Tuck M W, Crick R P
International Glaucoma Association, King's College Hospital, London, UK.
Ophthalmic Physiol Opt. 1993 Jul;13(3):227-32. doi: 10.1111/j.1475-1313.1993.tb00463.x.
This study analyses records from 189 optometric practices in England and Wales on the glaucoma screening of 123,415 patients aged > 40 years during a prospective 6 month period. Its purpose is to compare the effectiveness of the various modes of screening which were used. All optometrists tested every patient by ophthalmoscopy. The 146 who, in addition, conducted tonometry on a routine basis detected a confirmed glaucoma in 0.35% of their patients, whilst the 43 who used tonometry 'on suspicion' detected a case in 0.25%, (P < 0.02). The 47 optometrists who conducted perimetry frequently (i.e. in > or = 15% of sight tests) detected a case in 0.46% of patients, whilst the other 142, who did little or no perimetry, detected a case in 0.29%, (P < 0.001). Eleven optometrists who relied mainly on ophthalmoscopy had a detection rate of only 0.12%. Optometrists with the most comprehensive modes of screening had the greatest referral accuracy. It was concluded that more widespread adoption of routine tonometry for people aged approximately greater than 40 years is necessary to reduce the present substantial number of false negatives; and that the frequent use of visual field analysis is additionally required to achieve the best results.
本研究分析了英格兰和威尔士189家验光诊所对123415名40岁以上患者进行青光眼筛查的记录，为期6个月，属前瞻性研究。其目的是比较所采用的各种筛查方式的有效性。所有验光师均通过检眼镜检查每位患者。另外，146名定期进行眼压测量的验光师在其0.35%的患者中检测出确诊青光眼，而43名“怀疑时”才进行眼压测量的验光师在其0.25%的患者中检测出病例（P<0.02）。47名频繁进行视野检查（即在≥15%的视力检查中进行）的验光师在0.46%的患者中检测出病例，而其他142名很少或不进行视野检查的验光师在0.29%的患者中检测出病例（P<0.001）。11名主要依靠检眼镜检查的验光师的检出率仅为0.12%。采用最全面筛查方式的验光师转诊准确率最高。研究得出结论，为减少目前大量的假阴性病例，有必要在40岁以上人群中更广泛地采用常规眼压测量；此外，还需要频繁使用视野分析以取得最佳效果。
