Takaisin Tulosta

Hermosäie-, papilla- ja näkokenttämuutosten yhteneväisyys

Lisätietoa aiheesta
Anja Tuulonen
28.3.2023

The structure/function relationship «Leaney J, Healey PR, Lee M ym. Correlation of stru...»9 in 169 eyes of 169 glaucoma patients was retrospectively studied at different levels of severity, and with different disc sizes, between the Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography. Patients were divided on visual field criteria into early (mean deviation > -4 dB), moderate (-4 dB < mean deviation < -10 dB) and severe (mean deviation < -10 dB) disease. Bivariate correlation (Spearman's rho) between mean threshold scores for each area and the corresponding mean retinal nerve fibre layer thickness sectoral measurement were calculated.

Both imaging techniques showed only moderate correlations at best. Spectral domain optical coherence tomography (global retinal nerve fibre layer Spearman's rho = 0.670, P < 0.01) had higher correlation coefficients compared with Heidelberg Retinal Tomography rim area (Spearman's rho = 0.449, P < 0.01) and retinal nerve fibre layer (Spearman's rho = 0.421, P < 0.01). Disc size did not have a significant influence on the structure/function relationship.

Another survey «van der Schoot J, Reus NJ, Garway-Heath DF ym. Acc...»10 was targeted to determine the ability of ophthalmologists to match stereoscopic optic disc photographs to visual fields of varying severity (a total of 109 of 260 (42 %) invited ophthalmologists in 11 European countries). These had participated in the previous European Optic Disc Assessment Trial (EODAT), a trial on glaucoma diagnostic accuracy based on optic discs only.

Each participant matched stereo optic disc photographs of 40 healthy and 48 glaucomatous eyes to a visual field chosen from 4 options per disc. The 4 presented visual fields included the corresponding one and 3 other visual fields, varying in severity. Classification accuracy (as glaucomatous or healthy) was compared with EODAT data. Duplicate slides allowed for the assessment of intraobserver agreement.

The overall accuracy of ophthalmologists for correctly matching stereoscopic optic disc photographs to their visual fields was 59 %. When incorrectly matched, the observers generally overestimated the visual field severity (P < 0.001), notably in eyes with early glaucoma. The intraobserver agreement was, on average, moderate (0.52).

A randomised sample of 3001 Caucasian participants aged 45-49 years of the Northern Finland Birth Cohort Eye Study was examined using 24-2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography as well as SD-OCT of the peripapillary RNFL «Karvonen E, Stoor K, Luodonpää M ym. Combined stru...»11. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive '2 out of 3' rule based on the clinician's evaluation of ONH and RNFL photographs and visual fields (VFs).

At a specificity of 98%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones.

SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.

Hermosäie-, papilla- ja näkökenttämuutokset tulevat seurannassa esiin eri aikoina (1–6 vuoden viiveellä). Niiden korrelaatio yksittäisenä ajankohtana on huono.

Taulukko 1. Hermosäie-, papilla- ja näkökenttämuutosten yhteneväisyys. Yhteenveto tutkimuksista vuosilta 1985–2000.
* w-on-w = "white-on-white" (perinteinen näkökenttä)
** SWAP = sinikeltaperimetria
Yhteneväisyys % Seurannan pituus Tutkimustyyppi Kirjallisuusviite
Papilla- ja hermosäielöydökset 7/36 19 3,3 (1–7) vuotta, papilla/hs progressio 29/14 (suhde 2) Prospektiivinen «Caprioli J, Prum B, Zeyen T. Comparison of methods...»1
7/18 39 5 vuotta Prospektiivinen «Quigley HA, Katz J, Derick RJ ym. An evaluation of...»2
7/29 24 6 (5–9) vuotta, papilla/progressio 11/25 (suhde 0,4) Prospektiivinen «Katz J, Gilbert D, Quigley HA ym. Estimating progr...»3
14/23 61 10 vuotta (5–15) vuotta Retrospektiivinen «Tuulonen A, Airaksinen PJ. Initial glaucomatous op...»4
RNFL + papilla vs automaattiVF NK 3 kuukauden välein 9/36 25 3,3 (1–7) vuotta Prospektiivinen «Caprioli J, Prum B, Zeyen T. Comparison of methods...»1
4/18 22 6 vuotta (5–9) vuotta Prospektiivinen «Katz J, Gilbert D, Quigley HA ym. Estimating progr...»3
8/14 57 3,3 (1–6) vuotta, flicker chronoscopia vs Competer RCT (korkean riksin OHT) «Heijl A, Bengtsson B. Diagnosis of early glaucoma ...»5
Papilla vs
w-on-w* 13/22 59 4 vuotta (2–9) vuotta Kohortti «Girkin CA, Emdadi A, Sample PA ym. Short-wavelengt...»6
SWAP** 16/22 73 Nämä luvut, kun kentissä käytetään kliinisiä kriteerejä
w-on-w 7/22 32 Sama tutkimus AGIS-kriteerein
SWAP 12/22 55
Papilla vs automaattiperimetria 6/19 31 6 vuotta (5–9) vuotta Prospektiivinen «Katz J, Gilbert D, Quigley HA ym. Estimating progr...»3
2/8 25 6 vuotta Retrospektiivinen «Zeyen TG, Caprioli J. Progression of disc and fiel...»7
Papilla vs Goldmann perimetri 3/20 15 6 vuotta (5–7,5) Prospektiivinen «Odberg T, Riise D. Early diagnosis of glaucoma. Th...»8

Kirjallisuutta

  1. Caprioli J, Prum B, Zeyen T. Comparison of methods to evaluate the optic nerve head and nerve fiber layer for glaucomatous change. Am J Ophthalmol 1996;121:659-67 «PMID: 8644809»PubMed
  2. Quigley HA, Katz J, Derick RJ ym. An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage. Ophthalmology 1992;99:19-28 «PMID: 1741133»PubMed
  3. Katz J, Gilbert D, Quigley HA ym. Estimating progression of visual field loss in glaucoma. Ophthalmology 1997;104:1017-25 «PMID: 9186444»PubMed
  4. Tuulonen A, Airaksinen PJ. Initial glaucomatous optic disk and retinal nerve fiber layer abnormalities and their progression. Am J Ophthalmol 1991;111:485-90 «PMID: 2012151»PubMed
  5. Heijl A, Bengtsson B. Diagnosis of early glaucoma with flicker comparisons of serial disc photographs. Invest Ophthalmol Vis Sci 1989;30:2376-84 «PMID: 2807794»PubMed
  6. Girkin CA, Emdadi A, Sample PA ym. Short-wavelength automated perimetry and standard perimetry in the detection of progressive optic disc cupping. Arch Ophthalmol 2000;118:1231-6 «PMID: 10980768»PubMed
  7. Zeyen TG, Caprioli J. Progression of disc and field damage in early glaucoma. Arch Ophthalmol 1993;111:62-5 «PMID: 8424726»PubMed
  8. Odberg T, Riise D. Early diagnosis of glaucoma. The value of successive stereophotography of the optic disc. Acta Ophthalmol (Copenh) 1985;63:257-63 «PMID: 4036552»PubMed
  9. Leaney J, Healey PR, Lee M ym. Correlation of structural retinal nerve fibre layer parameters and functional measures using Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography at different levels of glaucoma severity. Clin Experiment Ophthalmol 2012;40:802-12 «PMID: 22594488»PubMed
  10. van der Schoot J, Reus NJ, Garway-Heath DF ym. Accuracy of matching optic discs with visual fields: the European Structure and Function Assessment Trial (ESAFAT). Ophthalmology 2013;120:2470-5 «PMID: 23809273»PubMed
  11. Karvonen E, Stoor K, Luodonpää M ym. Combined structure-function analysis in glaucoma screening. Br J Ophthalmol 2021;: «PMID: 34230023»PubMed