电脑视野检查假阴性反应性质的临床研究
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摘要
目的：
通过一系列的临床实验与调查，研究电脑视野检查(Octopus101视野计)中假阴性反应的性质。分为三部分：
一，探讨单侧青光眼缺损患者电脑视野检查假阴性反应率的眼间差异及相关因素；
二，研究正常人、青光眼患者、有视野缺损的非青光眼患者间的假阴性反应率差异及与视野指数的关系；
三，探讨随访检查中，稳定的青光眼患者的假阴性反应率的变化和相关视野指数的变化规律。
方法：
一，选取2000年1月至2002年10月在青岛大学医学院附属医院眼科视野检查室行Octopus101静态视野视野检查的单侧青光眼视野缺损患者66例进行研究；比较患者眼间视力、眼压、杯盘比、检查时间及假阴性反应率、假阳性反应率、平均偏差、平均光敏感度的差异，并分析了的假阴性反应率的相关因素。
二，对30例正常人，68例青光眼患者，21例有视野缺损的非青光眼患者进行前瞻性研究。每位患者只随机取一眼纳入检查范围。对每位受检者行Octopus101静态视野检查(2001年10月到2002年10月间)。检查程序选择G2。分析各组受检者假阴性反应率的差异及其相关因素及无关因素。
三，对正常人和青光眼患者各25人进行了前瞻性的视野随访对比观察。每位受检者均随机取一眼纳入研究。在8月内(2001年10月到2002年10月间)行3-4次连续Octopus101静态视野检查。分析两组人群假阴性反应率及相关因素的变化。
结果：
一，视野缺损眼与视野正常眼的FN差异显著(P＜0.01)，并且与检查的先后顺序无关，而二眼在视力、眼压、瞳孔直径等方面无明显差异(P＞0.05)；视野缺损眼MD与FN相关，在MD越高的眼，FN越高；而正常眼MD与FN无关。
二，不同患者组间视力、眼压及瞳孔直径的差别无显著性(P＞0.05)。各组的FN均与
这此因素无明显相关。正常人组的短期波动小于青光眼组和有视野缺损的非青光眼
患者。假阴性反应在时间上呈大致均匀分布。
三，随访检查中，稳定的青光眼患者的FN仍高于正常人，并且与平均缺损等因素
密切相关;稳定的青光眼患者的FN亦相对稳定，但有少数患者出现较大波动。
结论:
·，假阴性反应率作为可靠性指数来监测受检者的专心程度、注意力集中程度，是
不合适的。
几，假阴性反应率与平均偏差、短期波动及绝对暗点数量等密切相关，与长期波动
也有定的关联，从检查原理推测，其发生与绝对缺损边缘区阐值波动性增大有关。
几，假阴性反应率可以粗略地反映视野缺损尤其是局部较深缺损的状况，在视野检
查及视野随访中有一定的参考价值。
Objective:
To study the properties of false-negative responses of visual field tests on Octopus 101 perimetry through a series of clinical delectations and investigations.The study was divided into three independent portions:
1, To detect intereye differences of false negative responses rate(FN) and mean deviation(MD) in glaucoma patients with unilateral visual field defect. 2,To study the discrepancy of FN between normal subjects,glaucoma patients and non-glaucoma patients with visual field damage,and relationships between FN and visual field indexes.
3,To investigate stabilization of FN in glaucoma patients and chang of the correlation between FN and visual field defect. Methods:
1, Glaucoma patients with nomal visual field in one eye and damaged in another who performed automated perimetry between Jan 2000 and Oct 2002 were involved in this study. Intereye differences of false negative FN and MD were analyzed; 2,A prospective study was performed on NS(30cases),GP(68 cases),NGP(21 cases).One eye was selected at radom for test.OctopuslOl perimetry was performed on each subject with programme G2(Oct2001-Oct2002).Diffrerences of FN between groups and correlation factors were analyzed .
3,A prospective follow-up study was carried out on NS(25 cases) and GP(25 cases).All subjects handled 3-4 successive automated perimetry in a 8-months duration (Oct2001-Oct2002) and indexes observed similar to part 2.
Results:
1, FN between nomal eyes and damaged eyes was significant different(P<0.001),and this kind of differences has no relationship with consequence of the tests.No significant differences were found in visual acuity,IOP,pupil diameter intereyes(P>0.05). 2,No significant differences of visual acuity,IOP,and pupil diameter was found between NS,GP,and NGP(P>0.05).There was no correlation between FN and these factors for all groups.FN,SF of NS group were far lower than those of GP and NGP(P<0.01).In
general,the distributing of false negative responses was equalence in every time section.
3,Relative tranquilization was kept for FN in a 8-months period follow-up tests,but
counterpoise was also observed in several patients and MD changed meantime.
Conclusions:
1,FN reflects visual field state of glaucoma patients in some extent while it is in-
properiate to take it as a predict index of attentiveness of the patients.
2,Closely relationship were found between FN and MD,SF,ADL and LF in some
extent.To explain it from test principle ,it was linked to the increasing of the threshold
variation in the border of the absolute visual field defect.
3, FN could be a indication of visual field defect .especially local visual field with deep
depression.
通过一系列的临床实验与调查，研究电脑视野检查(Octopus101视野计)中假阴性反应的性质。分为三部分：
一，探讨单侧青光眼缺损患者电脑视野检查假阴性反应率的眼间差异及相关因素；
二，研究正常人、青光眼患者、有视野缺损的非青光眼患者间的假阴性反应率差异及与视野指数的关系；
三，探讨随访检查中，稳定的青光眼患者的假阴性反应率的变化和相关视野指数的变化规律。
方法：
一，选取2000年1月至2002年10月在青岛大学医学院附属医院眼科视野检查室行Octopus101静态视野视野检查的单侧青光眼视野缺损患者66例进行研究；比较患者眼间视力、眼压、杯盘比、检查时间及假阴性反应率、假阳性反应率、平均偏差、平均光敏感度的差异，并分析了的假阴性反应率的相关因素。
二，对30例正常人，68例青光眼患者，21例有视野缺损的非青光眼患者进行前瞻性研究。每位患者只随机取一眼纳入检查范围。对每位受检者行Octopus101静态视野检查(2001年10月到2002年10月间)。检查程序选择G2。分析各组受检者假阴性反应率的差异及其相关因素及无关因素。
三，对正常人和青光眼患者各25人进行了前瞻性的视野随访对比观察。每位受检者均随机取一眼纳入研究。在8月内(2001年10月到2002年10月间)行3-4次连续Octopus101静态视野检查。分析两组人群假阴性反应率及相关因素的变化。
结果：
一，视野缺损眼与视野正常眼的FN差异显著(P＜0.01)，并且与检查的先后顺序无关，而二眼在视力、眼压、瞳孔直径等方面无明显差异(P＞0.05)；视野缺损眼MD与FN相关，在MD越高的眼，FN越高；而正常眼MD与FN无关。
二，不同患者组间视力、眼压及瞳孔直径的差别无显著性(P＞0.05)。各组的FN均与
这此因素无明显相关。正常人组的短期波动小于青光眼组和有视野缺损的非青光眼
患者。假阴性反应在时间上呈大致均匀分布。
三，随访检查中，稳定的青光眼患者的FN仍高于正常人，并且与平均缺损等因素
密切相关;稳定的青光眼患者的FN亦相对稳定，但有少数患者出现较大波动。
结论:
·，假阴性反应率作为可靠性指数来监测受检者的专心程度、注意力集中程度，是
不合适的。
几，假阴性反应率与平均偏差、短期波动及绝对暗点数量等密切相关，与长期波动
也有定的关联，从检查原理推测，其发生与绝对缺损边缘区阐值波动性增大有关。
几，假阴性反应率可以粗略地反映视野缺损尤其是局部较深缺损的状况，在视野检
查及视野随访中有一定的参考价值。
Objective:
To study the properties of false-negative responses of visual field tests on Octopus 101 perimetry through a series of clinical delectations and investigations.The study was divided into three independent portions:
1, To detect intereye differences of false negative responses rate(FN) and mean deviation(MD) in glaucoma patients with unilateral visual field defect. 2,To study the discrepancy of FN between normal subjects,glaucoma patients and non-glaucoma patients with visual field damage,and relationships between FN and visual field indexes.
3,To investigate stabilization of FN in glaucoma patients and chang of the correlation between FN and visual field defect. Methods:
1, Glaucoma patients with nomal visual field in one eye and damaged in another who performed automated perimetry between Jan 2000 and Oct 2002 were involved in this study. Intereye differences of false negative FN and MD were analyzed; 2,A prospective study was performed on NS(30cases),GP(68 cases),NGP(21 cases).One eye was selected at radom for test.OctopuslOl perimetry was performed on each subject with programme G2(Oct2001-Oct2002).Diffrerences of FN between groups and correlation factors were analyzed .
3,A prospective follow-up study was carried out on NS(25 cases) and GP(25 cases).All subjects handled 3-4 successive automated perimetry in a 8-months duration (Oct2001-Oct2002) and indexes observed similar to part 2.
Results:
1, FN between nomal eyes and damaged eyes was significant different(P<0.001),and this kind of differences has no relationship with consequence of the tests.No significant differences were found in visual acuity,IOP,pupil diameter intereyes(P>0.05). 2,No significant differences of visual acuity,IOP,and pupil diameter was found between NS,GP,and NGP(P>0.05).There was no correlation between FN and these factors for all groups.FN,SF of NS group were far lower than those of GP and NGP(P<0.01).In
general,the distributing of false negative responses was equalence in every time section.
3,Relative tranquilization was kept for FN in a 8-months period follow-up tests,but
counterpoise was also observed in several patients and MD changed meantime.
Conclusions:
1,FN reflects visual field state of glaucoma patients in some extent while it is in-
properiate to take it as a predict index of attentiveness of the patients.
2,Closely relationship were found between FN and MD,SF,ADL and LF in some
extent.To explain it from test principle ,it was linked to the increasing of the threshold
variation in the border of the absolute visual field defect.
3, FN could be a indication of visual field defect .especially local visual field with deep
depression.
引文
1 Interzeag. OCTOPUS Visual Field Digest #4 Edition, 1998.
2 Lee M, Zulauf M, Capriori J.The influence of patient reliability on visual field outcome. Am J Ophthalmol. 1994; 117: 756-761.
3 Cascario MA, Stewart WC, Sutherland SE. Influence of missed catch trials on the visual field in normal subjects. Grafes Arch Clin Exp Ophthalmol. 1991;229:437-441.
4 Katz J Sommer A.Reliability indexes of automated perimetry. Arch Ophthalmol. 1988; 106: 1252-1254.
5 Katz J,Sommer A.Screening for glaucomatous visual field loss. The effect of patient reliability. Ophthalmology. 1990; 97(8): 1032-1037.
6 戴惟葭，郭丽．正常人和青光眼计算机视野检查的可靠性研究．临床眼科杂志，1998，5，295-297．
7 McMillan TA, Stewart WC, Hunt HH. Association of reliability with reproducibility of the glaucomatous visual field. Acta Ophthalmol Copenh. 1992; 70(5): 665-670.
8 Nelson-Quigg JM, Twelker JD, Johnson CA. Response properties of normal observers and patients during automated perimetry. Arch Ophthalmol. 1989; 107: 1612-161
9 Birt CM. Shin DH, Samudrala V, et al. Analysis of reliability indices from Humphery visual field tests in an urban glaucoma population. Ophthalmology. 1997; 104(7):1126-1130.
10 Bengtsson B,Heilj A.False-negative responses in glaucoma perimetry indicators of patient performance or test reliability? Invest Ophthalmol. 2000 Jul; 41(8): 2201-4.
11 中华医学会第二届全国眼科学术会议专题总结．中华眼科杂志．，1980，16，106-107
12 Gaasterland DE, Blackwell B, Delly LG, et al. Advanced Glaucoma Intervention Study. 2. Visual field test scoring and reliability. Ophthalmology. 1994 101(8): 1445-1455.
13 袁援生，陈小明．现代临床视野检测．北京：人民卫生出版社．1999；54
14 王大博，可疑青光眼杯盘比值与静态阈值视野改变的观察 中国实用眼科杂志2002；02 (2)：132-133．
15 陈小明，吴振中，蒋幼芹．青光眼静态阈值不对称．眼科研究．1994；12(1)：43-45．
16 Johnson LN, Aminlari A, Sassani JW. Effect of intermittent versus continuous patient monitoring on reliability indices during automated perimetry. Ophthalmology. 1993; 100(1):76-84.
17 Van-Coevordpn RE,Mills RP,Chen YY.Continous visual field test supervision may not always be necessary.Ophthamology. 1999; 106(1) : 178-181．
18吴玲玲，井上洋一．Octopus123视野计诊断早中期青光眼的价值．浙江医科大学学 报．1997；26(1) ：17-20．
19余敏斌，周文柄，叶天才．正常人视野视网膜光敏感度的研究．中华眼科杂志．1994； 30(5) ：341-344．
20 Chauhan BC,Johnson CA.Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and nomal subjects.Invest Ophthalmol Vis Sci.1999;40(3) 648-656．
21 Haefliger IO,Flammer J.Fluctuation of the differential light threshold at the border of absolute scotomas.Comparison between glaucomatous visual field defects and blind spots.Ophthalmology.1991;98(10) :1529-1532．
22 Chauhan BC,Johnson CA.Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and nomal subjects.Invest Ophthalmol Vis Sci.l999;40(3) 648-656．
23 Felius J Langerhost CT,Vander Berg TJ,et al.Oculokinetic perimetry compared with standard perimetric threshold testing.Int Ophthalmol 1992; 16(4-5) ;221-226．
24Henson DB,Chaudry S,Artes PH,et al.Response variability in the visual field:omparison of optic neuritis,glaucoma,ocular hypertension,and normal eyes.Invest Ophthalmol Vis Sci.2000;41(2) :417-421．
25 Hutchings N, Wild JM,Hussey MK et al.The long-term fluctation of the visual field in stable glaucoma.Invest Ophthalmol Vis Sci.2000;41(11) 3429-3436．
26 Heijl A,Bengtsson B.The Effect of Perimetric Experience in Patients With Glaucoma.Arch Ophthalmol. 1996; 114:19-22．
27 Johnson CA,Nelson-Quigg JM.A prospective three-year study of response properties of nomal subject and patients during automated perimetry. Ophthalmology. 1993; 100:267-274．
28 Chauhan BC,Mohandas RN,Whelen JH,et al.Comparision of reliability indices in conventional perimetry and high-pass resolution perimetry. Ophthalmology. 1993; 100(7) : 1089-1094．
29 Katz J,Sommer A,Witt K .Reliability of visual field results over repeated testing.Ophthalmology. 1991 ;98:70-75．
30 Heijl A,Lindgren A,Lindgren G.Test-retst variability in glaucomatous visual fields.Am J Ophthalmol. 1989; 108:130-135．
31 Yesim A Mucize Y,Nazife S,et al.False-negative responses in primary open-angle glaucoma.Ann Ophthalmol.2000;32(4) :287-288．
2 Lee M, Zulauf M, Capriori J.The influence of patient reliability on visual field outcome. Am J Ophthalmol. 1994; 117: 756-761.
3 Cascario MA, Stewart WC, Sutherland SE. Influence of missed catch trials on the visual field in normal subjects. Grafes Arch Clin Exp Ophthalmol. 1991;229:437-441.
4 Katz J Sommer A.Reliability indexes of automated perimetry. Arch Ophthalmol. 1988; 106: 1252-1254.
5 Katz J,Sommer A.Screening for glaucomatous visual field loss. The effect of patient reliability. Ophthalmology. 1990; 97(8): 1032-1037.
6 戴惟葭，郭丽．正常人和青光眼计算机视野检查的可靠性研究．临床眼科杂志，1998，5，295-297．
7 McMillan TA, Stewart WC, Hunt HH. Association of reliability with reproducibility of the glaucomatous visual field. Acta Ophthalmol Copenh. 1992; 70(5): 665-670.
8 Nelson-Quigg JM, Twelker JD, Johnson CA. Response properties of normal observers and patients during automated perimetry. Arch Ophthalmol. 1989; 107: 1612-161
9 Birt CM. Shin DH, Samudrala V, et al. Analysis of reliability indices from Humphery visual field tests in an urban glaucoma population. Ophthalmology. 1997; 104(7):1126-1130.
10 Bengtsson B,Heilj A.False-negative responses in glaucoma perimetry indicators of patient performance or test reliability? Invest Ophthalmol. 2000 Jul; 41(8): 2201-4.
11 中华医学会第二届全国眼科学术会议专题总结．中华眼科杂志．，1980，16，106-107
12 Gaasterland DE, Blackwell B, Delly LG, et al. Advanced Glaucoma Intervention Study. 2. Visual field test scoring and reliability. Ophthalmology. 1994 101(8): 1445-1455.
13 袁援生，陈小明．现代临床视野检测．北京：人民卫生出版社．1999；54
14 王大博，可疑青光眼杯盘比值与静态阈值视野改变的观察 中国实用眼科杂志2002；02 (2)：132-133．
15 陈小明，吴振中，蒋幼芹．青光眼静态阈值不对称．眼科研究．1994；12(1)：43-45．
16 Johnson LN, Aminlari A, Sassani JW. Effect of intermittent versus continuous patient monitoring on reliability indices during automated perimetry. Ophthalmology. 1993; 100(1):76-84.
17 Van-Coevordpn RE,Mills RP,Chen YY.Continous visual field test supervision may not always be necessary.Ophthamology. 1999; 106(1) : 178-181．
18吴玲玲，井上洋一．Octopus123视野计诊断早中期青光眼的价值．浙江医科大学学 报．1997；26(1) ：17-20．
19余敏斌，周文柄，叶天才．正常人视野视网膜光敏感度的研究．中华眼科杂志．1994； 30(5) ：341-344．
20 Chauhan BC,Johnson CA.Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and nomal subjects.Invest Ophthalmol Vis Sci.1999;40(3) 648-656．
21 Haefliger IO,Flammer J.Fluctuation of the differential light threshold at the border of absolute scotomas.Comparison between glaucomatous visual field defects and blind spots.Ophthalmology.1991;98(10) :1529-1532．
22 Chauhan BC,Johnson CA.Test-retest variability of frequency-doubling perimetry and conventional perimetry in glaucoma patients and nomal subjects.Invest Ophthalmol Vis Sci.l999;40(3) 648-656．
23 Felius J Langerhost CT,Vander Berg TJ,et al.Oculokinetic perimetry compared with standard perimetric threshold testing.Int Ophthalmol 1992; 16(4-5) ;221-226．
24Henson DB,Chaudry S,Artes PH,et al.Response variability in the visual field:omparison of optic neuritis,glaucoma,ocular hypertension,and normal eyes.Invest Ophthalmol Vis Sci.2000;41(2) :417-421．
25 Hutchings N, Wild JM,Hussey MK et al.The long-term fluctation of the visual field in stable glaucoma.Invest Ophthalmol Vis Sci.2000;41(11) 3429-3436．
26 Heijl A,Bengtsson B.The Effect of Perimetric Experience in Patients With Glaucoma.Arch Ophthalmol. 1996; 114:19-22．
27 Johnson CA,Nelson-Quigg JM.A prospective three-year study of response properties of nomal subject and patients during automated perimetry. Ophthalmology. 1993; 100:267-274．
28 Chauhan BC,Mohandas RN,Whelen JH,et al.Comparision of reliability indices in conventional perimetry and high-pass resolution perimetry. Ophthalmology. 1993; 100(7) : 1089-1094．
29 Katz J,Sommer A,Witt K .Reliability of visual field results over repeated testing.Ophthalmology. 1991 ;98:70-75．
30 Heijl A,Lindgren A,Lindgren G.Test-retst variability in glaucomatous visual fields.Am J Ophthalmol. 1989; 108:130-135．
31 Yesim A Mucize Y,Nazife S,et al.False-negative responses in primary open-angle glaucoma.Ann Ophthalmol.2000;32(4) :287-288．
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