评价无视野计检查经验者接受倍频技术型、趋势定向型视野检查以及标准SITA、快速SITA视野检查的敏感性和特异性

Purpose:To evaluate the sensitivity and specificity of the screening modes of frequency-doubling technology(FDT),tendency-oriented perimetry(TOP),SITA Standard(SS)and SITA Fast(SF)in perimetrically inexperienced individuals.Methods:One eye of 64 glaucoma patients and 53 normal subjects who had never undergone automated perimetry were tested with programs C-20-5(FDT),G1(TOP)and 24-2(SS and SF).The gold standard for glaucoma was the presence of a typical glaucomatous optic disc appearance on stereoscopic examination(judged by a glaucoma expert),and intraocular pressure(IOP)> 21 mmHg.The test order among strategies was randomized for each subject.To define an abnormal visual field,we applied three criteria for SS and SF and two criteria for TOP and FDT,all of which have been previously described in the literature.Sensitivities and specificities among the different criteria were compared using the Cochran test.Results:Frequency-doubling technology showed the shortest mean test duration,followed by TOP,SF and SS(p < 0.05).Sensitivity ranges were 87.5-89.1% for SS,92.2-93.8% for SF,87.5-89.1% for TOP,and 82.8-85.9% for FDT(p=0.34).Specificity ranges were 73.6-83% for FDT,56.6-62.3% for TOP,60.4-69.8% for SF and 66.0-71.7% for SS.The specificity obtained with criterion 2 for FDT(based on the presence of two or more abnormal locations regardless of the severity of abnormal points)was higher than those measured with the other strategies(p < 0.01).Conclusion:When testing individuals with no perimetric experience,moderate sensitivities and specificities should be expected,regardless of the strategy chosen.

青光眼患者视盘地形图与视网膜神经纤维层厚度的相关性

Purpose: To test the correlation between optic disc topography (as measured by confocal scanning laser ophthalmoscopy [CSLO]) and retinal nerve fibre layer (R NFL) measurements (as measured by scanning laser polarimetry [SLP]) in glaucoma. Material and methods: A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24-2 full threshold Humphrey visual field, SLP with the GDx (Version 1.0.12) and CSLO with the TOPSS. Receiver operator ch aracteristic curves were created for each individual CSLO and SLP parameter. Lin ear correlations between the four best parameters from each device were calculat ed. Finally, linear correlations between the same variables, controlled for the severity of visual field damage, were calculated. Results: The best individual p arameters in the diagnosis of glaucoma for each device were cup area, vertical c up: disc ratio, cup: disc area ratio and average cup depth for CSLO, and the Num ber, maximummodulation, ellipse modulation and superior nasal for SLP. Moderate to strong correlations were observed in 62%of the pairs. However, only 6%and 1 2%of the correlations remained moderate when we controlled for the visual field mean deviation and correct pattern standard deviation, respectively. Conclusion s: The correlation between optic disc topography and RNFL measurements in glauco ma patients is moderate and highly dependent on the level of visual field loss.

年龄、性别、种族、屈光不正和视盘参数对激光扫描偏振检查敏感性和特异性的影响

Purpose: To evaluate the influence of age, sex, race, refractive error and opt ic disc topography on the sensitivity and specificity of scanning laser polarime try (SLP) in the diagnosis of glaucoma. Methods: A total of 88 normal individual s and 95 glaucoma patients were included in this study. Glaucoma was defined on the basis of both optic nerve damage and visual field defects. Scanning laser po larimetry, optic disc topography, automated perimetry and refractometry were per formed in all subjects. The sensitivity and specificity of SLP were assessed app lying a previously calculated cut-off to a previously described linear discrimi nant function (LDF). Results: The sensitivity and specificity of SLP in the stud y population were 82%and 83%, respectively. Sensitivity and specificity were n ot affected by age, sex, race, average disc diameter or disc area. The sensitivi ty of SLP tended to be higher in myopes (93%) than in emmetropes (80%) and hyp eropes (71%) (P=0.08). Sensitivities were higher in individuals with cup areas >0.96 mm2(89%), rim areas ≤1.36 mm2 (92%), and cup area/disc area ratios >0.4 5 (89%) (P < 0.05). Stepwise logistic regression analysis indicated that the pr esence of a cup area > 0.96 mm2 and a rim area< 1.36 mm2 significantly increased the sensitivity of the LDF, whereas a cup area/disc area ratio ≤0.45 significa ntly increased the specificity of the LDF. Conclusion: The sensitivity and speci ficity of SLP may be influenced by refractive error and optic disc parameters th at are affected by glaucomatous damage (cup area, rim area and cup area/disc are a ratio). These parameters must be considered in studies evaluating the sensitiv ity and specificity of optic nerve/retinal nerve fibre layer imaging technologie s.