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流行病学的研究已经表明仅凭单一的眼压诊断青光眼和着手进行青光眼治疗通常是根据不足的。仅仅具有眼压增高的患者,10年内只有5％有发生可确定的视野缺损的可能性。眼科医生也可寻找青光眼性或极有可能是青光眼性的视神经损害。不幸的是,到此时往往已有一半或一半以上的视神经可能已经毁损了。因此,眼科医生必须小心地权衡和调整自已密切追踪(青光眼)病人的决断力。对于一个是边远农村地区村民的患者和一个是发达城市的、很容易得到定期眼科随访和医疗的居民,医师因随访病人的难易而要小心权衡和修正自已的决定。在要进行青光眼治疗前,主要的单项标准或联合判断标准一般包括:1)眼压明显增高。眼压越高,视神经损害的危险性越大,如果眼压持续是35mmHg 或更高,则不管有无其他青光眼体征,应立即进行治疗;2)很大的视杯。特别是不对称视杯或视盘几乎没有什么神经—视网膜盘檐;3)两眼不对称的视杯,尤其是眼压较高的一眼其杯盘比又较大;4)用直接检眼镜或无赤光、高分辨率的眼底照相观察到的弥散性视网膜神经纤维层损害;5)当充分了解与认识了手动视野计和自动视野计各自的敏感性和特异性的关系,用手动视野计和自动视野计查出的典型视野缺损;6)照相等记录的视杯面积增加。本文将详细讨论上述标准的优点、缺陷、局限,同时也讨论了近来发表的有关视网膜神经纤维层分析的资料及解释自动阈值视野检查的选择法。
Epidemiological studies have shown that glaucoma is often under-diagnosed with glaucoma alone with a single intraocular pressure. Only patients with elevated IOP have a 5% chance of a definitive visual field defect within 10 years. An ophthalmologist may also look for glaucoma or most likely glaucomatous optic nerve damage. Unfortunately, the optic nerve, which often accounts for more than half or more of this time, may have been damaged. As a result, ophthalmologists must carefully weigh and adjust the patient’s ability to follow closely on their own (glaucoma). For a patient who is a villager in a remote rural area and a resident in a developed city who can easily get regular ophthalmic follow-up and medical treatment, physicians should carefully weigh and correct their own decisions because of the difficulty of visiting the patient. Before going to glaucoma treatment, the main criteria for individual or joint judgment generally include: 1) IOP was significantly higher. The higher the intraocular pressure, the greater the risk of optic nerve damage, if the intraocular pressure is sustained 35mmHg or higher, with or without other signs of glaucoma, should be treated immediately; 2) a large cup. Especially the asymmetrical optic disc or optic disc almost no nerve - retinal disc eaves; 3) asymmetric eye cup two glasses, especially the higher intraocular pressure of its larger cup and disk ratio; 4) with direct ophthalmoscopy or 5) When fully aware of and understanding of the relationship between the manual and total autonomicroscope sensitivity and specificity of the visual field, with the manual field of view of the total And typical visual field defects detected by an autoradiometer; 6) an increase in the area of the optic cup recorded as a record. This article discusses in detail the pros and cons of these standards, their limitations, and discusses recently published data on retinal nerve fiber layer analysis and how to interpret automated threshold field-of-view methods.