倍频视野计、短波长自动视野计和标准自动视野计监测青光眼视野损害进展效能的对比分析

发布时间：2018-05-13 18:29

本文选题：青光眼进展 + 倍频视野计　；参考：《浙江大学》2016年博士论文

【摘要】：目的及时而准确地判定进展是青光眼病程临床管理中最重要和最具难度的任务之一。虽然病程中结构和功能均出现进行性损害,但与青光眼患者生活质量最直接相关的仍然是视功能的改变。早期并准确地识别视功能损害进展,有助于临床医师及时调整治疗方案,从而更好地保护患者残存的视功能、延缓其进一步丢失。标准自动视野计(SAP)是目前临床中最为广泛应用的青光眼视功能监测方法,但其重复检测的波动性(Test-retest variability)随着视野缺损程度的加重而加重,而且周边检测位点的波动性尤为显著,因而SAP在纵向追踪青光眼视野损害进展方面存在不足。倍频视野计(FDT)和短波长自动视野计(SWAP)是两种以早期诊断青光眼视野缺损为目的而研发的新型视野检查类型。当前版本的FDT(Matrix)视野检查,通过增加检测位点,采用与SAP类似的24-2检测模式,可获得较既往版本更为全面的视野信息；同时,与SAP相比,其在不同阶段病程中的检测波动性较低,且更为均匀一致。当前版本的SWAP (SITA)较既往的全阈值模式检测时间显著减少,检测波动性亦得到显著改善。大量的横断面研究资料已证实FDT和SWAP在青光眼视野损害早期诊断中的应用价值,但FDT和SWAP应用于青光眼视野损害进展监测中的可行性尚未明确。本研究通过对比分析FDT、SWAP 和 SAP追踪正常眼视野年龄相关性改变、已确诊原发性开角型青光眼(POAG)视野损害进展和疑似POAG眼潜在视野损害进展的效能,以明确当前版本的FDT和SWAP在纵向监测评估青光眼性视野损害进展中的应用价值。方法1.正常眼年龄相关性视野改变的FDT、SWAP 和 SAP评价本研究自DIGS和ADAGES数据库中纳入207例由综合分析病史和眼科检查结果(包括视力、色觉、屈光度、角膜厚度、眼压、裂隙灯、房角镜、散瞳眼底检查、立体视盘照相、OCT和视野检查)判定为正常的受试眼视野资料。纳入分析的同一受试眼的FDT、SWAP和SAP数据获取的时间间隔小于30天。FDT、 SWAP和SAP所报告的阈值敏感度值(单位dB)分别与受试者年龄(岁)行逐点普通最小二乘法线性回归分析,从而将不同视野检查类型中各个检查位点的阈值敏感度值均表达为以年龄为自变量的一元线性回归方程。2. 已确诊POAG眼视野损害进展的FDT、SWAP和SAP监测效能对比分析本研究自DIG S和ADAGES数据库中纳入由FDT、SWAP 和 SAP共同随访的84名113例已确诊P OAG患眼队列资料,平均随访时间为4.4士0.9年。FDT、SWAP和SAP检查所报告的以dB为单位的阈值敏感度数值均换算为相对于同年龄正常人群平均敏感度水平的百分数值(%%%N)。在共同的正常百分数度量体系下进行视野敏感度的逐点线性回归分析(PLR),并采用三种不同特异度水平的标准(严格、中等和宽松)判定视野变化趋势；对比分析不同视野检查类型的PLR判定结果以及相互的一致性。通过分层混合效应线性模型分析在所纳入的POAG队列中,FDT和SWAP所追踪到的视野平均敏感度的变化趋势,并于SAP作对比分析。3.疑似POAG眼视野损害进展的FDT和SAP监测效能对比分析本研究自DIGS和ADAGES数据库中纳入104名121例由FDT和SAP共同随访的疑似POAG患眼(存在明确的青光眼性视盘结构改变和／或高眼压症,但SAP检查未发现明确的青光眼性视野损害依据)队列资料,平均随访时间为6.6士1.5年。FDT和SAP检查所报告的以dB为单位的阈值敏感度数值均换算为相对于同年龄正常人群平均敏感度水平的百分数值(%N)。在共同的正常百分数度量体系下进行视野敏感度的逐点线性回归分析(PLR),并采用两种不同特异度水平的标准(严格和宽松)判定视野变化趋势；对比分析FDT和SAP数据的PLR判定结果以及相互的一致性。通过分层混合效应线性模型分析在所纳入的疑似POAG队列中,FDT所追踪到的视野平均敏感度的变化趋势,并于SAP作对比分析。结果1.在所纳入的40-75岁正常人群样本中,FDT、SWAP和SAP均可追踪到各个视野检测位点上具有统计学意义的阈值敏感度随年龄增加而线性递减的趋势(P0.05)。2.通过PLR分析,我们的研究表明根据更高特异度的严格判定标准,不同视野检查类型之间对于进展/好转的判定结果无统计学显著性差异；根据中等判定标准,FDT和SWAP报告的好转眼比例多于SAP；根据宽松判定标准,FDT所追踪到的进展眼比例少于SWAP和SAP。不同视野检查类型之间判定进展的一致性较低。二层次混合效应线性模型拟合结果显示在纳入研究的POAG队列中,FDT未能追踪到显著的平均敏感度进行性丢失趋势,而SAP则报告以-1.69 %N/年的速率进展；与SAP和FDT相比,SWAP显著低估基线的视野平均敏感度水平。3.通过PLR分析,我们的研究表明在不同严格程度的判定标准下,FDT和SAP对于进展／好转的判定结果无统计学显著性差异。FDT和SAP判定进展的一致性为较低到一般。二层次混合效应线性模型拟合结果显示在纳入研究的疑似POAG队列中,FDT和SAP均追踪到了显著的平均敏感度进行性丢失趋势,二者对进展速率的估算无显著性差异；与SAP相比,FDT估测的基线视野平均敏感度水平略低。结论1. FDT、SWAP和SAP均可追踪到正常眼中年龄相关性的视野敏感度衰退改变。2.对于已确诊的POAG患眼,FDT和SWAP检查未能表现出显著优于SAP的视野损害进展监测效能。对POAG患者个体而言,视野损害进展可能仅能被其中一种视野检查类型所识别。3.在仅明确视盘结构改变和/或高眼压症的疑似POAG眼中,FDT监测视野损害潜在进展的效能与SAP相仿。FDT可能有助于识别疑似POAG患眼中SAP检查未能发现的潜行视野损害进展趋势。4.以正常人群平均水平作为参照的相对百分数度量转换方法,可满足直接对比分析青光眼临床评估中不同检查类型(如视野vs.视野,或视野vs.结构)所获得的数据资料、界定统一的判定标准的要求,且直观明了,具有良好的临床应用价值。
[Abstract]:Objective to determine in a timely and accurate way that progress is one of the most important and difficult tasks in the clinical management of the course of glaucoma. Although structural and functional damage occurs during the course of the disease, the most direct correlation with the quality of life of glaucoma patients is the change of visual function. Early and accurate identification of visual impairment progress is helpful. The clinician adjusts the treatment plan in time so as to better protect the patient's residual visual function and delay its further loss. The standard automatic perimeter (SAP) is the most widely used clinical monitoring method of glaucomatous visual function in the current clinical practice, but the volatility of its repeated detection (Test-retest variability) is added with the aggravation of the degree of visual field defect. Heavy, and the peripheral detection loci are particularly volatile, so there is a shortage of SAP in longitudinal tracking of glaucomatous visual field damage. The frequency doubling perimeter (FDT) and the short wavelength automatic perimeter (SWAP) are two new types of perimetry for the purpose of early diagnosis of glaucoma visual field defects. The current version of the FDT (Matrix) field of vision Check, by adding the detection loci and using the 24-2 detection model similar to the SAP, the more comprehensive visual field information can be obtained from the previous version. At the same time, compared with the SAP, the detection volatility is lower and more uniform in different stages of disease. The current version of SWAP (SITA) is significantly less than the previous full threshold mode detection time. A large number of cross-sectional data have demonstrated the value of FDT and SWAP in the early diagnosis of glaucomatous visual field damage, but the feasibility of the application of FDT and SWAP to the monitoring of glaucomatous visual field damage is not clear. This study was conducted by comparison and analysis of FDT, SWAP and SAP to track the age related visual field of normal eyes. Sexual change, the effectiveness of the diagnosis of primary open angle glaucoma (POAG) visual field damage and the potential of potential visual field damage in POAG eyes, in order to identify the value of the current version of FDT and SWAP in the longitudinal monitoring of the progression of glaucomatous visual field damage. Method 1. the FDT, SWAP and SAP of the age-related visual field changes in normal eyes In the DIGS and ADAGES databases, 207 cases were determined by comprehensive analysis of medical history and ophthalmological examination results (including vision, color vision, refraction, corneal thickness, intraocular pressure, slit lamp, angle lens, pupil fundus examination, stereoscopic disc photography, OCT and visual field examination) as normal subjects' visual field data. FDT, SWAP, and SA of the same subjects were included in the analysis. The time interval of P data acquisition is less than 30 days.FDT, and the threshold sensitivity (unit dB) reported by SWAP and SAP is linear regression analysis with the subjects' age (year) by point by point ordinary least square method, thus the threshold sensitivity values of each check site in different field of vision are expressed as one linear regression with age independent variable. The comparative analysis of FDT, SWAP, and SAP monitoring effectiveness of the POAG eye visual field impairment in the.2. regression equation. This study was included in the DIG S and ADAGES database into the 84 patients who had been followed up by FDT, SWAP, and SAP. The average follow-up time was 4.4 and 0.9 years. The sensitivity values were converted to the percent value (%%%N) relative to the average level of sensitivity of the normal age population. The point by point linear regression analysis (PLR) was carried out under the common normal percentage measurement system, and the trend of visual field change was determined by three different levels of specificity (strict, medium and loose); Analysis of the PLR decision results and mutual consistency of different visual field check types. The variation trend of the average visual field sensitivity traced by FDT and SWAP in the included POAG queues was analyzed by the layered mixing effect linear model, and the FDT and SAP monitoring efficiency of.3. suspected POAG visual field damage progress was compared and analyzed in SAP. In the DIGS and ADAGES databases, 104 suspected POAG patients were followed up by FDT and SAP (there were clear glaucomatous optic disc structural changes and / or high intraocular pressure, but SAP examination did not find clear glaucomatous visual field damage basis). The average follow-up time was 6.6, 1.5 years,.FDT and SAP. The value of threshold sensitivity in the dB unit was converted to a percent value (%N) relative to the average sensitivity level of the normal age group. The point by point linear regression analysis (PLR) was carried out under the common normal percentage measurement system, and the visual field of two different levels of specificity (strict and loose) was used to determine the field of vision. Change trends; compare and analyze the PLR determination results of FDT and SAP data and the consistency of each other. The variation trend of the average visual field sensitivity traced by FDT in the suspected POAG queue is analyzed by the linear model of the mixed effect of the mixed effect, and the contrast analysis is made in SAP. Results 1. in the sample of the normal population aged 40-75 years, FDT, SWAP and SAP can track the statistically significant threshold sensitivity on the detection sites of various visual fields with the increase of age (P0.05).2. through PLR analysis. Our study shows that there is no significant difference in the determination of progress / improvement between different visual field test types according to the strict criteria of higher specificity. According to the medium criteria, the good turning ratio of the FDT and SWAP reports is more than that of SAP. According to the looser criteria, the proportion of the progressive eyes traced by the FDT is less than that between the SWAP and the SAP.. The two level mixed effect linear model fitting results show the POAG team in the study. In the column, FDT failed to track the significant average sensitivity progressive loss trend, while SAP reported the rate of -1.69%N/. Compared with SAP and FDT, SWAP significantly underestimated the baseline vision average sensitivity level.3. through PLR analysis. Our research shows that FDT and SAP are progressing / good under different stringent criteria. There was no statistically significant difference in the results of.FDT and SAP decision. The results of the two level mixed effect linear model showed that both FDT and SAP were traced to the significant average sensitivity progressive loss trend in the suspected POAG cohort, and the two had no significant estimation of the rate of progress. Difference; compared with SAP, the average baseline sensitivity of FDT was slightly lower than that of SAP. Conclusion 1. FDT, SWAP and SAP could track the age-related visual field sensitivity decline in normal eyes and.2. for diagnosed POAG eyes, FDT and SWAP failed to show significantly better monitoring effectiveness than SAP in visual field damage. For POAG patients In body, the development of visual field damage may only be identified by one of the type of visual field examination (.3.) in the suspected POAG eyes with only visual disc structure change and / or high intraocular pressure. The effectiveness of FDT monitoring the potential progression of visual field damage and SAP similar.FDT may help to identify the latent visual impairment that failed to be detected by the SAP examination in a suspected POAG eye. The trend.4. takes the average level of the normal population as a reference to the relative percentage measurement conversion method, which can satisfy the data obtained by the direct contrast analysis of different types of glaucoma clinical assessment (such as the visual field of vision, or the vs. structure of the field of vision), and define the requirements of the unified criteria, and have a good clinical response. Use value.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R775

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