Purpose: The aim of this study was to evaluate routine ophthalmic data to iden tify clinically useful risk factors for progressive visual field loss in patient swith primary open-angle glaucoma (POAG) already receivin...Purpose: The aim of this study was to evaluate routine ophthalmic data to iden tify clinically useful risk factors for progressive visual field loss in patient swith primary open-angle glaucoma (POAG) already receiving intraocular pressure -lowering treatments. Methods: A retrospective cohort study design was used. Ro utine ophthalmic data for all subjects were obtained from case records with the knowledge that baseline clinical data had been collected in a standardised manne r. Progression was defined according to the AGIS visual field defect scoring sys tem. Variables evaluated as candidate risk factors for progression were assessed by survival analysis. Factors exerting a significant effect on survival were su bsequently tested in a Cox proportional hazards model. Results: A cohort of 108 eligible POAG patients was followed over an average of 3.6 years, with an averag e visual field intertest interval of 8months. The incidence rate of progressive loss among the cohort was 5.4 cases per 100 person years. Increasing age was fou nd to be independently associated with a small but significantly increased risk of glaucomatous visual field defect progression (hazard ratio 1.07, P=0.022), an d a borderline association was also demonstrated with being male (hazard ratio 2 .76, P=0.057). Conclusions: This retrospective investigation has provided prelim inary information on factors associated with increased risk of progressive glauc omatous visual field loss that may inform clinical care strategies. Lack of conc ordance with other studies suggests that further prospective investigations are needed if risk stratification strategies are to be employed in caring for patien ts with chronic open-angle glaucoma.展开更多
To determine the sensitivity and specificity of measurements of the retinal ne rve fiber layer (RNFL) using the StratusOCT in glaucoma subjects with visual fie ld (VF) defects. Prospective cross-sectional study. One h...To determine the sensitivity and specificity of measurements of the retinal ne rve fiber layer (RNFL) using the StratusOCT in glaucoma subjects with visual fie ld (VF) defects. Prospective cross-sectional study. One hundred nine normal and 63 glaucoma subjects. Fast RNFL scans were performed in one eye of each patient using the StratusOCT. Sensitivity and specificity of different optical coherenc e tomography (OCT) criteria for identifying glaucoma subjects with glaucomatous VF defects. Areas under the receiver operating characteristic curves (AROCs) for various OCT parameters. Severity of VF defects in the glaucoma group was distri buted between mild (18 subjects), moderate (21 subjects), and severe (24 subject s). The average mean deviation of the glaucoma fields was-8.4 decibels (dB), wi th a standard deviation of 6.0 dB and a range from-0.14 to -28.0 dB. The sensi tivity and specificity using a criterion of average RNFL thickness abnormal at t he < 5%level were 84%and 98%, respectively. The sensitivity and specificity u sing a criterion of average RNFL thickness abnormal at the < 1%level were 68%a nd 100%. The sensitivity and specificity of using a criterion of ≥1 quadrants abnormal at the < 5%level were 89%and 95%. The sensitivity and specificity of using a criterion of ≥1 quadrants abnormal at the < 1%level were 83%and 100 %. The sensitivity and specificity of using a criterion of ≥1 clock hours abno rmal at the < 5%level were 89%and 92%. The sensitivity and specificity of usi ng a criterion of ≥1 quadrants abnormal at the < 1%level were 83%and 100%. T he AROC for mean RNFL thickness was 0.966. Other high AROC values included the s uperior quadrant (0.952), inferior quadrant (0.971), inferotemporal clock hour a t 7-o’clock (right eye) and 5-o’clock (left eye) (0.959), 6-o’clock hour ( 0.940), superotemporal clock hour at 11-o’clock (right eye) and 1-o’clock (l eft eye) (0.935), and 12-o’clock hour (0.924). The sensitivity and specificity of RNFL measurements using the new StratusOCT for glaucoma with manifest VF def ects are excellent. The best parameters seem to be ≥1 quadrants abnormal at the ≤5%level or ≥1 clock hours abnormal at the ≤5%level. Future studies are ne eded to determine the sensitivity and specificity of this new technology for gla ucoma without VF defects.展开更多
Objectives: To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry find...Objectives: To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method: A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (Objecti Vision Pty, Ltd, Sydney, NewSouthWales, Australia) within a defined 12- month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed. Results: The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r=0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0% ), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6% ) and Humphrey visual field results (81.9% ) were similar, but mVEP specificity was better (89.2% vs 79.5% ). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture. Conclusions: Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.展开更多
Aim: To compare rarebit perimetry (RBP) with standard achromatic perimetry (SAP) in detecting early glaucomatous functional damage. Methods: 43 patients with ocular hypertension (OH),39 with early primary open angle g...Aim: To compare rarebit perimetry (RBP) with standard achromatic perimetry (SAP) in detecting early glaucomatous functional damage. Methods: 43 patients with ocular hypertension (OH),39 with early primary open angle glaucoma (POAG), and 41 controls were considered. Visual fields were assessed using the Humphrey field analyser (HFA)30- 2 and RBP tests. Differences among the groups were evaluated using Student-Newman-Keuls and χ 2 tests. Correlation between HFA and RBP parameters was assessed using the Pearson’ s correlation coefficients and regression analysis. Sensitivity and specificity of RBP in detecting early glaucomatous visual damage were calculated with different algorithms. Results: RBP-mean hit rate (MHR) was respectively 88.6% (SD 4.8% ) in controls; 79.1% (10.9% ) in the OH group; 64.3% (13.8% ) in the POAG group (differences statistically significant). Good correlation in the POAG group was found between HFA-mean deviation and RBP-MHR. Largest AROC (0.95) and optimal sensitivity (97.4% ) were obtained when an abnormal RBP test was defined as having (at least 1): MHR 15 areas with a non-hit rate of >10% ; ≥ 2 areas with a non-hit rate of >50% ; at least one area with a non-hit rate of ≥ 70% . Conclusions: The RBP appeared to be a rapid, comfortable, and easily available perimetric test (requiring only a PC device), showing a high sensitivity and specificity in detecting early glaucomatous visual field defects.展开更多
文摘Purpose: The aim of this study was to evaluate routine ophthalmic data to iden tify clinically useful risk factors for progressive visual field loss in patient swith primary open-angle glaucoma (POAG) already receiving intraocular pressure -lowering treatments. Methods: A retrospective cohort study design was used. Ro utine ophthalmic data for all subjects were obtained from case records with the knowledge that baseline clinical data had been collected in a standardised manne r. Progression was defined according to the AGIS visual field defect scoring sys tem. Variables evaluated as candidate risk factors for progression were assessed by survival analysis. Factors exerting a significant effect on survival were su bsequently tested in a Cox proportional hazards model. Results: A cohort of 108 eligible POAG patients was followed over an average of 3.6 years, with an averag e visual field intertest interval of 8months. The incidence rate of progressive loss among the cohort was 5.4 cases per 100 person years. Increasing age was fou nd to be independently associated with a small but significantly increased risk of glaucomatous visual field defect progression (hazard ratio 1.07, P=0.022), an d a borderline association was also demonstrated with being male (hazard ratio 2 .76, P=0.057). Conclusions: This retrospective investigation has provided prelim inary information on factors associated with increased risk of progressive glauc omatous visual field loss that may inform clinical care strategies. Lack of conc ordance with other studies suggests that further prospective investigations are needed if risk stratification strategies are to be employed in caring for patien ts with chronic open-angle glaucoma.
文摘To determine the sensitivity and specificity of measurements of the retinal ne rve fiber layer (RNFL) using the StratusOCT in glaucoma subjects with visual fie ld (VF) defects. Prospective cross-sectional study. One hundred nine normal and 63 glaucoma subjects. Fast RNFL scans were performed in one eye of each patient using the StratusOCT. Sensitivity and specificity of different optical coherenc e tomography (OCT) criteria for identifying glaucoma subjects with glaucomatous VF defects. Areas under the receiver operating characteristic curves (AROCs) for various OCT parameters. Severity of VF defects in the glaucoma group was distri buted between mild (18 subjects), moderate (21 subjects), and severe (24 subject s). The average mean deviation of the glaucoma fields was-8.4 decibels (dB), wi th a standard deviation of 6.0 dB and a range from-0.14 to -28.0 dB. The sensi tivity and specificity using a criterion of average RNFL thickness abnormal at t he < 5%level were 84%and 98%, respectively. The sensitivity and specificity u sing a criterion of average RNFL thickness abnormal at the < 1%level were 68%a nd 100%. The sensitivity and specificity of using a criterion of ≥1 quadrants abnormal at the < 5%level were 89%and 95%. The sensitivity and specificity of using a criterion of ≥1 quadrants abnormal at the < 1%level were 83%and 100 %. The sensitivity and specificity of using a criterion of ≥1 clock hours abno rmal at the < 5%level were 89%and 92%. The sensitivity and specificity of usi ng a criterion of ≥1 quadrants abnormal at the < 1%level were 83%and 100%. T he AROC for mean RNFL thickness was 0.966. Other high AROC values included the s uperior quadrant (0.952), inferior quadrant (0.971), inferotemporal clock hour a t 7-o’clock (right eye) and 5-o’clock (left eye) (0.959), 6-o’clock hour ( 0.940), superotemporal clock hour at 11-o’clock (right eye) and 1-o’clock (l eft eye) (0.935), and 12-o’clock hour (0.924). The sensitivity and specificity of RNFL measurements using the new StratusOCT for glaucoma with manifest VF def ects are excellent. The best parameters seem to be ≥1 quadrants abnormal at the ≤5%level or ≥1 clock hours abnormal at the ≤5%level. Future studies are ne eded to determine the sensitivity and specificity of this new technology for gla ucoma without VF defects.
文摘Objectives: To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method: A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (Objecti Vision Pty, Ltd, Sydney, NewSouthWales, Australia) within a defined 12- month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed. Results: The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r=0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0% ), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6% ) and Humphrey visual field results (81.9% ) were similar, but mVEP specificity was better (89.2% vs 79.5% ). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture. Conclusions: Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.
文摘Aim: To compare rarebit perimetry (RBP) with standard achromatic perimetry (SAP) in detecting early glaucomatous functional damage. Methods: 43 patients with ocular hypertension (OH),39 with early primary open angle glaucoma (POAG), and 41 controls were considered. Visual fields were assessed using the Humphrey field analyser (HFA)30- 2 and RBP tests. Differences among the groups were evaluated using Student-Newman-Keuls and χ 2 tests. Correlation between HFA and RBP parameters was assessed using the Pearson’ s correlation coefficients and regression analysis. Sensitivity and specificity of RBP in detecting early glaucomatous visual damage were calculated with different algorithms. Results: RBP-mean hit rate (MHR) was respectively 88.6% (SD 4.8% ) in controls; 79.1% (10.9% ) in the OH group; 64.3% (13.8% ) in the POAG group (differences statistically significant). Good correlation in the POAG group was found between HFA-mean deviation and RBP-MHR. Largest AROC (0.95) and optimal sensitivity (97.4% ) were obtained when an abnormal RBP test was defined as having (at least 1): MHR 15 areas with a non-hit rate of >10% ; ≥ 2 areas with a non-hit rate of >50% ; at least one area with a non-hit rate of ≥ 70% . Conclusions: The RBP appeared to be a rapid, comfortable, and easily available perimetric test (requiring only a PC device), showing a high sensitivity and specificity in detecting early glaucomatous visual field defects.
