Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard...Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard automated perimetry (SAP). Design: Experimental study. Participants: Thirty-five patients (22 with OHT and 13 with OAG) who had previously undergone at least 3 threshold SAP visual field examinations with the Humphrey Field Analyzer (HFA; Carl Zeiss Meditech Inc.,Dublin,CA),and 9 patients with OHT who had not previously undertaken any form of perimetry. Methods: Each patient attended for SWAP on 5 occasions,each separated by 1 week. At each visit,both eyes were examined using Program 24-2 of the HFA; the right eye was always examined before the left eye. Main Outcome Measures: (1) Change over the 5 examinations,in each eye,of the visual field indices Mean Deviation (MD),Short-term Fluctuation (SF),Pattern Standard Deviation (PSD),and Corrected Pattern Standard Deviation. (2) Change in each eye between Visits 1 and 5 in proportionate Mean Sensitivity (pMS) for the central annulus of stimulus locations compared with that for the peripheral annulus thereby determining the influence of stimulus eccentricity on any alteration in sensitivity. (3) Change between Visits 1 and 5 in the number and magnitude of the Pattern Deviation (PD) probability levels associated with any alteration in sensitivity. Results: The MD,SF,and PSD each improved over the 5 examinations (each at P< 0.001). The improvement in pMS between Visits 1 and 5 was greater for the peripheral annulus than for the central annulus by approximately two fold for the patients with OAG. Considerable variation was present between patients,within and between groups,in the number of locations exhibiting an improving sensitivity between Visits 1 and 5 by 1 or more PD probability levels. Conclusions: Care should be taken to ensure that,during the initial examinations,apparent field loss with SWAP in patients exhibiting a normal field by SAP is not the result of inexperience in SWAP. Apparently deeper or wider field loss in the initial examinations with SWAP compared with that exhibited by SAP in OAG also may arise from inexperience in SWAP.展开更多
Purpose: To examine the relationship between open- angle glaucoma (OAG) and retinal vessel diameter among baseline participants in the Blue Mountains Eye Study. Design: Population- based cross- sectional study. Partic...Purpose: To examine the relationship between open- angle glaucoma (OAG) and retinal vessel diameter among baseline participants in the Blue Mountains Eye Study. Design: Population- based cross- sectional study. Participants: The study included 3654 persons older than49 years, representing 82.4% of permanent residents living in an area west of Sydney. Methods:Participants had a detailed eye examination, including automated perimetry and stereo optic disc photography. A computer- assisted program measured retinal vessel diameters from digitized photographs of right eyes. Main Outcome Measures: Open- angle glaucomawas diagnosed frommatching visual field defects and optic disc cupping, without reference to intraocular pressure (IOP) level. Ocular hypertension was defined as IOP of >21 mmHg in either eye, without matching glaucomatous optic disc and field changes. Average retinal vessel diameters, measured from right eyes, were summarized as arteriolar and venular equivalents. The lowest quintile of the arteriolar equivalent or arteriole- to- venule ratio was used to define generalized retinal arteriolar narrowing. Results: The study included 3314 participants, after excluding those with incomplete data or nonglaucomatous optic nerve disease. Of persons included,59 (1.8% ) had evidence of glaucomatous damage affecting the right eye, 3065 (92.5% ) had no damage to either eye, and 163 (4.9% ) had ocular hypertension. Right eyes with glaucomatous damage had significantly narrower retinal arteriolar diameters (183± 2.6 μ m) than eyes without glaucoma (194± 0.4 μ m, P= 0.0001) or eyes with ocular hypertension (195± 1.6 μ m, P= 0.0002), after adjusting for age, mean arterial blood pressure, and other confounding variables, including refraction. Right eyes with glaucomatous damage were at least 2 times more likely to have generalized retinal arteriolar narrowing than eyes without glaucoma (odds ratio, 2.7; 95% confidence interval, 1.5- 4.8). Conclusions: These population- based data suggest that generalized retinal arteriolar narrowing, an indicator of localized vascular change, is significantly associated with optic nerve damage caused by OAG. It is not clear whether such a retinal arteriolar change reflects an ischemic process leading to optic nerve damage or results from loss of retinal neurons secondary to glaucoma.展开更多
文摘Purpose: To document the magnitude of any learning effect for short-wave length automated perimetry (SWAP) in patients with either ocular hypertension (OHT) or open-angle glaucoma (OAG) who are experienced in standard automated perimetry (SAP). Design: Experimental study. Participants: Thirty-five patients (22 with OHT and 13 with OAG) who had previously undergone at least 3 threshold SAP visual field examinations with the Humphrey Field Analyzer (HFA; Carl Zeiss Meditech Inc.,Dublin,CA),and 9 patients with OHT who had not previously undertaken any form of perimetry. Methods: Each patient attended for SWAP on 5 occasions,each separated by 1 week. At each visit,both eyes were examined using Program 24-2 of the HFA; the right eye was always examined before the left eye. Main Outcome Measures: (1) Change over the 5 examinations,in each eye,of the visual field indices Mean Deviation (MD),Short-term Fluctuation (SF),Pattern Standard Deviation (PSD),and Corrected Pattern Standard Deviation. (2) Change in each eye between Visits 1 and 5 in proportionate Mean Sensitivity (pMS) for the central annulus of stimulus locations compared with that for the peripheral annulus thereby determining the influence of stimulus eccentricity on any alteration in sensitivity. (3) Change between Visits 1 and 5 in the number and magnitude of the Pattern Deviation (PD) probability levels associated with any alteration in sensitivity. Results: The MD,SF,and PSD each improved over the 5 examinations (each at P< 0.001). The improvement in pMS between Visits 1 and 5 was greater for the peripheral annulus than for the central annulus by approximately two fold for the patients with OAG. Considerable variation was present between patients,within and between groups,in the number of locations exhibiting an improving sensitivity between Visits 1 and 5 by 1 or more PD probability levels. Conclusions: Care should be taken to ensure that,during the initial examinations,apparent field loss with SWAP in patients exhibiting a normal field by SAP is not the result of inexperience in SWAP. Apparently deeper or wider field loss in the initial examinations with SWAP compared with that exhibited by SAP in OAG also may arise from inexperience in SWAP.
文摘Purpose: To examine the relationship between open- angle glaucoma (OAG) and retinal vessel diameter among baseline participants in the Blue Mountains Eye Study. Design: Population- based cross- sectional study. Participants: The study included 3654 persons older than49 years, representing 82.4% of permanent residents living in an area west of Sydney. Methods:Participants had a detailed eye examination, including automated perimetry and stereo optic disc photography. A computer- assisted program measured retinal vessel diameters from digitized photographs of right eyes. Main Outcome Measures: Open- angle glaucomawas diagnosed frommatching visual field defects and optic disc cupping, without reference to intraocular pressure (IOP) level. Ocular hypertension was defined as IOP of >21 mmHg in either eye, without matching glaucomatous optic disc and field changes. Average retinal vessel diameters, measured from right eyes, were summarized as arteriolar and venular equivalents. The lowest quintile of the arteriolar equivalent or arteriole- to- venule ratio was used to define generalized retinal arteriolar narrowing. Results: The study included 3314 participants, after excluding those with incomplete data or nonglaucomatous optic nerve disease. Of persons included,59 (1.8% ) had evidence of glaucomatous damage affecting the right eye, 3065 (92.5% ) had no damage to either eye, and 163 (4.9% ) had ocular hypertension. Right eyes with glaucomatous damage had significantly narrower retinal arteriolar diameters (183± 2.6 μ m) than eyes without glaucoma (194± 0.4 μ m, P= 0.0001) or eyes with ocular hypertension (195± 1.6 μ m, P= 0.0002), after adjusting for age, mean arterial blood pressure, and other confounding variables, including refraction. Right eyes with glaucomatous damage were at least 2 times more likely to have generalized retinal arteriolar narrowing than eyes without glaucoma (odds ratio, 2.7; 95% confidence interval, 1.5- 4.8). Conclusions: These population- based data suggest that generalized retinal arteriolar narrowing, an indicator of localized vascular change, is significantly associated with optic nerve damage caused by OAG. It is not clear whether such a retinal arteriolar change reflects an ischemic process leading to optic nerve damage or results from loss of retinal neurons secondary to glaucoma.
