Mutlukan E
Department of Ophthalmology, Henry Ford Health Sciences Center, Detroit, MI 48202, USA.
Eye (Lond). 1995;9 ( Pt 6):745-50. doi: 10.1038/eye.1995.188.
The occurrence of generalised or diffuse visual field depression in primary open angle glaucoma (POAG), in contrast to the presence of characteristic localised defects, is controversial. The frequency of diffuse visual field loss to automated static perimetry in the early stages of POAG was determined and compared with the frequency of localised defects. Twenty-five eyes of 25 consecutive POAG patients who met the selection criteria were tested on the Humphrey Visual Field Analyser with the Central 30-2 Threshold Test. Patients' mean age was 68 years. All eyes had visual acuity better than 6/9 with correction, refractive error of less than +/- 7 dioptres, no media opacities and normal pupils (3-6 mm). For all eyes, the frequency of abnormality on the STATPAC Total Deviation (TD) and Pattern Deviation (PD) plots were determined for all individual test points. Mean values and standard deviations were compared. The TD plots represent a composite of both diffuse and localised visual field depression, while PD plots are intended to reflect localised field defects. The frequency of involvement of the test points on the TD plots was higher than on the PD plots (mean +/- SD: 41.5 +/- 11.2% vs 27.5 +/- 10.9%) for all presenting defects. When only deep defects (STATPAC p < 1% and p < 0.5%) were evaluated, TD involvement was still more frequent than the PD (20.1 +/- 9.4% vs 13.2 +/- 7.2%). The topographical pointwise incidence of pure generalised sensitivity loss in the visual field was less frequent when only deep defects were taken into consideration (6.9 +/- 5.7%), and the incidence increased progressively with the inclusion of intermediate and shallow field defects (9.6 +/- 6.8% and 14.0 +/- 8.4% respectively). A component of diffuse sensitivity depression is present at all significant levels of visual field loss in glaucoma. This component of generalised loss decreases as the depth of the field defects increases. This finding suggests that early diffuse field loss converts into well-defined pattern defects at later stages.
与典型局限性缺损的存在不同，原发性开角型青光眼（POAG）中出现的广泛性或弥漫性视野缺损存在争议。本研究确定了POAG早期自动静态视野检查中弥漫性视野缺损的发生率，并与局限性缺损的发生率进行比较。对符合入选标准的25例连续POAG患者的25只眼进行了Humphrey视野分析仪中央30-2阈值测试。患者的平均年龄为68岁。所有患眼矫正视力均优于6/9，屈光不正小于±7屈光度，无介质混浊，瞳孔正常（3-6mm）。对于所有患眼，确定所有单个测试点在STATPAC总偏差（TD）和模式偏差（PD）图上的异常频率。比较均值和标准差。TD图代表弥漫性和局限性视野缺损的综合情况，而PD图旨在反映局限性视野缺损。对于所有呈现的缺损，TD图上测试点受累的频率高于PD图（均值±标准差：41.5±11.2%对27.5±10.9%）。仅评估深度缺损（STATPAC p<1%和p<0.5%）时，TD受累仍比PD更频繁（20.1±9.4%对13.2±7.2%）。仅考虑深度缺损时，视野中单纯广泛性敏感度丧失的地形逐点发生率较低（6.9±5.7%），随着纳入中度和轻度视野缺损，发生率逐渐增加（分别为9.6±6.8%和14.0±8.4%）。在青光眼所有显著程度的视野缺损中均存在弥漫性敏感度降低的成分。这种广泛性丧失成分随着视野缺损深度的增加而减少。这一发现表明，早期弥漫性视野缺损在后期会转变为明确的模式缺损。
