VF loss. Worse myopia is associated with functional progression, even when excluding patients with high myopia.

TRANSLATIONAL RELEVANCE

We provide evidence for the relationship between SE and VF progression and inform clinical practice by highlighting even mild myopia as a highly prevalent possible risk factor for glaucoma progression.

摘要

目的

本研究旨在调查近视对青光眼局部视野(VF)丧失及进展的影响。

方法

我们纳入了112,633次24-2视野检查;纵向分析纳入了在4年期间至少有5次可靠视野检查结果的患者。近视程度通过视野检查中提取的等效球镜度(SE)来衡量。线性回归和Cox回归分别确定近视对局部视野丧失及进展的影响。我们计算了三种视野进展结果:(1)平均偏差(MD)进展:MD斜率<0;(2)总偏差(TD)逐点进展:至少3个TD位置的TD斜率≤-1分贝(dB)/年;(3)MD快速进展:MD斜率≤-1 dB/年(P值<0.05)。对所有受试者进行纵向分析,并排除高度近视患者(SE≤-6.00屈光度[D])。

结果

更负的SE值与旁中心视野区域更差的TD值相关(高达-0.14 dB/D)。更负的SE与MD(优势比[OR]=0.95)、TD逐点进展(OR=0.96)和MD快速进展(OR=0.94;P<0.001)相关。排除高度近视患者时结果相似(P<0.001):MD(OR=0.95)、视野指数(VFI)(OR=0.95)和MD快速进展(OR=0.94)。

结论

较低的SE值与更差的旁中心视野丧失相关。即使排除高度近视患者,更严重的近视也与功能进展相关。

转化相关性

我们提供了SE与视野进展之间关系的证据,并通过强调即使是轻度近视也是青光眼进展的高度普遍的可能危险因素,为临床实践提供了参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/749e/12476162/a15b4474a466/tvst-14-9-34-f001.jpg

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