Birt C M, Shin D H, Samudrala V, Hughes B A, Kim C, Lee D
Kresge Eye Institute, Wayne State University, Detroit, Michigan, USA.
Ophthalmology. 1997 Jul;104(7):1126-30. doi: 10.1016/s0161-6420(97)30173-0.
Visual field assessment is extremely important in glaucoma management, but interpretation is affected by the quality of the patient's performance. The authors have investigated the reliability of visual field performance by a randomly selected sample of the chronic glaucoma population at an urban tertiary care practice.
Patient reliability in Humphrey automated visual field testing was studied in 106 randomly selected chronic open-angle glaucoma patient charts, which provided 768 tests (mean, 7.2 +/- 4.8 fields; range, 2-18 fields). Reliability criteria were established as less than 20% fixation losses, less than 33% false-negative error, and less than 33% false-positive error, as recommended by Humphrey Instruments, Inc (San Leandro, CA).
Patients performed reliably in 61% of right eye fields, 58% of left eye fields, and 59.5% overall. Of the 106 patients, only 35 (33%) were always reliable in both eyes, whereas 8 (7.5%) were always unreliable in both eyes. The most common cause of unreliability was fixation loss (39%), whereas false-positive error (5%) and false-negative error (9%) were less frequent. A more severely depressed mean deviation correlated significantly with poorer performance on the three reliability indices, with false-negative error having the greatest correlation, followed by fixation loss and false-positive error. Corrected pattern standard deviation correlated closely only with false-negative error. Prolonged test time also correlated with all three reliability indices. Age was a significant factor for fixation loss but not for false-negative or false-positive error.
The authors conclude that fewer than two thirds of the Humphrey visual fields were reliable with the authors' urban tertiary care population of patients with glaucoma. Relaxing the fixation loss criterion to less than 33% improved the rate of reliability to approximately 75%. The severity of glaucomatous visual field defects, test time, and age were identified as factors influencing the reliability of the Humphrey visual fields.
视野评估在青光眼治疗中极为重要，但解读会受到患者表现质量的影响。作者通过在一家城市三级医疗中心随机抽取慢性青光眼患者样本，研究了视野表现的可靠性。
在106份随机抽取的慢性开角型青光眼患者病历中研究了汉弗莱自动视野检测中患者的可靠性，共提供了768次检测（平均7.2±4.8次视野检测；范围2 - 18次视野检测）。按照汉弗莱仪器公司（加利福尼亚州圣莱安德罗）的建议，将可靠性标准设定为注视丢失率低于20%、假阴性错误率低于33%以及假阳性错误率低于33%。
患者右眼视野检测可靠性达61%，左眼视野检测可靠性达58%，总体可靠性为59.5%。106例患者中，仅35例（33%）双眼始终可靠，而8例（7.5%）双眼始终不可靠。最常见的不可靠原因是注视丢失（39%），而假阳性错误（5%）和假阴性错误（9%）则较少见。平均偏差越低，三项可靠性指标的表现越差，其中假阴性错误的相关性最大，其次是注视丢失和假阳性错误。校正模式标准差仅与假阴性错误密切相关。检测时间延长也与三项可靠性指标相关。年龄是注视丢失的一个重要因素，但与假阴性或假阳性错误无关。
作者得出结论，在作者所在城市三级医疗中心的青光眼患者群体中，不到三分之二的汉弗莱视野检测结果可靠。将注视丢失标准放宽至低于33%可将可靠性提高至约75%。青光眼视野缺损的严重程度、检测时间和年龄被确定为影响汉弗莱视野检测可靠性的因素。
