视觉对比敏感度下降而视力正常175例中年患者4年随访观察

Follow-up observation of 175 middle-aged patients with reduced visual contrast sensitivity and normal vision for 4 years

目的通过对视觉对比敏感度(contrast sensitivity,CS)下降而视力正常的中年患者进行连续4 a的随访观察,探讨视功能受损患者多种眼病的发病趋势。方法采用队列研究设计,纳入2014年9至12月在沧州市中心医院体检的CS下降而视力正常的中年患者175例175眼(40~58岁)作为观察组;纳入同期年龄匹配的无CS下降且视力正常体检者167人167眼(40~59岁)作为对照组。对纳入的受检者每年进行CS、最佳矫正视力、直接检眼镜以及光学相干断层扫描(optical coherence tomography,OCT)检测,小部分患者行荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查,连续观察4 a,共实施5次检查,两组受检者均以较差CS值眼纳入研究,评估患者视网膜厚度的动态变化情况,观察特发性黄斑前膜(idiopathic epiretinal membrane,IERM)、白内障、视网膜微血管病变以及CS、视力下降趋势。结果在连续4 a的动态监测中,观察组视盘全周、视盘上1/4象限视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度呈进行性下降趋势(均为P<0.01);观察组2018年视盘全周RNFL厚度(96.335±9.374)μm、视盘上1/4象限RNFL厚度(120.526±9.211)μm均明显低于2014年(102.444±9.351)μm和(124.124±9.178)μm,差异均有统计学意义(均为P<0.01);经趋势性检验,观察组IERM、白内障、视网膜微血管病变的患病率呈明显上升趋势(χ^2=29.267、6.507、4.884,均为P<0.01),对照组此趋势变化不明显(χ^2=3.435、1.404、3.145,均为P>0.05);观察组、对照组均表现为明显的CS和视力下降趋势(χ^2=89.554、17.181,均为P<0.01;χ^2=85.970、8.677,均为P<0.01)。结论CS下降的中年人群虽大部分视力正常,但在随后数年中呈视神经纤维层进行性变薄和多种眼底疾病发病率上升趋势,该人群是多种眼底疾病的高危人群,CS和OCT检查是适合眼科体检筛诊工作的易行、有效手段。

Objective To investigate the incidence trends of multiple ocular diseases in patients with visual impairment by observing the middle-aged people with reduced contrast sensitivity(CS)and normal vision for 4 years.Methods A cohort study.A total of 175 middle-aged patients(aged 40-58 years,175 eyes)with decreased CS and normal vision,who were found in physical examination in Cangzhou Center Hospital from September to December 2014 were included as the observation group.During the same period,167 age-matched patients(aged 40-59 years,167 eyes)with normal CS and vision were collected as the control group.CS,best corrected visual acuity,direct ophthalmoscope and optical coherence tomography(OCT)examinations were performed annually,and Fundus fluorescein angiography(FFA)was done with some patients in necessity.Both groups were included in the study with worse CS values.It was analyzed that the incidence tendency of idiopathic epiretinal membrane(IERM),cataract,fundus microangiopathy,decreased vision and the dynamic changes in retinal thickness based on the 5 examinations over 4 years.Results During 4 consecutive years of dynamic monitoring,the observation group showed a progressive downward trend in the thickness of the optic nerve fiber layer(RNFL)around the optic disc and 1/4 quadrant above the optic disc(all P<0.01).In the observation group,the thickness detection values of RNFL[(96.335±9.374)μm]and 1/4 quadrant of optic disc[(120.526±9.211)μm)]in 2018 were significantly lower than those in 2014[(102.444±9.351)μm,(124.124±9.178)μm,respectively](all P<0.01).The prevalence of IERM,cataract,retinal microangiopathy in the observation group showed a significant increase(χ^2=29.267,6.507,4.884,all P<0.01),while no significant change in the control group(χ^2=3.435,1.404,3.145,all P>0.05).The two groups showed significant trend of CS and vision decline(χ^2=89.554,17.181,both P<0.01;χ^2=85.970,8.677,both P<0.01).Conclusion Although most of the middle-aged people with reduced CS have normal vision,they show progressive thinning of RNFL and increased incidence of various fundus diseases in subsequent years of observation.This group has a high risk of various fundus diseases.CS and OCT examinations are reliable,non-invasive and convenient to operate,which are effective means for ophthalmic physical examination and screening.