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中山眼科中心布赖恩霍顿视觉研究所高度近视注册研究视野缺陷分类

Ding X, Chang RT, Guo X, et al.

期刊名称:British Journal of Ophthalmology

卷期:2016年第100卷第12期

摘要

目的:旨在描述一种新型近视和青光眼视野综合分类系统,以报告中国7-70岁年轻人高度近视的视野缺陷。方法:共对来自前瞻性中山眼科中心布赖恩霍顿视觉研究所(ZOC-BHVI)高度近视登记研究中的487例高度近视(球面≤-6.0D)患者的1434个视野(包括确认的重复异常缺陷)进行了分析。覆盖高度近视和青光眼类别的预定义分类是:正常,扩大盲点,疑似异常和异常九个亚型。两个独立的评分者评估了1434个视野中的前150个,用于初始分级校准,使用剩余的1284个视野评估分级者的一致性。对于视野的百分比分布,重复和不可靠的视野被排除,仅留下894个视野。结果:这种组合分类系统的分级者一致性κ值为0.6195CI 0.59-0.63)。在894个独特的视野中,最常见的视野是正常(33.7%),其次是扩大的盲点(25.6%)。 “弓状样”视野缺陷(包括鼻尖,早期弓形和晚期弓形)的百分比为16.1%,晚期弓形占3.4%。结论:高度近视和青光眼组合视野分类的分级者一致性尚能接受。研究发现年轻高近视中16.1%的缺陷与经典的青光眼缺陷类似。正在追踪这些受试者以评估哪些患者将进展以区分近视与青光眼性视野缺陷。

PURPOSE:To describe a new combined myopia and glaucoma visual field classification system in order to report the visual field defects in a population of mostly young Chinese high myopes aged 7-70 years.METHODS:A total of 1434 visual fields (including confirmatory repeats of abnormal defects) from 487 high myopes (sphere -6.0 D) were analysed from the prospective Zhongshan Ophthalmic Center-Brien Holden Vision Institute (ZOC-BHVI) High Myopia Registry Study. The predefined classification definitions covering high myopia and glaucoma categories were: normal, enlarged blind spot, abnormal suspect and abnormal with nine subtypes. Two independent graders reviewed the first 150 of 1434 fields for initial grading calibration and the remaining 1284 fields were used to assess intergrader agreement. For the percentage distribution of visual fields, the repeats and unreliable fields were excluded, leaving 894 fields.RESULTS:The intergrader agreement of this combined classification system was a κ value of 0.61 (95% CI 0.59 to 0.63). Among the 894 unique fields, the most common visual field was normal at 33.7% followed by enlarged blind spot at 25.6%. The per cent of 'arcuate-like' field defects (combining nasal step, early arcuate and advanced arcuate) was 16.1% with advanced arcuate at 3.4%.CONCLUSIONS:A proposed combined visual field classification for high myopia and glaucoma demonstrates acceptable intergrader agreement. A total of 16.1% of defects in young high myopes were found to mimic classic glaucomatous defects. These subjects are being followed prospectively to assess which ones will progress to differentiate myopic from glaucomatous field defects.


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