視野の局所変動による緑内障性視野異常の判定

摘要

Purpose: To compare the usefulness of local fluctuation and that of visual field parameters for assessing glaucomatous visual field loss. Subjects and methods : The subjects were 162 patients (323 eyes) who received perimetry two or more times at a mean age of 53 years. The mean observation period was 3 years and 10 months. Two types of criteria were established for these subjects, and eyes with normal visual fields were included in the analysis. We investigated whether an abnormal visual field could be predicted by specific parameters of the Cox proportional-hazards model using an abnormal visual field in each criterion as an objective variable, and each measurement parameter obtained in a perimetry test as an explanatory variable. Measurement parameters included fixation loss, false positive, false negative, mean deviation, pattern standard deviation, short-term fluctuation, corrected pattern standard deviation, glaucoma hemifield test, local fluctuation (LF), and cluster. Results : With both types of criteria, the presence of LF at any timepoint had a significant correlation with the appearance of an abnormal visual field: crude hazard ratio of 4.3 (95% confidence interval (CI) : 3.2-5.9) and adjusted hazard ratio of 4.9 (95% CI: 3.4-7.0) in criterion 1; and crude hazard ratio of 3.0 (95% CI: 2.4-3.8) and adjusted hazard ratio of 3.5 (95% CI : 2.6-4.8) in the other criterion, according to the Cox proportional-hazards regression analysis. Conclusion : The presence of LF appears to be useful for predicting glaucomatous visual field loss in eyes with normal visual fields at the initial perimetry.%緑内障の定義は，日本緑内障学会のガイドライ ンによると「視神経と視野に特徴的な変化を有 し，通常眼圧を十分に下降させることにより，視 神経障害を改善もしくは進行を阻止しうる眼の機 能的．構造的異常を特徴とする疾患」である．