glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”10.53432/2078-4104-2022-21-1-23-35glaucoma-366Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОценка эффективности периметрии с удвоением пространственной частоты в диагностике оптиконейропатийEvaluation of the effectiveness of frequency doubling technology perimetry in the diagnosis of optic neuropathiesСимаковаИ. Л.SimakovaI. L.

Симакова Ирина Леонидовна, д.м.н., доцент кафедры офтальмологии

194044, Санкт-Петербург, ул. Боткинская, д. 21

Dr. Sci. (Med.), Associate Professor at the Academic Department of Ophthalmology

21 Botkinskaya St., Saint Petersburg, 194044

irina.l.simakova@gmail.comТихоновскаяИ. А.TikhonovskayaI. A.

врач-офтальмолог диагностического отделения клиники офтальмологии

194044, Санкт-Петербург, ул. Боткинская, д. 21

Ophthalmologist at the Diagnostic Department of the Clinic of Ophthalmology

21 Botkinskaya St., Saint Petersburg, 194044

ФГБВОУ ВПО «Военно-Медицинская академия» имени С.М. Кирова МО РФРоссияS.M. Kirov Military Medical AcademyRussian Federation2022140320222112335Copyright © Симакова И.Л., Тихоновская И.А., 20222022Симакова И.Л., Тихоновская И.А.Simakova I.L., Tikhonovskaya I.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.glaucomajournal.ru/jour/article/view/366ЦЕЛЬ

ЦЕЛЬ. Сравнить диагностическую эффективность двух пороговых стратегий периметрии с удвоением пространственной частоты (FDT, Frequency Doubling Technology) у пациентов с начальной стадией первичной открытоугольной глаукомы (ПОУГ), оптической формой рассеянного склероза (РС) и застойным диском зрительного нерва (ДЗН) в рамках открытого сравнительного клинического исследования.

МЕТОДЫ

МЕТОДЫ. В исследовании участвовали 78 пациентов (105 глаз) с оптиконейропатиями (ОН). В зависимости от этиологии ОН пациентов разделили на 3 группы: в 1-ю группу вошли 30 больных (46 глаз) c начальной стадией ПОУГ в возрасте от 30 до 65 лет (54,9±1,3); во 2-ю — 26 пациентов (26 глаз) с диагнозом оптическая форма РС (эпизод ретробульбарного неврита в анамнезе) в возрасте от 22 до 44 лет (33,7±6,5); в 3-ю — 22 пациента (33 глаза) в возрасте от 18 до 66 лет (35,7±14,9) с застойным ДЗН, который развился в подавляющем большинстве случаев (25 глаз, 75,7%) вследствие различных новообразований головного мозга. В 4-ю, контрольную, группу включили 60 здоровых лиц (60 глаз) в возрасте от 20 до 65 лет, которых разделили на 2 равные подгруппы – молодого (24,8±4,4) и старшего (56,4±3,9) возраста.

Всем испытуемым при комплексном офтальмологическом обследовании выполняли стандартную и нестандартную периметрию, используя анализатор поля зрения Humphrey Visual Field Analyzer II 745i (HFA II, Германия – США, пороговая стратегия 24-2) и авторскую модификацию FDT-периметрии в виде 2 пороговых стратегий: известной FDT-16 и новой FDT-64.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Пороговые стратегии FDT-16 и FDT-64 более эффективны в диагностике глаукомной оптиконейропатии (ГОН), что подтверждается более высоким уровнем чувствительности их результатов по 2 критериям, а именно — количеству выявленных скотом (n скотом ≥2) и количеству кластеров из скотом у больных ПОУГ (88 и 100%; 95 и 83% соответственно) по сравнению с таковым у пациентов с РС (61 и 76%; 85 и 54% соответственно) и застойным ДЗН (51 и 78%; 88 и 70% соответственно). Уровень специфичности результатов пороговых стратегий FDT-16 и FDT-64 значительно выше специфичности периметрии по HFA II (100, 80 и 63% соответственно).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Пороговые стратегии FDT-периметрии наиболее эффективны в выявлении ГОН, что подтверждает более высокий уровень чувствительности их результатов у больных начальной стадией ПОУГ по сравнению с уровнем чувствительности результатов пациентов с РС и застойным ДЗН. Уровень специфичности результатов обеих стратегий FDT-периметрии намного превосходит уровень специфичности данных периметрии по HFA II, что свидетельствует о преимуществе FDT-периметрии в разделении здоровых людей и больных с ОН, причем не только глаукомного генеза.

PURPOSE

PURPOSE. To compare the diagnostic effectiveness of two perimetric threshold strategies with frequency-doubling technology in patients with early primary open-angle glaucoma (POAG), the optical form of multiple sclerosis (MS) and papilledema in an open-label comparative clinical study.

MATERIAL AND METHODS

MATERIAL AND METHODS. The study involved 78 patients (105 eyes) with optic neuropathies (ON). The patients were divided into 3 groups depending on the etiology of optic neuropathy: the first group included 30 patients (46 eyes) with early POAG aged 30 to 65 years (54.9±1.3); the second group included 26 patients (26 eyes) diagnosed with the optic form of MS (an episode of retrobulbar optic neuritis in the medical history) aged 22 to 44 years (33.7±6.5); the third group consisted of 22 patients (33 eyes) aged from 18 to 66 years (35.7±14.9) with papilledema caused in the majority of cases by various brain tumors (25 eyes or 75.7%). The fourth (control) group consisted of 60 healthy individuals (60 eyes) aged 20 to 65 years, who were divided into 2 equal subgroups – younger (24.8±4.4) and older (56.4±3.9).

Standard and non-standard perimetry was performed on all subjects during a comprehensive ophthalmic examination using the Humphrey 745i Visual Field Analyzer II (HFA II, «24-2» threshold strategy) (Germany-USA) and the author's own modification of Frequency Doubling Technology (FDT) Perimetry, in the form of 2 threshold strategies: the well-known «FDT-16» and the new «FDT-64».

RESULTS

RESULTS. Both the «FDT-16» and the «FDT-64» threshold strategies were more effective in diagnosing glaucomatous optic neuropathy (GON), as confirmed by the higher sensitivity of their results to two criteria — the number of identified scotomas (n of scotomas n≥2), and the number of scotoma clusters in patients with POAG (88 and 100%; 95 and 83%, respectively) compared with those in patients with MS (61 and 76%; 85 and 54%, respectively) and papilledema (51 and 78%; 88 and 70%, respectively). The specificity of the «FDT-16» and «FDT-64» threshold strategies was significantly higher than the specificity of Humphrey perimetry (100, 80 and 63%, respectively).

CONCLUSION

CONCLUSION. Both perimetric threshold strategies with frequency-doubling technology were found to be the most effective in detecting GON. This confirms that they are more sensitive in patients with early POAG when compared with the sensitivity in patients with MS and papilledema. The level of specificity of both FDT perimetry strategies far exceeds the level of specificity of Humphrey perimetry data, which indicates the advantage of FDT perimetry in separating healthy people from patients with ON, and not only of glaucoma genesis.

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The authors declare that there are no conflicts of interest present.