The Comparison Of Light Threshold Fluctuation,Vessel Density And Nerve Fiber Layer Thickness In The Early Diagnosis Of POAG

Part I:Detective significance of retinal light threshold fluctuations in the early diagnosis for primary open-angle glaucoma in high-risk groupObjective:To investigate the diagnostic significance of retinal light threshold fluctuations in the early diagnosis of primary open-angle glaucoma in high-risk group.Methods:Longitudinal cohort analysis.Subject of high-risk group for POAG had normal visual fields and optic discs at baseline.Visual field and RNFL and GCC of OCT were retested every 6 months during the follow-up 8 years.When confirmed with repeatable visual fields or disc progression,the diagnosis for POAG is given and recorded as a turning point.The retinal threshold fluctuations from baseline to turning point in diagnosed group were compared with undiagnosed group and control group,following by discussion of the influencing factors,correlation to other indices and observation of the changes with time.Results:1.The average of the retinal light threshold fluctuations was-6.05 dB and range was-14 dB to 3 dB from baseline to the turning point.2.In the two years just before POAG confirmed,the retinal light threshold fluctuation showed a significant increase.3.Since age is influencing factor,it is important to focus on the retinal light threshold fluctuation in 10° to 20° of visual field within the age of 45 for the early screening of POAG.4.The retinal threshold light fluctuation was negatively correlated with the visual field index and mean deviation,and was positively correlated with the pattern standard deviation and the vertical cup-to-disc-ratio.Conclusion:Retinal light threshold fluctuations have a high diagnostic efficiency in the early diagnosis for POAG in high-risk group.Part ?:Evaluation for the time relationship between retinal light threshold fluctuations and changes of retinal nerve fiber layer and ganglion cell complex thickness in high-risk populations of POAGObjective:To investigate the time relationship between retinal light threshold fluctuations and changes of retinal nerve fiber layer and ganglion cell complex thickness in high-risk group of POAG.Methods:Longitudinal cohort analysis.Subject of high-risk group for POAG had normal visual fields and optic discs at baseline.Visual field and RNFL and GCC of OCT were retested every 6 months during the follow-up 8 years.When confirmed with repeatable visual fields or disc progression,the diagnosis for POAG is given and recorded as a turning point.The retinal threshold fluctuations,retinal nerve fiber layer,retinal ganglion cell complex thickness from baseline to turning point were compared in early POAG group and control group,and the relationship with time was discussed.Results:Along with the time,the retinal light threshold fluctuations of both early POAG and the control increased gradually.The fluctuations of early POAG group were significantly greater than the control.The average changes of RNFL and GCC in both early POAG and the control decreased gradually,the change rate of average RNFL was greater than the one of average GCC.As a method of examination for patients with pre-POAG,the light threshold fluctuation has a moderate negative correlation with the thickness of RNFL and a high negative correlation with the thickness of GCC.Threshold fluctuations are still present in POAG populations with no visual field defects and optic disc changes,with good discriminative ability.The diagnostic efficacy of it is better than RNFL and GCC thickness at 1 year before diagnosis.Conclusion:Although OCT can provide useful information as an auxiliary diagnostic tool,it should not replace visual field test as a primary tool for early diagnosis of glaucoma.If the retinal light threshold fluctuation in perimetry is fully used,the early diagnosis rate of POAG will be improved.Fart ?:Study on the vessel density in the early diagnosis of POAGObjective:To investigate the value of macular and peripapillary vessel density in the early stage of POAG.Methods:Population-based cross-sectional study.Use Angio-OCT to measure the macular and peripapillary in normal healthy people and early POAG patients.Obtain the macular and peripapillary vessel density,retinal nerve fiber layer thickness,retinal light threshold fluctuations,calculate AUROC of the three types of parameters,and analyze.Results:l.Use Angio-OCT to obtaine around the macular and peripapillary vessel density can be used to distinguish between early POAG patients and healthy people.2.The specificity of peripapillary and macular vessel density in the early diagnosis of POAG was significantly lower than the fluctuation of the threshold light of the retina and the thickness of the retinal nerve fiber layer.For the sensitivity of early diagnosis of POAG,the inferior quadrant of peripapillary is larger than the threshold light of the retina and the thickness of the retinal nerve fiber layer.3.The vessel density in each quadrant of the macula is less than peripapillary of the corresponding quadrant.The peripapillary vessel density is more specific and sensitive than the macular vessel density to the early diagnosis of POAG.Compared with the diagnostic ability in the quadrants,in the peripapillary,inferior quadrant was better;in the macular area,average vessel density was better.3.Diagnostic ability of peripapillary and macular vessel density was lower than the retinal light threshold fluctuations and retinal nerve fiber layer thickness significantly in the early diagnosis of POAG.Conclusion:The peripapillary and macular vessel density can be used to distinguish between early POAG patients and healthy people.The specificity of early diagnosis of POAG of peripapillary and macular vessel density was significantly lower than the retinal light threshold fluctuations and retinal nerve fiber layer thickness,peripapillary inferior quadrant is more sensitive to early diagnosis of POAG.