背景:在神经系统疾病中经常发生视野丧失,对于怀疑或已知疾病的患者通常需要视野检查。目前没有关于如何评估神经系统疾病的视野的指南。有各种各样的视野程序可用,错误的程序选择可能无法检测视野损失。我们报告了对四种常见神经系统疾病中视野丧失模式的现有证据基础以及所使用的视野检查程序的系统审查结果,以帮助设计未来的研究和临床实践指南。
方法:对文献进行了系统的检索。纳入标准需要在一种或多种目标条件下测试和/或报告视野丧失的研究;特发性颅内高压,视神经病变,chiasmal压缩和冲程。搜索了学术上的在线数据库和寄存器。此外,还手工搜索了文章。使用了与四个目标条件和视野有关的MESH术语和替代方案。研究选择由两名作者独立进行。数据由一位作者提取,并经过一秒钟的验证。
结果:这篇综述包括330项研究;51项与特发性颅内高压有关,144与视神经病变有关,105关于交叉压缩,21与中风有关,10与混合神经眼科人群有关。
结论:使用Humphrey周长的30-2和24-2程序最常报告,然后是使用Goldmann周长的手动动力学视野检查法,涵盖本综述中的所有四个条件。报告了各种各样的其他周边和程序。视野缺陷的模式在四个条件下差异更大。中央视野检查广泛用于神经系统疾病,但几乎没有证据证明其诊断准确性,特别是考虑到外围视野可能首先受到影响,而中央视野可能直到进展后期才受到影响。需要进一步的研究才能就如何最好地标准化神经系统疾病的视野检查达成共识。
BACKGROUND: Visual field loss occurs frequently in neurological conditions and perimetry is commonly requested for patients with suspected or known conditions. There are currently no guidelines for how visual fields in neurological conditions should be assessed. There is a wide range of visual field programs available and the wrong choice of program can potentially fail to detect visual field loss. We report the results of a systematic
review of the existing evidence base for the patterns of visual field loss in four common neurological conditions and the perimetry programs used, to aid the design of future research and clinical practice guidelines.
METHODS: A systematic search of the literature was performed. The inclusion criteria required studies testing and/or reporting visual field loss in one or more of the target conditions; idiopathic intracranial hypertension, optic neuropathy, chiasmal compression and stroke. Scholarly online databases and registers were searched. In addition articles were hand searched. MESH terms and alternatives in relation to the four target conditions and visual fields were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second.
RESULTS: This
review included 330 studies; 51 in relation to idiopathic intracranial hypertension, 144 in relation to optic neuropathy, 105 in relation to chiasmal compression, 21 in relation to stroke and 10 in relation to a mixed neuro-ophthalmology population.
CONCLUSIONS: Both the 30-2 and 24-2 program using the Humphrey perimeter were most commonly reported followed by manual kinetic perimetry using the Goldmann perimeter across all four conditions included in this
review. A wide variety of other perimeters and programs were reported. The patterns of visual field defects differ much more greatly across the four conditions. Central perimetry is used extensively in neurological conditions but with little supporting evidence for its diagnostic accuracy in these, especially considering the peripheral visual field may be affected first whilst the central visual field may not be impacted until later in the progression. Further research is required to reach a consensus on how best to standardise perimetry for neurological conditions.