원발개방각녹내장 환자에서 표준자동시야검사의 장기 변동성
Long-term Visual Field Variability in Patients with Primary Open-angle Glaucoma
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목적: 원발개방각녹내장 환자에서 C24-2 표준자동시야검사의 장기 변동성에 영향을 미치는 인자를 알아보고자 한다. 대상과 방법: 경과관찰이 6년 이상, 12회 이상 자동시야검사를 시행한 원발개방각녹내장 환자의 의무기록을 후향적으로 조사했다. Pointwise variability는 시간에 따른 52개의 total deviation 변화에 대해, global variability는 시간에 따른 mean deviation (MD) 변화에 대해 선형 회귀 분석을 시행하여, 모델의 추정 값과 실제 값의 차이를 이용해 평균 제곱근 오차로 계산했다. 모델의 변수 선택을 위해 hierarchical clustering을 이용해 변수 군집화를 시행, 유사도 지표로 squared Spearman 상관분석을 사용했다. 시야검사 장기 변동성과 변수 사이 관계는 선형혼합모형으로 분석했다. 결과: 원발개방각녹내장 환자 157명 246안이 분석에 포함되었다. 망막신경섬유층두께 모델에서 기저 유두주위 망막신경섬유층두께가 얇을수록, 기저 안압, 평균 안압이 낮을수록, 안압 변동이 클수록, 시야 진행 속도가 빠를수록 시야검사의 장기 변동성은 증가하였다(모든 p≤0.037). MD모델에서 기저 MD, 기저 안압, 평균 안압이 낮을수록, 시야 진행 속도가 빠를수록 시야검사의 장기 변동성이 증가했다(모든 p≤0.035). 결론: 안압이 낮고 녹내장 손상이 심한 원발개방각녹내장 환자에서 안압 변동폭이 크고, 시야 진행 속도가 빠를 경우 시야 악화 판단에 있어 시야검사의 장기 변동성을 고려해야 할 것으로 생각된다.
Abstract
Purpose: To investigate factors associated with variability in the longitudinal visual field (VF) test in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study enrolled POAG patients with VF ≥ 12 who were followed up for ≥ 6 years. First, 52 total deviation values of VF series for each eye were linearly regressed against time (years), and the root mean square error (RMSE) of the residuals was used to measure long-term pointwise VF variability. The mean deviation (MD) of the VF series for each eye was linearly regressed against time (years), and the RMSE of the residuals was used to measure long-term global VF variability. Using hierarchical clustering, variable clustering was performed to select variables and Spearman’s correlation was used as a similarity index. We fitted a mixed effect linear regression model and evaluated factors associated with the long-term VF variability in each regression model. Results: The study included 246 eyes of 157 patients with POAG. Worse baseline peripapillary retinal nerve fiber layer (RNFL) thickness, lower baseline intraocular pressure (IOP), lower mean IOP, greater IOP fluctuation, and a faster VF decay rate were associated with increased long-term pointwise VF variability in the RNFL thickness model (all p ≤ 0.037). Worse baseline MD, lower baseline IOP, lower mean IOP, and faster VF decay rate were associated with increased long-term global VF variability in the MD model (all p ≤ 0.035). Conclusions: Lower baseline and mean IOP, greater IOP fluctuation, worse glaucoma severity, and a faster VF decay rate were associated with greater long-term VF variability in patients with POAG. These factors should be considered when evaluating VF progression.
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