| 网站首页 | 眼科中心 | 协和眼科 | 会议中心 | 医学资源 | 精美图片 | 论坛 | 会员中心 | 帮助中心 | 换眼科点 | 申请权限 | 全站搜索 | 博客 | 手术视频 | 眼科淘宝 | 
最新公告:

  没有公告

您现在的位置: 心灵之窗-眼科医生网 >> 眼科中心 >> 医生俱乐部 >> 临床精要 >> 正文
专题栏目
更多内容
相关文章
更多内容
WGA关于青光眼进展的国际共识           ★★★
WGA关于青光眼进展的国际共识
作者:佚名 文章来源:本站原创 点击数: 更新时间:2015-1-29 23:42:40

Pay attention to examination quality

  1. Examinations of poor quality will likely lead to an erroneous assessment of progression.
    Comment: The most important factors to reduce test variability are a proper explanation of the test to the patient, appropriate instrument setup and 1:1 monitoring of the patient by a trained technician.
  2. Do not rely automatically on the VF reliability indices.
    Comment: The VF reliability indices may be unreliable! The most useful index is the ‘False Positive’ rate; values greater than 15% likely represent a less reliable performance; values less than 15% do not guarantee reliability. The technician is the best judge to exam quality.
  3. If unreliable tests require repeating, the patient should be carefully re-instructed.

Use the same threshold test

  1. Clinicians should select their preferred perimetry technology, test pattern, and thresholding strategy for the baseline tests and stick with the same test throughout the follow up.
    Comment: any analysis of progression can only be performed if a compatible threshold algorithm and test pattern is used.
  2. In advanced glaucoma, smaller angular size SAP testing grids, e.g., HFA 10-2 may be of value in a minority of patients.
    Comment: Kinetic perimetry and SAP with larger targets (e.g., size V) may also be useful.
    Comment: The advantages of a change in test pattern (e.g., from a 24-2 to a 10-2 grid) should also be weighed against the disadvantages for progression analysis by commercial software.

Clinical trials

  1. Event analyses aim to identify a statistically significant difference between study arms and not necessarily a clinically significant difference.
    Comment: As glaucoma is a chronic progressive disease and progression is generally linear, small amounts of progression that reach statistical significance become larger, clinically significant amounts of progression if there is no additional therapy.
  2. Rate analyses of VF indices are an appropriate statistical approach to identify differences between treatment groups.
    Comment: Rate analysis methods have been used often in trials for other chronic progressive diseases, such as dementia.
  3. Difference in the progression ‘event’ criterion applied in the various clinical trials limits comparison of the incidence of progression determined in those trials.
    Comment: Comparison of groups in different clinical trials is also hampered by mismatch of subjects with regard to stage of glaucoma, quality of visual field exams, and other traits.

Research needs

  1. The development of ‘event’ criteria for progression based on individual patient test-retest variability.
  2. There is a need to compare event-based endpoints and rate of progression outcomes in a data set with data acquired with appropriate frequency and test intervals with respect to clinical trials.
  3. Further research is needed into the added value of smaller angular size test grids, and different size stimuli, e.g., size V, in advanced glaucoma.
  4. Determine appropriate dynamic ranges of stimulus contrasts for size III, and develop new stimuli with larger dynamic ranges of appropriate stimulus contrasts.
  5. Improve the interface between perimetrist and device, and between patient and device.
  6. Identify, or develop, stimulus types (e.g., FDT) and test algorithms which provide optimal information content for progression analysis in children and adults who have difficulty performing a reliable SAP test.
  7. Develop alternate methods for selecting stimulus locations in order to avoid extensive testing of blind areas and to focus on areas of interest.
  8. Further assess the benefits of using prior threshold as a starting point in a follow-up test (or if threshold is < 0 dB previously, confirmation at that point that a 0 dB stimulus is not seen is sufficient).
  9. Determine the optimal frequency and timing of tests for individual patients.
  10. Use of good mathematical modeling.
  11. Develop better approaches to identify learning effects.
  12. Identify the appropriate test and frequency of testing for patients with progressive glaucomatous optic neuropathy and SAP within normal limits.

 

上一页  [1] [2] [3] [4] [5] [6] [7] 下一页

眼科资讯录入:毛进    责任编辑:毛进 
  • 上一篇眼科资讯:

  • 下一篇眼科资讯: 没有了
  • 【字体: 】【发表评论】【加入收藏】【告诉好友】【打印此文】【关闭窗口
      网友评论:(只显示最新10条。评论内容只代表网友观点,与本站立场无关!)

    | 设为首页 | 加入收藏 | 联系站长 | 友情链接 | 版权申明 |
    眼科医生网 眼科医生网版权所有 @ 1998-2012
    部分文章和资源来源于网络,如果侵犯了您的版权,请指出! 站长:毛进
    信息产业部备案
    *京ICP备12035550号