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视野可靠性评估循证标准 Evidence-based Criteria for Assessment of Visual Field Reliability

Yohannan, J., Wang, J., Brown, J., et al.




摘要:目的:旨在评估假阳性(FP),假阴性(FN),固视丢失率(FL)和测试持续时间(TD)对青光眼严重程度不同阶段视野(VF)可靠性的影响。设计:回顾性研究。研究对象:909例疑似或明显青光眼以及5次以上视野检查患者的1538只眼,共计10262个视野。方法:利用纵向数据多层次模型计算预测的平均偏差(MD)。计算预测和观察到的MD(ΔMD)之间的差异作为一个可靠指标。采用多层次模型评估FPFNFLTD对ΔMD的影响。主要观察指标:ΔMDFPFNFL增加10%,TD增加1分钟相关。结果:在任何疾病分期,FL对ΔMD几乎没有影响(每10%异常捕获试验<0.2分贝[dB]),任何水平的FL水平均不会产生≥1dB的ΔMD FP产生大于预期的MD,异常捕获试验增加10%,轻微(MD> -6dB),中等(-6MD<-12dB)和严重的(-12MD-20dB)疾病的ΔMD= 0.42,0.730.66dB,异常捕获试验超过20%,ΔMD分别= 1.572.063.53 dB 低于预期MD时,FN通常产生MD FN20%异常捕获试验的影响最小(各个严重程度每10%增量ΔMD> -0.14dB)。超过20%的异常捕获试验中,异常捕获试验中每增加10%,分别与轻度,中度和重度疾病中ΔMD= -1.27-0.53-0.51 dB相关联。早期22%的FP26%的FN,中期14%的FP34%的FN,严重(晚期)疾病的16FP51%的FN |ΔMD| 1dB TD 1分钟的增量产生的ΔMD-0.35-0.40 dB之间。结论:FL对已确诊的青光眼患者的可靠性几乎没有影响。 FP以及较小程度的FNTD对可靠性有显着影响。 FPFN的影响随着疾病严重程度以及异常捕获试验的范围而变化。根据我们的研究结果,我们提出了针对临床或研究应用对VF可靠性进行分类的循证严重程度特定标准。

PURPOSE:Assess the impact of false-positives (FP), false-negatives (FN), fixation losses (FL), and test duration (TD) on visual field (VF) reliability at different stages of glaucoma severity.DESIGN:Retrospective.PARTICIPANTS:A total of 10262 VFs from 1538 eyes of 909 subjects with suspect or manifest glaucoma and 5 VF examinations.METHODS:Predicted mean deviation (MD) was calculated with multilevel modeling of longitudinal data. Differences between predicted and observed MD (ΔMD) were calculated as a reliability measure. The impact of FP, FN, FL, and TD on ΔMD was assessed using multilevel modeling.MAIN OUTCOME MEASURES:ΔMD associated with a 10% increment in FP, FN, and FL, or a 1-minute increase in TD.RESULTS:FL had little impact on ΔMD (<0.2 decibels [dB] per 10% abnormal catch trials), and no level of FL produced 1 dB of ΔMD at any disease stage. FP yielded greater than expected MD, with a 10% increment in abnormal catch trials associated with a ΔMD= 0.42, 0.73, and 0.66 dB in mild (MD >-6 dB), moderate (-6 MD <-12 dB), and severe (-12 MD -20 dB) disease, respectively, up to 20% abnormal catch trials, and a ΔMD= 1.57, 2.06, and 3.53 dB beyond 20% abnormal catch trials. FNs generally produced observed MDs below expected MDs. FN were minimally impactful up to 20% abnormal catch trials (ΔMD per 10% increment >-0.14 dB at all levels of severity). Beyond 20% abnormal catch trials, each 10% increment in abnormal catch trials was associated with a ΔMD=-1.27,-0.53, and-0.51 dB in mild, moderate, and severe disease, respectively. |ΔMD| 1 dB occurred with 22% FP and 26% FN in early, 14% FP and 34% FN in moderate, and 16% FP and 51% FN in severe disease. A 1-minute increment in TD produced ΔMDs between-0.35 and-0.40 dB.CONCLUSIONS:FL have little impact on reliability in patients with established glaucoma. FP, and to a lesser extent FNs and TD, significantly affect reliability. The impact of FP and FN varies with disease severity and over the range of abnormal catch trials. On the basis of our findings, we present evidence-based, severity-specific standards for classifying VF reliability for clinical or research applications.


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