Comparison of Optic Nerve Imaging Methods to Distinguish Normal Eyes from Those with Glaucoma 不同的视神经成像技术鉴别正常眼和青光眼的比较Michael J. Greaney, Douglas C. Hoffman, David F. Garway-Heath, Mamdouh Nakla, Anne L. Coleman and Joseph Caprioli PURPOSE. To compare the ability of qualitative assessment of optic nerve head stereophotographs (ONHPs), confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT) to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. 目的：比较视神经乳头立体照相(ONHPs)、共聚焦激光扫描眼底镜(CSLO)、激光扫描偏振仪(SLP)、光学相干断层成像技术(OCT)对于定性鉴别正常眼和有早中期视野损坏的青光眼的视乳头的能力。METHODS. Eighty-nine eyes (63 normal, 63 age-matched with glaucoma) of 89 subjects more than 40 years of age were studied. Receiver operating characteristic (ROC) curves were generated from discriminant analysis of CSLO, SLP, and OCT measurements and from ONHP scores. Sensitivity at 80% and specificity at 90% were calculated. Differences between individual methods and combinations of methods were assessed for statistical significance. Agreement on categorization between methods () was assessed. 方法：89名超过40岁的研究对象中包括63只正常眼，63只年龄匹配的青光眼。分析了视神经乳头立体照相评分、共聚焦激光扫描眼底镜、激光扫描偏振仪、光学相干断层成像对青光眼诊断的ROC曲线。计算了这些检查方法在敏感性为80％，特异性为90％的取值。评价了不同检查方法之间或者联合检查方法之间的统计学差异。评价了不同方法在区分正常与非正常的一致性。RESULTS. The average visual field mean deviation (MD ± SD) in patients with glaucoma was -3.9 ± 2.2 dB, and the average pattern standard deviation (PSD) was 4.7 ± 3.4 dB. In normal subjects the average MD was 0.1 ± 0.9 dB and the average PSD was 1.5 ± 0.3 dB. Optimal sensitivities, specificities, and areas under ROC curves were, respectively: ONHP (0.94, 0.87, 0.93), CSLO (0.84, 0.90, 0.92), SLP (0.89, 0.87, 0.94), and OCT (0.82, 0.84, 0.88). Best agreement on categorization () was between ONHPs and CSLO (0.70). The ROC area for the combination of methods was 0.99, higher than for any method alone. The ROC area for the combination of methods was significantly better than the CLSO rim area (P = 0.012) and the OCT retinal nerve fiber layer (RNFL) thickness (P = 0.002). 结果：青光眼患者的视野平均变化是-3.9 ± 2.2 dB，平均形觉标准差是4.7 ± 3.4 dB，而正常人的对应值分别是0.1 ± 0.9 dB和1.5 ± 0.3 dB。各种检查方法的最佳敏感性、特异性和ROC面积分别是：ONHP (0.94, 0.87, 0.93), CSLO (0.84, 0.90, 0.92), SLP(0.89, 0.87, 0.94)和OCT (0.82, 0.84, 0.88)。分类最佳一致性是ONHPs和CSLO（0.70)。两种方法联合的诊断曲线的ROC面积是0.99，比其他任何单独的方法好。联合方法的诊断曲线的ROC值明显比CLSO的盘沿面积（P=0.012）和OCT的视网膜神经纤维层厚度（P=0.002）都好。CONCLUSIONS. The quantitative methods CSLO, SLP, and OCT were no better than qualitative assessment of disc ONHPs by experienced observers at distinguishing normal eyes from those with early to moderate glaucoma. A combination of the imaging methods significantly improves this capability. 结论：就区分正常人与轻度到中度青光眼患者而言，定量视神经成像技术的方法例如CSLO、SLP和OCT并不比有经验的观察者定性分析视乳头形态更好。但是联合应用这些方法可以显著提高准确判断的能力。(Investigative Ophthalmology and Visual Science. 2002;43:140-145.)   眼科资讯录入：毛进    责任编辑：毛进